The Northeastern Society of Plastic Surgeons

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LGBT Access to Care: Bias in Plastic Surgery
John Henry Pang, MD, Jordan Fishman, MD MPH, Francesco Egro, MD, Xiao Zhu, MD, Joseph Losee, MD, Vu Nguyen, MD.
University of Pittsburgh Medical Center, Pittsburgh, PA, USA.

PURPOSE - Underrepresented minority (URM) patients are systematically disadvantaged in their access to care. Lesbian, gay, bisexual and transgender (LGBT) patients are subjected a unique set of healthcare disparities not faced by other URMs. To better understand how this specific population faces difficulties in their access to care within plastic surgery, this study aimed to delineate the demographics of and attitudes toward the LGBT population within the plastic surgery academic community.
METHODS – An anonymous survey was distributed to faculty and residents in every plastic surgery residency within the United States. Questions targeted perceptions of and attitude towards the impact of sexual orientation and gender identity on plastic surgery training and work experiences.
RESULTS – We received 385 responses from 201 residents (52.5%) and 179 attending surgeons (46.5%). Thirty respondents self-identified as LGB, none as transgender. Of LGB respondents, 59% were open about their sexuality to all residents and 21% were open to all attendings.
While 65% did not fear rejection/reprisal following disclosure of their sexuality, the majority (95.6%) were not open during the application/interview process. 13% were advised not to disclose their sexual orientation while applying/interviewing. 17% of LGB respondents experienced homophobic remarks from residents and 26% experienced such remarks from attendings. However, 90% did not report the incident. Respondents witnessed transphobic and/or homophobic remarks made by hospital staff including nurses (34.3%), residents (24.1%), and attendings (23.8%). 7.9% witnessed discriminatory care toward LGBT patients/family. 32.7% reported teaching medical students LGBT health issues while 18.9% disagreed in doing so.
CONCLUSIONS – Despite recent social progress towards acceptance of the LGBT community, there exists ongoing discrimination within the plastic surgery and healthcare community. Though a majority of LGB respondents did not fear rejection/reprisal following sexuality disclosure, it is significant that a third still did, reflecting ongoing fears of the community. That over a quarter of respondents overheard transphobic/homophobic remarks speaks to the need for ongoing education/training. That training/education on the health concerns of LGBT patients is opposed by large percentage of respondents speaks to the acuity of this need. There is also, however, clear evidence of support/tolerance within academic plastic surgery, as evidenced by the majority of LGB residents who are open to residents/attendings and the small percentage advised not to disclose their sexuality during interviews. While more progress is needed to ensure equitable access to care, academic plastic surgery is increasingly tolerant of the LGBT community.


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