In 2022, the US Supreme Court ruling Dobbs v. Jackson Women’s Health Organization declared there is no constitutional right to abortion, and regulation was transferred to individual states. Urology residents and their partners are of prime reproductive age and can be personally impacted by abortion access restrictions. Additionally, surgeons experience higher rates of pregnancy complications and are more likely to delay family planning and utilize assisted reproductive technology.¹ Because abortion is the standard-of-care management for many miscarriages,² urologists have an increased likelihood of needing access to the full spectrum of reproductive care. With over 60% of US counties lacking a practicing urologist (Figure), all efforts must be made to improve this workforce shortage.³ This includes understanding how state laws on reproductive access impact the urology workforce.

The membership of the Society of Women in Urology was surveyed about their attitudes towards Dobbs v. Jackson Women’s Health Organization and how state laws affect their job-related decision-making. Of the 329 respondents, 88% disagreed/strongly disagreed with the Dobbs ruling. On a practical level, 60% of respondents reported that state abortion restrictions will impact where they choose their next job. Among practicing urologists, 41% said that if Dobbs had happened when looking for their current position, they would have chosen a different job. Participants were given the ability to include free text comments about the impact of the Dobbs decision on their work. They expressed fear for their own well-being and a desire to avoid or move away from states with restrictive abortion laws. Common themes were also the deterioration of patient-provider confidentiality, professional demoralization, and calls to action for better reproductive care for women urologists.⁴

To further understand the effect of the Supreme Court decision, we felt it imperative to understand the impact on urology trainees. The Association of American Medical Colleges evaluated trends in residency applications from the 2022-2023 Match and reported that states with complete abortion bans had significant decreases in the number of residency applications across all specialties (not limited to obstetrics and gynecology).⁵ We surveyed applicants to the 2023 Urology Match to better understand how the Dobbs ruling may affect their professional decision-making, including where they applied and how they ranked programs.

Of the 503 registered applicants, 215 (42%) completed our survey. Overall, 88% of respondents disagreed with the Dobbs decision, and 25% factored state laws into their decision to apply to programs. We found that 1 in 5 students eliminated programs from their rank lists because they were in states with restrictive abortions laws. Additionally, 59% of applicants said they would be concerned about their or their partner’s health and safety if they matched in a restrictive state. However, due to the competitive nature of the Urology Match, 68% of applicants reported feeling at least somewhat obligated to apply in states where abortion legislation conflicts with their personal beliefs.⁶

Reproductive health care access has clear implications for the urology workforce. There is an increasing number of women entering urology—currently 33% of US residents are female⁷—and many men are also making family planning decisions or have partners. Since states with the lowest densities of urologists also have the most restrictive abortion laws,⁴ these findings have significant downstream implications for the distribution of urologists across the country.

Thank you to the Society of Academic Urologists for their support in distributing our survey to 2023 Urology Match applicants, and for an education grant to further study the effect of Dobbs v. Jackson and reproductive access on Urology Residency Match applicants.

Acknowledgments

We thank Eric Singer, MD; Simone Thavaseelan, MD; Akanksha Mehta, MD; Allie Tabakin, MD; John Gore, MD; and Vijay Vemulakonda MD, JD, for their help in this work.