Passions for women’s preventive health and tackling the primary care shortage fuel a physician’s research program
Through posing questions and providing care, a Tucson native brings patient outcomes, public interest and policy into focus.
Assistant Professor of Medicine Anna Morenz, MD, MPH, has followed her interests in primary care access and medical education as the co-author of a recent JAMA Network Open study.
Photo by Anna C. Christensen
Assistant Professor of Medicine Anna Morenz, MD, MPH, returned to her hometown in 2024 to follow her interests in academic medicine and clinical care.
“I was born and raised in Tucson,” she said. “I left for college, medical school and residency training, but was always committed to come back and serve my home community.”
Her education took her on a winding path. As an undergraduate at Dartmouth College, she focused on medical anthropology, which put her on the road to Harvard Medical School. There, she honed her interests in women’s health and primary care, which laid the groundwork for a residency in internal medicine.
Fourth-year medical students typically apply to multiple residency programs, which provide comprehensive specialty training for new MDs. Dr. Morenz was drawn to the University of Washington’s internal medicine residency, which had a primary care track. She saw it as the perfect combination of her interests in women’s health, preventive care and health disparities.
A passion for research
The University of Washington’s residency program is also where Dr. Morenz found a passion for research.
“Previously, I had done basic science research in a chemistry lab, and it felt way too fiddly and remote from patients. The most interesting science and best questions come directly from the world around us,” she recalled. “At University of Washington, I was exposed to researchers who showed me how research could ask clinically relevant questions and evaluate health impacts of policies that vary state to state. I loved that and stayed to do my research fellowship and Master of Public Health.”
Now, as a primary care internist, she serves patients at Banner – University Medicine. As a faculty member at the College of Medicine – Tucson, she mentors the next generation of physicians and builds a research program.
“I’m trying to blend a career in primary care and teaching as well as research,” she said. “My research is focused on health disparities in access to primary care — where they are occurring, why they might be occurring, who’s most affected, and trying to design and test interventions to address those health disparities.”
Changing landscapes
Guided by her interests in primary care access and medical education, Dr. Morenz and her co-authors, at the University of North Carolina at Chapel Hill and the University of Washington, recently published a study in JAMA Network Open that examined changes to residency application rates after the 2022 Dobbs v. Jackson Women’s Health Organization Supreme Court decision overturned long-held constitutional protections for abortion care.
Using statistical techniques to control for numerous factors, including the complex ways different states responded to Dobbs — with some enacting further restrictions or bans while others expanded access and protection — the team tested the hypothesis that states with abortion restrictions received fewer residency applications in the year after Dobbs compared to the year before.
“We found that applications decreased to states that enacted restrictions versus states that did not, and this decrease was seen for both men and women applicants,” Dr. Morenz said. “The findings were most pronounced for specialties that may be diagnosing or handling pregnancy: OBGYN, internal medicine, family medicine and emergency medicine.”
But it wasn’t just doctors whose work might involve abortion, miscarriage management or other restricted care. Apart from highly competitive specialties — dermatology, neurosurgery, orthopedics, otolaryngology and plastic surgery — all residencies saw declines in application rates in states with restrictions.
“That does not mean those residency slots are going unfilled. The match system ensures that a majority of residency slots in the U.S. are filled,” she said. “The million-dollar question is, where do they practice after residency, and are they more likely to leave? And if so, would that exacerbate existing primary care workforce shortages in states that enacted these restrictions?”
Unintended consequences
Dr. Morenz says the JAMA study is a little different from her typical work, which focuses on patient outcomes. But she hopes that, by following the data on Dobbs’ effects on the medical workforce, she’ll be able to trace them to their potential impacts on patients.
Though their recently published study isn’t raising any alarm bells about residency programs in states with abortion restrictions failing to fill open positions, she still characterizes their findings as a “signal.” Nationwide, there is a shortage of primary care physicians. Dr. Morenz says her team plans to examine whether post-Dobbs state-level policies will affect where physicians go after completing residency training in primary care and other specialties.
“You are very likely to stay in a state where you train for residency,” she said. “But if it was not your top pick — not a state where you want to have your family and your career — you may be more likely to leave afterward. That is very concerning.”
Although Arizona had abortion restrictions when the data for the JAMA study were collected, a voter initiative has since amended the state’s constitution to recognize the right to abortion.
Using publicly available data tracking where health care providers practice, her team will follow doctors as they graduate from residency and launch their careers as full-fledged physicians. The first cohort of post-Dobbs residents who entered internal medicine and family medicine residency programs are set to graduate this summer, and their counterparts in OBGYN and emergency medicine residency programs will graduate in the summer of 2027.
As a practicing internist, Dr. Morenz sees firsthand how gaps in primary care affect patients.
“I’ve been shocked by how much of a primary care shortage Southern Arizona has,” she said. “Many of my patients tell me they have waited a year to establish care with me.”
The team is interested in investigating other ways Dobbs might be inadvertently affecting primary care. For example, if state-level restrictions lead to the closure of women’s health clinics, other care they provide, such as vaccination and screening for sexually transmitted infections and cancer, could become more difficult to access.
“We’re using various data sets to understand what we call ‘spillover effects,’ unintended consequences on women’s preventive care in the wake of abortion restrictions and subsequent clinic closures,” she said.
A wider impact
Although returning to Tucson felt like a natural choice for Dr. Morenz, she hopes the findings uncovered by their JAMA paper and any follow-up studies will help the public understand where other early-career physicians decide to practice — and why. Ultimately, she wants to help the public understand the complex relationships between policy and patient outcomes.
“A lot of my work relates to policy issues that are not decided by people who are reading our nerdy academic medical journals,” she said. “We have to communicate our science outside of academic journals in understandable, approachable ways. Otherwise, what’s the impact of our research?”
Reflecting on her path as a physician-researcher, Dr. Morenz says working with colleagues to improve the patient experience is one of the most rewarding aspects of her job.
“I love the teamwork that’s involved in research, and playing off everyone’s different skill sets,” she said. “That’s what’s so exciting and unique about research — the passion for asking important questions that bring people to the table.”