糖心vlog

At this time, there is no large-scale systematic process for routinely collecting and publicly disseminating data on sexual and gender minority (SGM) identity among attending physicians and individuals across all stages of medical training鈥攆rom medical school matriculation to completion of graduate medical education. Without these data, institutional leaders may lack the foundational information necessary to develop tailored strategies to achieve equitable career advancement and professional fulfillment among SGM physicians or lack objective metrics by which they may evaluate a given program鈥檚 success.

In their cross-sectional survey study, Streed and colleagues¹ used national survey data from academic medical institutions participating in the Healthcare Professional Well-Being Academic Consortium to estimate the prevalence of SGM attending and trainee physicians in the US and to examine the association of SGM identity with burnout, professional fulfillment, and intent to leave practice or training. Among the 15 participating institutions, 8 included SGM demographic questions in the Healthcare Professional Well-Being Academic Consortium surveys conducted with attending physicians and 6 included these questions in surveys conducted with trainee physicians. Using data collected from more than 10鈥�000 attending and trainee physicians, the authors¹ found that SGM attending physicians were underrepresented relative to the general population of SGM adults (4.6% vs 7.6%). The study鈥檚 findings related to burnout, professional fulfillment, and intent to leave practice were also notable. After adjusting for age, race, and ethnicity, SGM attending physicians had increased odds of reporting burnout (adjusted odds ratio [aOR], 1.57; 95% CI, 1.27-1.94) and lower odds of reporting professional fulfillment (aOR, 0.80; 95% CI, 0.64-0.99) compared with non-SGM attending physicians; however, intent to leave practice did not significantly differ.¹ Compared with non-SGM trainees, SGM trainees also had increased odds of reporting burnout after adjusting for age, race, and ethnicity (aOR, 1.47; 95% CI, 1.10-1.96); however, professional fulfillment and intent to leave training did not significantly differ.¹ This Invited Commentary seeks to highlight several of the authors鈥� findings and suggest opportunities for further interrogation.

To my knowledge, this study¹ is the first to report the disproportionately low prevalence of SGM physicians and the association of SGM identity with worse occupational well-being in a large, multicenter analytic sample of physicians across a range of medical specialties in academic medical institutions. Although the number and types of institutions participating in the consortium² were not wholly representative of the settings in which SGM physicians practice, verifying these disparities is a pivotal early step in the process of creating interventions to bolster and safeguard the occupational well-being of SGM physicians. However, to progress from documenting to substantively eliminating these disparities, leadership at academic medical institutions must acknowledge that the responsibility of cultivating sustainable practices to achieve equitable representation and occupational well-being among SGM physicians ultimately lies with organizational leadership. Institutional leaders have a responsibility to anticipate and mitigate the degree to which SGM physicians within their organization may experience a 鈥渕inority tax,鈥�³ whereby they bear a disproportionate burden of responsibilities related to efforts to create a more diverse and inclusive institution鈥攔esponsibilities that often do not align with traditional metrics used to determine promotion and efforts that are not accompanied by pay in grants or administrative support.³ Furthermore, as the call to dismantle these initiatives becomes more widespread, institutional leadership must be transparent and steadfast in their willingness and ability to allocate sustainable funding and other material resources for the development of organization-level interventions to achieve equitable representation and occupational well-being.^4-6

Streed and colleagues¹ also discussed the possibility of conducting intersectional analyses to examine the experiences of SGM physicians with multiple marginalized identities and aid in the development of interventions to support SGM physicians. It would be helpful to contextualize analyses of SGM physicians鈥� experiences within structural power relations and include 鈥渁 framework that not only analyzes heterosexism as a system of oppression, but also conceptualizes its links to race, class, and gender as comparable systems of oppression.鈥�⁷ This would require both more comprehensive data collection about physicians鈥� identities and social positions and a foundational understanding of intersectionality and the matrix of domination.⁷ However, the findings of such analyses might better enable researchers and institutional leaders to identify intervenable factors underlying occupational well-being at the organizational and system level and tailor interventions to address those factors.

Finally, as the first study to document the low prevalence of SGM physicians within academic medical institutions, this study¹ helped elucidate the importance of building coalitions across and within groups that have been historically marginalized and excluded in medicine. By standing in solidarity and leveraging their collective power, these coalitions can strive to hold institutional leadership accountable and commit to cultivating sustainable programs and practices to support more affirming and inclusive medical training, improve occupational well-being, and achieve equitable career advancement and professional fulfillment in academic medical institutions.

Published: November 13, 2024. doi:10.1001/jamanetworkopen.2024.43891

Open Access: This is an open access article distributed under the terms of the CC-BY License. 漏 2024 Watson DL. 糖心vlog Open.

Corresponding Author: Dovie L. Watson, MD, MSCE, Division of Infectious Diseases, Department of Medicine, University of Pennsylvania Perelman School of Medicine, 3400 Spruce St, 3 Silverstein Pavilion, Ste E, Philadelphia, PA 19104 (dovie.watson@pennmedicine.upenn.edu).

Conflict of Interest Disclosures: None reported.