Impact of Gender-Affirming Care Legislation on Medical Student Plans for Residency

Purpose: This study explored how state policies limiting access to gender-affirming care (GAC) for youth have impacted medical student decisions and plans for residency training. Methods: We administered a cross-sectional mixed-methods survey among medical students in the United States from March 7, 2024 through April 12, 2024. Respondents were asked if and how legislation limiting access to GAC for youth has or will impact their residency plans. Quantitative analysis included descriptive statistics and multinomial logistic regression analyses that assessed factors associated with the belief that GAC-restricting legislation would, would not, or may impact the residency program they attend in the future and concern that GAC-restricting legislation may be enacted where they pursue residency. Qualitative responses were analyzed thematically with axial coding. Results: Our sample included 237 medical students. Among those who applied to residency in the 2023–2024 application cycle ( n = 38), 55.26% reported that legislation limiting access to GAC for youth impacted the residency programs to which they applied. Among those who did not apply to residency in 2023–2024 ( n = 199), 58.79% reported that this legislation would impact the residency program they attend in the future. In qualitative responses, respondents cited two primary concerns alone or in combination: professional opportunity and personal safety. Conclusion: State legislation limiting youth access to GAC may have broad, long-term impacts on the distribution of physicians across the United States. Further research should investigate the effect of GAC-restricting legislation on the composition, capacity, and well-being of the health care workforce.