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The doctor is in

the front cover of a crosscurrents magazine- the main image is a vase with bold coloured flowers

Sexual minority physicians still serve in silence

By Abigail Pugh

Winter 2004-05, Vol 8 No 2

 

In 1973, the American Psychiatric Association removed homosexuality from the nomenclature of psychiatric disorders. Other associations followed suit; for example, the American Psychoanalytic Association began accepting gay and lesbian trainees. This was a crucial development for U.S. and Canadian students who wished to specialize in psychiatry, since psychoanalytic training was an important component of the speciality. But while these momentous decisions spurred official acceptance of homosexuality as a viable sexual orientation, the experiences of physicians and medical students suggest that, unofficially, homosexuality remains the subject of discrimination in the medical community. Given this pathologized history and continuing stigma, what are the realities of being a sexual minority physician or medical student?

Studies have found that physicians and other health care professionals still experience discrimination in subtle and not-so-subtle ways. A 2001 article in the British Medical Journal (BMJ) that reviewed the literature between 1966 and 2000 found that up to 41 per cent of physicians and medical students have heard homophobic remarks or experienced homophobia in the workplace. A 1991 study in the Canadian Journal of Psychiatry revealed that one-third of family practice and psychiatry residents and faculty were homophobic. More recently, a 2000 study published in the Canadian Medical Association Journal (CMAJ) found that gay and lesbian medical students and residents face significant challenges on their way to becoming qualified physicians. Among these, perhaps the most painful and complicated decision is whether and how up front to be with colleagues and supervisors about their sexual orientation. Dr. Chris McIntosh, a psychiatry resident and chair of the Steering Committee of the Southern Ontario Gay and Lesbian Association of Doctors (SOGLAD), says that “how ‘out’ to be on resumés is always a hot topic of debate at SOGLAD.”

Dr. Jennifer Potter is a general practitioner in Boston, Massachusetts, who openly acknowledges that she is a lesbian. In a 2002 article for the Annals of Internal Medicine, she writes: “The medical establishment was an inhospitable place for gay trainees in the 1980s. As recommended by my premedical advisor, I concealed my lesbianism during the medical school application process… (Once at Harvard) I had to cope with tacit and overt advice that my lesbianism would be tolerated only as long as I kept quiet about it.”Potter feels that overt discrimination in the medical community is waning, but that it still exists. She offers the example of a friend, a respected medical specialist, who has recently left a heterosexual marriage because he is gay. But he is “terribly lonely” because he thinks that admitting his sexuality to the medical community is a career risk.

Dr. Mary Barber, president of the Association of Gay and Lesbian Psychiatrists in Philadelphia, Pennsylvania, agrees that staying in the closet remains the preferred choice for many medical professionals: “For the physician, there is the fear of not getting promoted and not getting good assignments due to supervisors not accepting their sexuality. But physicians who don’t come out may not have as close a relationship with their supervisor and may seem odd if they never talk about home life or never bring anyone to hospital functions. So they may still lose out.”

Increasing the visibility and acceptance of sexual minority physicians requires proactive training, both in medical schools and in the form of continuing education for existing practitioners. The 2000 CMAJ survey of medical students found that respondents’ assessment of professional and personal risk in coming out was influenced by the presence of identifiable supports, curricula inclusive of gay and lesbian sexuality and health issues and effective policies censuring discrimination based on sexual orientation.

In their 2001 BMJ article, Dr. Brian Burke and Dr. Jocelyn White offer various suggestions for enhancing well-being among sexual minority physicians, including coming out where possible, joining an LGBT organization, asking one’s organization to include sexual orientation in its non-discrimination statement, volunteering to speak at medical schools and acting as a mentor for a sexual minority medical student or resident.

While depathologizing homosexuality is an important step toward increasing acceptance of minority sexual identity, for some physicians, the stakes of full disclosure are still too high.

 

“We expend a lot of energy coping with homophobia that the institution throws at us – a ton of energy that we can turn instead toward making ourselves better doctors.” – ontario medical student, 2000

 

Advocates for sexual minority physicians and medical students

The Southern Ontario Gay and Lesbian Association of Doctors is a Toronto-based group of physicians and medical students.

The Association of Gay and Lesbian Psychiatrists (AGLP) works collaboratively with the American Psychiatric Association.

The American Medical Student Association includes an advocacy committee called Lesbian, Gay, Bisexual and Transgender People in Medicine.

The Gay and Lesbian Medical Association works to maximize the quality of health services for LGBT people and lobbies for both health care clients and professionals.

Gay Medics is a U.K.-based resource that serves LGBT doctors and medical students. It also works collaboratively with the American Psychiatric Association.

The American Medical Student Association includes an advocacy committee called Lesbian, Gay, Bisexual and Transgender People in Medicine.

• The Gay and Lesbian Medical Association works to maximize the quality of health services for LGBT people and lobbies for both health care clients and professionals.