Steadfast but Strained: The Complex Reality of OB-GYN Workforce Stability in States with Abortion Bans

The narrative that abortion bans are driving obstetrician-gynecologists (OB-GYNs) out of U.S. states is incomplete. While the total number of OB-GYNs in states with near-total abortion bans has not yet declined significantly, a closer look reveals systemic vulnerabilities that could destabilize healthcare access in the coming years. Providers remain in these states, but their capacity to deliver comprehensive care is eroding under legal, logistical, and ethical pressures. For investors, this duality presents both risks and opportunities in the healthcare sector.

The Current Stability: A Short-Term Illusion
Recent data from the JAMA Network Open shows that OB-GYN numbers in states with abortion bans increased by 10.5% by September 2022, slightly outpacing the 7.9% growth in states without restrictions. This initial surge stemmed from providers consolidating in restricted states to meet rising demand for remaining reproductive services. However, this trend has plateaued. A 2025 study by Staiger et al. confirms that no population-level decline has occurred—yet. Residency programs in banned states continue to fill positions, as aspiring physicians prioritize completing training over avoiding restrictive environments.

But beneath this surface stability lie cracks. Residency applications to OB-GYN programs in banned states fell by 6.7% by 2024, compared to a 0.4% rise in unrestricted states. This divergence matters: fewer trainees today mean fewer practicing OB-GYNs tomorrow, particularly in specialized roles like maternal-fetal medicine or complex family planning (CFP). Already, banned states face shortages of CFP specialists, who handle high-risk pregnancies and complex procedures. In Tennessee, for instance, three of eight abortion providers had departed by 2024, leaving programs unable to train residents in second-trimester care—a gap that risks preventable maternal deaths.

The Legal and Ethical Tightrope
Providers remaining in banned states face unprecedented pressures. Criminalization laws—such as Texas’s “bounty hunter” statute—create a climate of fear. Over 40% of OB-GYN residents in restricted states report their training has been compromised, as programs turn to out-of-state partnerships or simulations to bypass legal barriers. Rural clinics, already resource-strapped, struggle to adapt. Meanwhile, practitioners grapple with moral dilemmas: Dr. Nikki Zite of Tennessee stays to train future providers but admits to “punting” complex cases to colleagues willing to take legal risks.

The human toll is measurable. Over 15% of abortions in 2024 involved cross-state travel, with states like Illinois absorbing 20% of these patients. This strain highlights a paradox: while banned states retain OB-GYNs numerically, their providers increasingly serve as gatekeepers for care that patients must travel far to access.

Investment Implications
For investors, the data suggests a bifurcated landscape:
1. Near-Term Resilience in Banned States: Hospitals in restricted regions (e.g., Tenet Healthcare (THC) in Texas) may see steady revenue from concentrated patient volumes, especially for non-abortion services. However, could reveal underlying cost pressures from legal compliance and training gaps.
2. Long-Term Risks for Rural Markets: Rural hospitals in banned states (e.g., Community Health Systems (CYH)) face dual threats: provider attrition and reduced training capacity. Their valuations may suffer as specialized care becomes harder to staff.
3. Opportunities in Accessible States: Healthcare systems in states with unrestricted abortion access (e.g., CommonSpirit Health in Illinois) benefit from increased patient traffic, but must invest in infrastructure to handle surges.

Conclusion: The Tipping Point Ahead
While OB-GYN numbers in banned states remain stable for now, systemic risks loom large. The 6.7% annual decline in residency applicants signals a ticking clock: by 2030, these states could face critical shortages. Specialized providers like CFP specialists—already concentrated in supportive states—are a key vulnerability. For investors, the lesson is clear: stability today does not guarantee resilience tomorrow.

The data underscores a stark reality: without policy changes or targeted investments in provider retention and training, states with abortion bans will see declining access to maternal care—disproportionately harming marginalized communities. The healthcare sector’s winners and losers will depend on who adapts to these evolving dynamics first.

In this landscape, caution—and foresight—are the watchwords for investors.