Sexual minority representation and recruitment success across medical specialities in the United Kingdom: a longitudinal analysis of NHS England data (2021–2024)

Abstract Background Promoting equality, diversity, and inclusion (EDI) within the NHS is a key priority. While international literature suggests sexual minority individuals may be disproportionately represented in certain medical specialties, this has only been explored via questionnaires and surveys in UK postgraduate training, and not in a large, longitudinal study. This study mapped sexual minority representation across UK specialties and evaluated whether recruitment outcomes differ significantly from heterosexual counterparts. Methods A longitudinal cohort analysis was conducted using NHS England recruitment data (2021–2024). Specialties with fewer than 500 total observations were excluded due to data suppression. Sexual minority proportions were calculated at three recruitment stages: application, offer, and acceptance. Recruitment equity was assessed using Odds Ratios (ORs) with 95% Confidence Intervals (CIs) to compare the odds of receiving an offer between sexual minority and heterosexual applicants ( p < 0.05). Results Of 214,415 applications, 4% ( n = 7,751) identified as a sexual minority. Sexual minority applicants received 5% of offers ( n = 3,734) and accepted 5% of posts ( n = 2,740). Marked variation occurred between specialties. At entry level (ST1), sexual minority applicant proportions were highest in community sexual and reproductive health (9%), public health (7%), and histopathology (6%), and lowest in cardiothoracic surgery (2%), general practice (2%), and clinical radiology (3%). At higher level (ST3), psychiatry subspecialties (7%) and anaesthetics (5%) showed the highest representation, whereas acute internal medicine (1%) and trauma and orthopaedic surgery (1%) showed the lowest. Of the 32 specialities included after removing 21 specialities with fewer than 500 total offers, sexual minority applicants were not disadvantaged in obtaining offers. At entry level (ST1), sexual minority applicants had significantly higher odds of receiving offers in multiple specialties, notably for core psychiatry training (OR 3.4, 95% CI 3.0–4.0). At higher level (ST3), sexual minority applicants had significantly higher odds of receiving offers in acute internal medicine, haematology, trauma and orthopaedic surgery, and clinical oncology. Conclusion UK recruitment processes provide an equitable gateway for sexual minority doctors, showing no systemic bias in offer rates. However, marked variation in representation suggests cultural perceptions or self-selection may influence career choices, highlighting a need to investigate potential structural barriers in low-representation specialties.