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Waiting to Come Out

Discrimination, and the potential for it, still keeps many medical students and residents from being out about their sexual orientation or gender identity.

The New Physician May-June 2010

Like most medical schools, Northwestern University has lesbian, gay, bisexual and transgender (LGBT) students. Yet, very few of them are out of the closet.

“There are some students who are out to themselves, but I’m the only student in the second-year class who is out to fellow classmates, professors and patients,” says Brian Holoyda.

“Chris,” a former medical student at Northwestern who spoke on the condition of anonymity, stayed in the closet because he was worried about discrimination. He was prematurely outed to fellow residents before his intern year. “Being outed really scared me.”

Even though the gay liberation movement began more than 40 years ago, homophobia continues to play a major role in the mistreatment of LGBT patients and health care providers. Health disparities among the LGBT population are widely documented, with many people assuming that HIV and AIDS are still diseases primarily among gay men.

Additionally, many medical students and practicing physicians are still not comfortable being open about their sexuality. One study showed that 95 percent of students applying for medical school did not disclose their sexuality, and 46 percent were not open when applying for residency.

A separate survey, conducted by the Association of American Medical Colleges (AAMC) during the 2005-2006 academic years, found that 15 percent of respondents were aware of mistreatment of LGBT students at their schools, and 7 percent described the overall environment at their institutions as hostile to such students.

Fear of discrimination and harassment are the main reasons why medical students do not come out to classmates and professors. Chris says that he has been discriminated against in different ways. “It varies from generalized gay jokes to passive-aggressive comments to direct personal insults. I have experienced it all, in both medical school and residency.”

While Holoyda has not been personally harassed, he was confronted with anti-gay prejudice during his very first class at Northwestern. His professor presented a case about a man with a broken leg admitted to a hospital who revealed to a psychiatrist that he was gay. Upon asking the class what should be done next, a student said that because the man was gay, an HIV test should be ordered. The professor agreed with the student even though there was no discussion about the man’s risk factors, like sexual history and injection drug use, explains Holoyda.

“From my first day of medical school,” he says, “I developed a heightened awareness about the fact that there were going to be problems in medical school regarding LGBT people.”

Discrimination continues

Ongoing discrimination and stigma against LGBT patients and health care providers are still common, according to new national surveys by the Gay & Lesbian Medical Association (GLMA) in partnership with the American Medical Association (AMA). One survey examined GLMA’s members’ perceptions of discrimination against LGBT patients and medical professionals. The second one surveyed physicians in the AMA’s database to understand physicians’ experiences, practices, attitudes and training related to their LGBT patients and colleagues.


Compared with a 1994 survey, there has been improvement in attitudes, but there exists significant discrimination even in medical school, says James Beaudreau, GLMA’s education and policy director. “We’re still analyzing the results, but what we’ve seen so far raises serious concerns.”

Whether a student or resident wants to be out is complicated further by the fact that there is no federal law that consistently protects LGBT people from employment discrimination, and it remains legal in many states to discriminate based on sexual orientation and gender identity. Doctors who work for the federal government are protected, but those in the private sector are not.

“People don’t realize that you can be fired from your job in most places in this country simply for being gay,” says Beaudreau. “That in and of itself provides an important rationale for why a physician may want to stay in the closet if they were gay and in a place where they had no legal protection.”

Many medical schools have adopted nondiscrimination clauses, and the AAMC developed a set of LGBT “good practices” that recommend changes in professional and curricular policies for member institutions.

Many LGBT students remain in the closet, or probably never even enter medicine, because there are so few role models and mentors, says Shane Snowdon, director of the LGBT Resource Center at the University of California, San Francisco.

“There’s no question that high-school and college students who are LGBT are unlikely to know any role models in medicine and so they don’t realize that being a physician could be a viable profession for them,” Snowdon says. “Even today, no dean of a medical school has publicly acknowledged being LGBT.”

Snowdon developed an “out” list of more than 350 LGBT students, staff and faculty. “Mentoring can counteract the closeting that often happens with LGBT students and may help students move into other specialties,” she says. Currently, OB-Gyn, pediatrics, psychiatry, internal medicine and family medicine are considered gay-friendly specialties with more role models.

Holoyda is trying to remedy the lack of mentors by developing a program through GLMA. As the student representative on the organization’s board, Holoyda has made mentorship a major priority. “We already have 40 mentors who are willing to work with students,” he says.

In or out

Snowdon finds that she frequently plays the role of mentor, and is often asked by students or residents whether they should come out on their applications. She does not overlook the lingering biases that still exist, but insists that they should ultimately do what feels right to them.


Students need to consider how they want to talk about being LGBT on their application or during interviews, Snowdon says. She adds that there are several questions applicants should ask themselves: Do you want to mention your sexual orientation or gender identity because it’s encouraged you to pursue medicine, because you have important leadership or volunteer experience to discuss, or because it’s relevant to your personal life?

Dr. Jason Schneider, immediate past president of GLMA, did not reveal that he was a gay man on his application to New York University School of Medicine. “When applying, I knew I wanted to go to a school where I would be accepted as a medical student and a gay man, but I didn’t have a good reason to talk about it on my application.”

Studies show that more students come out when applying to residency, holding back until that point because once they come out, there’s no going back. However, there are some cases where people will go back in the closet during residency. “Sometimes they don’t remain out because of the specialty they have chosen or the geographic region,” says Snowdon.

Schneider decided to talk about his role in LGBT groups when applying for residency. “During medical school I became active in LGBT issues, and so it was relevant to my future as an intern-ist,” he says. “My advice is that if a student has leadership skills or has done volunteer work with LGBT groups and it’s integral to who they are as a future doctor, then they should include it in their CV and talk about it in their personal statement.”

If you decide to be out during the application process, be prepared to talk about it during the interview, says Snowdon. “Talking about it can have some positive results. Don’t feel like you have to clam up.”

For Holoyda, being out in medical school has been important for him because he wants to be himself. When he is seeing patients, he wears on his lapel the American Medical Student Association’s Rainbow Caduceus pin with the colors that are a universal symbol of LGBT pride. “Since wearing it, no one has been offended or taken aback, but for patients who know what the symbol means, maybe it will help them feel more comfortable being in my care.”

Holoyda is cautiously optimistic that with the support of the Office of Minority and Cultural Affairs, a few faculty who are out, and his straight allies at Northwestern, he is slowly making a difference to help the school’s administration better understand the needs of LGBT students. He is working to establish SafeSpace training for his school’s administration, which is designed to help straight individuals become culturally competent in working with LGBT populations.

He is also proud that he helped arrange a meeting between students, the director of the Office of Minority and Cultural Affairs and the course directors around the case of the gay man with HIV that is presented to first-years. “We were able to voice our opinions about the case, and supposedly it is going to change next year,” says Holoyda. “I’ll definitely be keeping my eye on that one.”

Paul Wynn is a health care writer based in Brooklyn, New York.

Resources

The Association of American Medical Colleges (AAMC) Web site provides resources to develop curriculum around educating straight medical students and patients on LGBT issues, including institutional self-assessment tools.
www.aamc.org/members/gsa/glbt

The Gender & Sexuality Committee of the American Medical Student Association provides news about LGBT projects and conferences, and a highly useful directoryÑcreated by feedback from studentsÑthat rates medical schools and residency programs on LGBT-friendliness.
www.amsa.org/gender

The Gay & Lesbian Medical Association is the country’s largest group representing LGBT health care professionals with about 1,200 members. The organization will hold its annual meeting in San Diego (Sept. 22-25).
www.glma.org

Besides its “Out List” of 350+ LGBT students, staff and faculty, the Web site of the University of California, San Francisco’s LGBT Resource Center includes an e-mail list for UCSFers to join, as well as news updates, calendar listings and information about groups advocating for LGBT people.
lgbt.ucsf.edu

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