What's Important: Applying to Orthopaedic Surgery as a Member of the LGBTQ Community.

Abstract

During the first day of my orthopaedic subinternship last summer, I was excited to finally be back in the operating room. Before the case began, the surgeon briefly left the room while I stayed to get things ready. It was then that I heard disparaging remarks from OR staff about the patient, who had only gone under anesthesia seconds before. The patient was transgender, and several staff in the room were ridiculing her appearance and gender expression. I was horrified. But, worried about reprisals, I did nothing. Later, ashamed of my inaction, I became more cognizant than ever of the need for LGBTQ (lesbian, gay, bisexual, transgender, queer) representation in all medical specialties—but especially in those, such as orthopaedics, where it is so lacking. Orthopaedic surgery is often regarded as among the least diverse medical specialties. A recent analysis of the Association of American Medical Colleges graduating students survey showed that orthopaedic surgery was miles behind other specialties in LGBTQ representation1. As a gay man, I felt intimidated during the residency application process. Would I be able to find an open and accepting program that valued who I am and recognized my potential? At the time, I was not aware of a single orthopaedic surgeon identifying as LGBTQ; I certainly didn’t have access to a mentor who was also queer. Some might argue that such concerns are overblown. However, it is commonly recognized that the ranks of women and underrepresented minorities in the field lag far behind other specialties2. How then does a person find a program they can be sure will align with their values? Luckily, I had excellent mentors—although they were all straight—who coached me on application strategies. One recommended that I embrace my sexual identity and use it as a selling point, but another suggested that I apply like any other applicant and use my position to change the system from the inside out. Both advised that more accepting programs could be found in bigger cities. It appears that our field is attempting to make changes with respect to diversity. Orthopaedic societies that focus on diversifying the field, including the Ruth Jackson Orthopaedic Society and the J. Robert Gladden Orthopaedic Society, have made tremendous strides for female and Black practitioners. However, to my knowledge, no such organizations exist for queer orthopods. Furthermore, orthopaedic surgeon census data, which include gender and race, often omit sexual orientation. One silver lining of the pandemic is the increased emphasis on social media for resident recruitment. I paid close attention to the content that programs chose to highlight in their posts. Putting diversity efforts and social justice front and center suggested to me that a program would be more likely to be accepting. Conversely, a dearth of residents or faculty members of marginalized genders, sexualities, and racial groups in the resident classes or on faculty was a red flag. Obviously, when a program had an LGBTQ resident or faculty member, I immediately felt more comfortable applying there. But those instances were few. Language, too, can be a powerful signal. I found that the way programs communicated could give me helpful clues into their priorities. Using gender-neutral language—such as “partner” instead of “husband” or “wife”—made me feel safer and more welcomed. There is a certain hospitality in introductions, or even email signatures, that contain pronoun designations. I also noticed that many programs featured statements on their websites citing their commitment to diversity. It was a nice thought, and it would have been nicer had they all mentioned sexual and gender identity, but most of them did not. Orthopaedics needs big changes3,4, but making it more hospitable to LGBTQ people can start with these littlest tweaks. I urge all medical colleagues and staff to maintain a zero-tolerance policy when it comes to discriminatory language or behaviors. Our colleagues will follow our lead, and our patients will benefit tremendously. Orthopaedic surgeons need to be ready to care for all patients, and tending effectively to a diverse community requires a diverse corps of providers. Recruiting and welcoming more sexual and gender minorities into the field—as well as brushing up on the care needs of these populations5,6—will create a world in which the sort of transphobia I witnessed in the OR during my subinternship is a thing of the past. I’ve seen glimpses of this world already. I remember, during a separate subinternship, that one of the attending surgeons I worked with wore a rainbow-colored lanyard. That small action made me feel comfortable enough to put a rainbow flag pin on my own lanyard. And I remember the gratifying feeling of a young LGBTQ patient in clinic who told us, with tears in her eyes, “I like your lanyards. Thank you.”