Does Mistreatment and Perceived Stress Impact Career Choice for LGBTQ+ US Medical Students?: An Analysis of AAMC Data

Abstract

Introduction The impact of psychosocial stressors on specialty choice among sexual minority vs sexual majority medical students remains unclear. Past studies have suggested that sexual minority individuals are less likely to pursue specialties considered to have more intensive postgraduate training. We explored how sexual orientation, Perceived Stress Scale (PSS), and cumulative experience of mistreatment (ie, mistreatment experience variable [MEV]) during medical school influences specialty selection using longitudinal data from the Association of American Medical Colleges matriculation (2014) and graduation (2018) questionnaires. Design, Setting, and Participants A multinomial logistic regression model evaluated the association of sexual orientation, PSS, and MEV on specialty choice, adjusting for age, gender, race, US geographical region of medical school, and 2 interaction terms. Interactions between sexual orientation and PSS and MEV were not significant. The sample included 12 128 participants. Results Compared with heterosexual students, homosexual students were less likely to choose general surgery or surgical subspecialties (P = .004) and orthopedics (P = .002) over internal medicine. Homosexual students with a PSS score of 7 or greater were less likely to choose general surgery or surgical subspecialty (P = .03), orthopedics (P = .02), and emergency medicine (P < .001) than internal medicine. Additionally, homosexual students who reported an MEV score of 3 or greater were less likely to choose orthopedics (P = .007) over internal medicine. Conclusions These data suggest that stress and mistreatment during medical school significantly impact specialty choice, particularly for homosexual students. To correct these disparities and broaden LGBTQ+ representation across all specialties, institutions need to explore early career advising for students with greater perceived stress and increase efforts to eradicate mistreatment of sexual minority students during medical training.