In 2022, the US Supreme Court ruling in Dobbs v. Jackson Women's Health Organization effectively overturned the famous 1973 Roe v Wade decision, returning the decision about abortion policy to individual states. Many states had laws that would ban abortion if Roe v Wade was ever overturned, and those laws immediately went into effect. Other states responded by enacting legislation to protect the availability of abortion. Overall, the landscape for medical care in the US changed overnight, with different effects in different parts of the country.
How did that change affect the incentives to become a doctor? That is effectively the question addressed in this 2024 article by Joshua Hess (University of South Carolina), published in the journal Economics Letters (ungated earlier version here). Hess looks at the effect of the decision on medical school applications, focusing on the change between years before 2022 (before the Dobbs decision) and 2022 and 2023 (after the Dobbs decision), for states with and without abortion restrictions after the Dobbs decision. In other words, Hess applies a difference-in-differences analysis (evaluating the difference between states with and without abortion restrictions on their books, between the time before and the time after the Dobbs decision, when those restrictions would become effective).
Looking at the share of women applying to medical schools, Hess finds that:
Women’s share of applications to treated schools increased by 0.65% (p-value = 4.8×10−06) relative to control schools in 2022 and by 1.17% (p-value = 3.2 × 10−06) in 2023.
So, Hess finds that women make up a larger share of medical school applications in treated states. I find that a little surprising. But then things get a little weirder, because:
...there is little change in total enrollments over the time frame. It increased from 21,507 in 2018 to 22,845 in 2023. Consequently, changes in women’s (men’s) share strongly imply a similar change in the number of women (men) medical students.
In other words, taking those two results together, states that have abortion bans must have gained more medical school applications from women and fewer applications from men, after the Dobbs decision (and relative to states without abortion bans).
It is difficult for me to understand the decision-making of medical school applicants here. However, I can offer some idle speculation. In states with abortion bans, the status of health care as a profession declined after the Dobbs decision. Moreover, the status of women's health care declined even more, making women's health less attractive as a specialty, compared with other specialties. There is some weak supporting evidence for this, as Hess finds that:
...the share of women applicants to top OB/GYN schools in states with abortion bans increased by nearly 1% more than not top OB/GYN schools in states with abortion bans...
OB/GYN is a medical specialty that attracts more women than men, and the larger effect there than overall is consistent with reducing the status of women's health care. However, if the decrease in the status of health care as a profession was explaining these results, then the total number of medical school applications should decline, when Hess notes that it hasn't changed. Instead, more women are being attracted to medical school, and fewer men.
Are the outside options (the next best alternative to medical school) better for men than for women? I don't know the answer to that question, but even if that were true it would only explain the decrease in male medical school applicants, and not the corresponding increase in female applicants.
That leaves me with one last possible explanation: that women responded to the threat to women's health in states with abortion bans by deciding to become doctors. That would be an effective way of fighting to protect women's health, a form of resistance. So, even as men become less likely to apply to medical school due to the reduction in status of medicine (especially in women's health care), women respond by applying to medical school in greater numbers.
Hess isn't able to extricate the reasons underlying the results he finds. So, my takeaway from this paper is that it raises more questions than it answers. Clearly, this is not the final word on this topic, and hopefully there is other research going on that will help us to better understand why there has been such a gender shift in medical school applications.
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