Career or Identity: Investigating specialty selection among LGBTQ+ medical students using a multi-institutional questionnaire

Background: A workforce representative of all populations, including lesbian, gay, bisexual, transgender and queer/questioning/other (LGBTQ+) medical students, is critical to providing care to patients of all backgrounds. Understanding why LGBTQ+ students choose one specialty over another is important to identify targets of focus to ensure this balanced recruitment of LGBTQ+ students to specialties in medicine. Purpose: To compare factors influencing career choices among LGBTQ+ compared to non-LGBTQ+ students and to identify specific reasons for or against pursuing Ophthalmology, Dermatology and Otolaryngology. Methods: Multi-institutional survey distributed to medical students in their final year of training through institutional email and social media posting. The questionnaire was distributed 2 weeks prior to Ophthalmology Match Day and closed the day following Ophthalmology Match Day (March 19, 2021). Survey respondents were asked to rate the importance of specific considerations for choosing a particular specialty on a 3-point Likert scale. Results: 286 medical students in their final year of training responded to the questionnaire. Forty-three (18%, n=237) respondents identified as LGBTQ+. LGBTQ+ students were 55% less likely to cite extremely high importance of having a mentor in the same field as non-LGBTQ+ students (OR = 0.45, 95% CI = 0.22 – 0.92, p = 0.040). They were equally likely compared to non-LGBTQ+ students to value mentorship, work-life balance, job availability, social recognition, and high income potential. More LGBTQ+ students cited competitiveness as a reason against pursuing Dermatology compared to their non-LGBTQ+ peers (70.7% vs. 51.7%, p=0.027), and more LGBTQ+ students cited an inability to find same-sexual-orientation role models as a reason against pursuing Otolaryngology compared to non-LGBTQ+ students (9.8% vs. 2.8%, p=0.043). Conclusions: LGBTQ+ students surveyed differed slightly from non-LGBTQ+ counterparts when taking factors into consideration for their medical specialty, as they all value mentorship, work-life balance, job availability, social recognition, and high income potential. When considering subspecialties of Dermatology, Otolaryngology and Ophthalmology, there is a decreased emphasis among LGBTQ+ students to find mentors in their field of choice. The reasons for this need to be further evaluated.