LGBTQ+ Physicians: History, Progress, and Recommendations for a Better Future.

To the Editor: We celebrate Dr. Rachel Levine's history-making confirmation as assistant secretary of health, making her the highest-ranking openly transgender official in U.S. history. Until recently, contributions to medicine by physicians who were openly lesbian, gay, bisexual, transgender, and queer (LGBTQ+) were rarely documented, let alone celebrated. The dearth of knowledge on the medical contributions of openly LGBTQ+ physicians is partly due to the lack of data collection on the sexual orientation, gender identity, and expression (SOGIE) of physicians. It is not surprising that, even if asked, the possibility of harassment and discrimination in the workplace hinders some LGBTQ+ physicians from fully divulging this information. For many years, openly LGBTQ+ physicians faced backlash to their practices, ostracization from colleagues, and denial of opportunities. 1,2 Before the Bostock v. Clayton County case in 2020, LGBTQ+ employees were protected from discrimination in only 22 states and Washington, DC. 3 The current challenges for LGBTQ+ individuals include not only overt discrimination but also microaggressions and weaponization of professionalism. Anecdotal evidence indicates that patients may ask LGBTQ+ physicians whether they have an opposite-sex partner or spouse, putting the physician in an uncomfortable position of deciding whether to hide or disclose to a patient whose ideology is not known. Colleagues may have implicit, deeply ingrained beliefs based on cisgender heteronormative societal ideas. For example, preconceived notions that unique LGBTQ+ experiences such as Pride celebrations and gay bars are deemed unprofessional. For transgender and nonbinary medical professionals, simply presenting with a gender expression congruent with their gender identity may appear unprofessional to some colleagues and patients. While the sentiments and attitudes of the U.S. public toward LGBTQ+ persons have improved through the years, much work still needs to be done: First, we believe that comprehensive, systematic, and thoughtful data collection and analysis on SOGIE of the medical workforce are essential. A responsible institution encourages its LGBTQ+ staff to feel free to be themselves and own their identities without fear of retribution. We hope that enough of today's institutions are responsible in that way, which would ensure that the SOGIE data would be reasonably accurate. Second, representation in medicine and leadership matters. LGBTQ+ students and young trainees need mentors and role models from the LGBTQ+ community. We encourage all medical institutions to continue to empower their LGBTQ+ staff to seek leadership positions and be intentional in supporting their careers. Last, institutions should ensure that policies are inclusive, transgender-friendly, and nonheteronormative. Medical schools and training institutions should commit to teaching LBGTQ+ health. We are hopeful for the future of LGBTQ+ individuals in medicine and seek equality, equity, and inclusivity for all.