LGBT Access to Care: Bias in Plastic Surgery
John Henry Y. Pang, MD, Jordan Fishman, MD, Francesco Egro, MD, Xiao Zhu, BA, Joseph Losee, MD, Vu Nguyen, MD.
University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
PURPOSE: Underrepresented minority (URM) patients are often systematically disadvantaged in their ability to access care. Of these, lesbian, gay, bisexual and transgender (LGBT) patients are subjected a unique set of healthcare disparities not faced by other URMs. To better understand how this specific URM population faces novel difficulties in their access to care within plastic surgery, this study aimed to delineate the demographics of and attitudes toward the LGBT population within the plastic surgery academic community.
METHODS: An anonymous survey was distributed to faculty and residents in every plastic surgery residency within the United States. Respondents were asked their training status or faculty position, gender identity and sexual orientation. Subsequent questions targeted perceptions of and attitude towards the impact of sexual orientation and gender identity on plastic surgery training and work experiences.
RESULTS: We received 385 responses from 201 residents (52.5%) and 179 attending surgeons (46.5%). Thirty respondents self-identified as LGB, none as transgender. Of LGB respondents, 59% were open about their sexuality to all residents, 36% to some, and 4% to none. Only 21% were open to all attendings, most (68%) were open to some, and 10% to none. While 65% did not fear rejection/reprisal following disclosure of their sexuality, the overwhelming majority (95.6%) were not open during the application/interview process. Some (13%) were advised not to disclose their sexual orientation while applying or interviewing. During training, 17% of LGB respondents experienced homophobic remarks from residents and 26% experienced such remarks from attendings. However, 90% did not report the incident. Many respondents reported witnessing transphobic and/or homophobic remarks made by hospital staff including nurses (34.3%), other residents (24.1%), and attendings (23.8%). Only 7.3% of respondents admitted making transphobic or homophobic statements and only 7.9% reported witnessing discriminatory care toward LGBT patients and patients' partners. Only 6.9% felt that homosexuality was immoral while 5.5% felt that being transgender was immoral. 32.7% of respondents reported teaching medical students awareness and sensitivity to the health concerns of LGBT patients while 18.9% disagreed in doing so.
CONCLUSION: Our data suggests that despite recent social progress towards the acceptance of the LGBT community, there exists ongoing discrimination within both the plastic surgery and healthcare community. Though a majority of LGB respondents did not fear rejection/reprisal following disclosure of their sexuality, it is significant that a third still did, reflecting ongoing fears of the community. That over a quarter of respondents overheard transphobic/homophobic remarks speaks to the need for ongoing education/training. That training/education on the health concerns of LGBT patients is opposed by large percentage of respondents speaks to the acuity of this need. There is also, however, clear evidence of support and tolerance within academic plastic surgery, as evidenced by the majority of LGB residents who are open to some or all residents and attendings and only a small percentage of LGB respondents were advised not to disclose their sexuality during interviews. While more progress is needed to ensure equitable access to care, academic plastic surgery is increasingly tolerant of the LGBT community.
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