Experiences of Transgender and Gender Nonbinary Medical Students and Physicians

Abstract

To explore the experiences of transgender and gender nonbinary (TGNB) medical students and physicians in the United States. Methods: The authors conducted a 79-item online survey using Likert-type and open-ended questions to assess the experiences of TGNB-identified U.S. medical students and physicians. Variables included demographic data, disclosure of TGNB status, exposure to transphobia, and descriptions of educational and professional experiences. Recruitment was conducted using snowball sampling through Lesbian, Gay, Bisexual, Transgender, Queer professional groups, list-servs, and social media. The survey was open from June 2017 through November 2017. Results: Respondents included 21 students and 15 physicians (10 transgender women, 10 transgender men, and 16 nonbinary participants). Half (50%; 18) of the participants and 60% (9) of physicians had not disclosed their TGNB identity to their medical school or residency program, respectively. Respondents faced barriers on the basis of gender identity/expression when applying to medical school (22%; 11) and residency (43%; 6). More than three-quarters (78%; 28) of participants censored speech and/or mannerisms half of the time or more at work/school to avoid unintentional disclosure of their TGNB status. More than two-thirds (69%; 25) heard derogatory comments about TGNB individuals at medical school, in residency, or in practice, while 33% (12) witnessed discriminatory care of a TGNB patient. Conclusion: TGNB medical students and physicians faced significant barriers during medical training, including having to hide their identities and witnessing anti-TGNB stigma and discrimination. This study, the first to exclusively assess experiences of TGNB medical students and physicians, reveals that significant disparities still exist on the basis of gender identity.

Pronouns and Advocacy in Medicine

“…A recent study examined experiences of TGNB medical students and physicians. 12 The researchers found that 22% of participants reported barriers attributable to their gender identity while applying to medical school and 43% while applying for residency. They also found that 78% of participants censored themselves during training to avoid disclosing their TGNB identity and that 69% heard derogatory comments about TGNB individuals during their training or practice.…”

Experiences of Transgender and Nonbinary Physicians During Medical Residency Program Application

“…A transgender person's gender identity differs from sex assigned at birth, and nonbinary people have a gender identity outside the traditional male/female binary. 1,2 US prevalence of transgender and nonbinary (TNB) people is 0.3 to 2.7%, [3][4][5] and the Association of American Medical Colleges reports rising matriculation of TNB medical students, from 596 in 2016 to 1010 in 2018. 6 Thus, increasing numbers of TNB students are applying for residency positions.…”

“…In a 2019 report, 60% of physicians did not disclose their gender identity to residency programs due to lack of perceived support, discrimination fears, or not yet understanding themselves as TNB. 2 About half of medical students do not disclose their gender identity during medical school. 7 TNB applicants are vulnerable to discrimination if they have not legally changed their name and gender, or do not adopt societally expected gender expressions.…”

“…7 TNB applicants are vulnerable to discrimination if they have not legally changed their name and gender, or do not adopt societally expected gender expressions. 1,2 A TNB student's name could differ on prior academic work, inadvertently forcing gender identity disclosure during residency application.…”

“…11 Literature examining experiences of TNB people in medical training and practice is limited to one small study (36 medical students, residents, and attendings). 2 It is likely that discriminatory practices still exist, although programs may also have supportive mechanisms in place. In order to increase recruitment of TNB applicants, it is important to understand the current landscape.…”