LGBTQ+ Representation In Medicine

By: Jordan La and Skyllar Kuppinger

Pride (noun):

1. A feeling of deep pleasure
2. The promotion of the self-affirmation, dignity, equality, and visibility of lesbian, gay, bisexual, transgender, and queer (LGBTQ+) people

Representation in medicine, a field historically dominated by masculine, heterosexual values, is especially important in the present day and the future to advance equitable care for minorities. LGBTQ+-identifying individuals have been shown to be at especially greater risk for certain health outcomes compared to heterosexual individuals. A study by Gonzales et al. showed that gay and bisexual individuals had higher self-reported rates of psychological distress and substance use. In addition, the US Institute of Medicine Committee on Lesbian, Gay, Bisexual, and Transgender Health Issues and Research Gaps and Opportunities states that LGBTQ+ people are at higher risk for homelessness and HIV infection. An institutionally-upheld obstacle to positive LGBTQ+ health outcomes is homophobia, or anti-LGBTQ+ biases, perpetuated by healthcare providers (Burke et al.). These factors indicate that the LGBTQ+ community represents a population with unique health needs. Increasing LGBTQ+ representation among physicians is one of many potential ways that these unique needs can be addressed.

Although the general public’s annual celebration of Pride has grown and gained positive attention in the media, there is still a scarcity of LGBTQ+ representation in medicine. The significance of this is seen in the study by Sitkin and Pachankis, which uncovered that the proportion of LGBTQ+ individuals in a given specialty is positively correlated with the perceived inclusivity of that specialty. As a result, professional advancement of sexual and gender minority (SGM) individuals in objectively competitive medical specialties (i.e. orthopedics, neurosurgery, general surgery) is less likely because of their portrayed exclusivity. This indicates that whether intentional or not, existing physicians do demonstrate biases or negative attitudes towards the LGBTQ+ community, including other physicians. Thus, in order to increase LGBTQ+ representation in all specialties, we must see a decrease in anti-LGBTQ+ bias among physicians in order to make the medical field more welcoming of LGBTQ+ physicians, and therefore of SGM patients.

Burke et al. discovered that an effective approach to achieving inclusivity may involve increased interactions with SGM individuals. It is already established that prior contact, particularly positive experiences, with a group different from one’s own, correlates with reduced bias against that particular group. More specifically, the findings from Burke et al.’s survey indicate that more frequent and positive interactions between straight participants and LGBTQ+ individuals is associated with more positive attitudes towards gay and lesbian people. Moreover, around 75% of the first-year medical students in the study exhibited implicit bias towards SGM individuals, highlighting the broad scope of the issue.

Considering these findings, the authors propose that medical schools promote intergroup interactions among both straight and LGBTQ+ individuals. This can be achieved by featuring gay men and lesbian women on speaker panels, incorporating hypothetical patient sexual/gender identities into clinical scenarios during training, implementing programs to boost recruitment of SGM students, and fostering an environment that affirms diverse identities within medical schools. Granting SGM individuals, particularly those entering the medical profession, a platform to voice their opinions in healthcare is also of utmost importance.

One such effort was undergone by Dr. Ding , a member of the American Medical Association Advisory Committee on LGBTQ Issues. As an LGBTQ+ medical student at the University of Pennsylvania, he joined a student-run group called Penn Med Pride. As a member of this group, he collaborated with the school’s administration to integrate LGBTQ+ health considerations into the curriculum and co-authored a paper on policies protecting transgender students.

Unfortunately, even though there is a clear need for LGBTQ+ representation in the medical field, such representation is inherently more challenging to quantify compared to racial/ethnic representation. Firstly, one’s sexual identity is not always immediately apparent to others. For example, Dr. Leggott, a gay physician, recounts a scenario in which a patient made a homophobic comment during a visit, completely unaware that Dr. Leggott himself was gay. Furthermore, many individuals may intentionally conceal their sexual orientation due to societal bias. In fact, a study by Mansh et al. demonstrated that out of the LGBTQ+ respondents from 176 medical schools in the U.S. and Canada, 29.5% chose to hide their identity during their time in medical school. Therefore, even if resources for LGBTQ+ medical students exist, such as Penn Med Pride, students might be unable to access them due to the fear of disclosing their identity. This concern becomes particularly relevant in geographical areas where acceptance of the LGBTQ+ community is less pervasive.

Thus, while the benefits of LGBTQ+ physician representation are evident, the presence of societal bias against the SGM community poses a formidable barrier to overcome. This emphasizes the vital role of social justice in medicine and serves as a somber reminder that more work is needed to achieve equal healthcare outcomes for all groups in society.

Jordan graduated from UCLA in 2023 with a major in Human Biology and Society. Skyllar graduated from UCLA in 2023 with a double major in Physiological Science and Spanish. Jordan and Skyllar are both THINQ interns.

Sources:

1. Gonzales, G., Przedworski, J., & Henning-Smith, C. (2016).Comparison of Health and Health Risk Factors Between Lesbian, Gay, and Bisexual Adults and Heterosexual Adults in the United States: Results From the National Health Interview Survey. JAMA Intern Med., 176(9), 1344–51. doi: 10.1001/jamainternmed.2016.3432
2. Institute of Medicine (US) Committee on Lesbian, Gay, Bisexual, and Transgender Health Issues and Research Gaps and Opportunities. The Health of Lesbian, Gay, Bisexual, and Transgender People: Building a Foundation for Better Understanding. Washington (DC): National Academies Press (US); 2011. PMID: 22013611.
3. Burke, S. et al. (2016). Do Contact and Empathy Mitigate Bias Against Gay and Lesbian People Among Heterosexual Medical Students? A Report from Medical Student CHANGES. Acad Med., 90(5), 645–651. doi: 10.1097/ACM.0000000000000661
4. Sitkin, N. A., & Pachankis, J. E. (2016). Prestige, Perceived Inclusion, and Medical School Climate. LGBT Health, 3(6). https://doi.org/10.1089/lgbt.2016.0058.
5. Mansh, M. et al. Sexual and Gender Minority Identity Disclosure During Undergraduate Medical Education: “In the Closet” in Medical School. Mo Med, 112(4): 266.
6. Kyle Leggott. (2020, March 3). Here’s why LGBTQ physicians should self-identify. AAFP. https://www.aafp.org/news/blogs/freshperspectives/entry/20200303fp-lgbtqphysicians.html#:~:text=The%20available%20data%20indicates%20that,a%20reluctance%20to%20self%2Didentify
7. Murphy, B. (2022, June 22). Gay, Lesbian and BI Medical Students Report Worse Emotional Climate. American Medical Association. https://www.ama-assn.org/medical-students/medical-student-health/gay-lesbian-and-bi-medical-students-report-worse-emotional#:~:text=Gay%2C%20lesbian%20and%20bi%20medical%20students%20report%20worse%20emotional%20climate,-Jun%2022%2C%202022&text=Medical%20students%20who%20are%20gay,published%20in%20JAMA%20Network%20Open.
8. Waller, J. (2023, June 29), Voices of Penn Medicine Pride: Creating a Culture of Inclusion During LGBTQ+ Pride Month and All Year Long. Penn Medicine. https://www.pennmedicine.org/news/news-blog/2023/june/voices-of-penn-medicine-pride