DoS Surgeons in the Media: “The Doctor is Out: Supporting Inclusion for LGBTQ+ Surgeons”

American College of Surgeons Bulletin
Tony Peregrin
March 8, 2023

 

“You come out as an LGBTQ+ individual virtually every day—it’s not like it happens once in a lifetime and you’re done,” said Harveshp D. Mogal, MD, MS, FACS, associate professor of surgery and section chief of complex abdominal oncology at the University of Washington (UW) Medical Center in Seattle.

 

Dr. Mogal (he/him) is a member of the Association of Out Surgeons and Allies (AOSA), a relatively new organization comprising LGBTQ+ surgeons and allies from all surgical specialties.¹

“For example, when you join a committee or you transition into a leadership position, you still face a lot of unknowns in terms of how people are going to respond to you as an out surgeon,” he added. “My hope is that with more of us joining organizations like AOSA, we will learn to normalize this process, and that eventually, being LGBTQ+ will just be part of the fabric of surgery rather than something that we have to struggle against because it’s not as accepted as it should be.”

The idea to form a group of LGBTQ+ surgeons and allies emerged on MedTwitter toward the end of 2018. AOSA—which had its inaugural founders’ meeting at Clinical Congress 2019 in San Francisco, CA—is committed to creating “a space for LGBTQ+ surgeons and trainees that promotes a dignified and successful surgical career without stigma, judgment, or discrimination,” according to the group’s mission statement. “We aim to achieve this through a combination of outreach, education, mentorship, and professional development.”^1,2

“If you’re not out, you constantly have to make sure not to make a comment about your personal life, about your partner, and so on. And that’s a lot of emotional energy when you’re trying to focus on operating.” —Dr. Nicole Goulet

AOSA held its first business meeting at Clinical Congress 2022 in San Diego, CA, during which members elected individuals to fill officer and chair positions within the organization.

“The decision to go into surgery when you identify as queer is a big one,” said Nicole Goulet, MD, FACS, (she/her), president of AOSA and director of the surgical intensive care unit at New York University Langone Hospital in Brooklyn. “While it’s getting better, there are still comments that are made by surgeons in the operating room that include derogatory terminology about being gay, and if you’re a surgeon who is not out, you think ‘Geez, I certainly need to make sure I hide this.’”

An article, written by members of the Resident and Associate Society of the ACS and published in the January 2021 issue of the ACS Bulletin, noted that “…it is unsurprising that LGBTQ+ surgery residents fear disclosure and instead pretend to be heterosexual to avoid potential problems. This approach not only is unhealthy, but also decreases the opportunity for those surgeons with ingenuous views to have meaningful interactions with LGBTQ+ people, which could help challenge biases.”³

Dr. Goulet cited data from two recent studies that provide additional context to the experiences of some LGBTQ+ surgical trainees.

A 2014 survey of 388 general surgery residents found that for those who identified as LGBTQ+, 57% reported actively concealing their sexual orientation from fellow residents owing to fear of rejection, and 52% from surgical attending physicians owing to fear of poor evaluations.^4,5 Among the surgical residents who experienced homophobic remarks, none reported the incident to leadership due to fear of reprisal among other reasons, according to Dr. Goulet.

A larger study published in 2019 surveyed 6,562 general surgery residents and found that for those who identified as LGBTQ+, 46.8% reported sexual harassment, 58.9% discrimination, and 75.2% bullying.^4,6 The study authors noted that while LGBTQ+ respondents were just as likely to be satisfied with their decision to become a surgeon, they were twice as likely to consider leaving their program and/or had suicidal thoughts in the past year.

“We’d all like to say that you can leave your personal life at home, but that’s just not the case,” said Dr. Goulet. “In surgery, we spend so much time together in residency, and then as colleagues in the operating room—and if you’re not out, you constantly have to make sure not to make a comment about your personal life, about your partner, and so on. And that’s a lot of emotional energy when you’re trying to focus on operating.”

“We are kind of exhausted being the outsiders or the ‘others’ within the group, where we are kind of expected to bring our full professional identity to work, but keep our personal identity completely divested from it,” added Dr. Mogal. “That being said, I think, in general, people in the workforce today are more open about expressing their full identity without fear of retribution or discrimination. But particularly in surgery, that change has come very slowly. And arguably, it still isn’t fully there, which is why we have organizations like the AOSA.”

In order to propel this positive change even further, it is important to examine LGBTQ+ equity through an intersectional lens, which considers the racial and ethnic backgrounds, differing abilities, and other variables and identities that comprise the LGBTQ+ community.⁷

Advancing intersectional equity starts by recognizing that certain individuals face overlapping forms of discrimination, such as an openly gay surgeon who also identifies as Black or has a disability. In order to support meaningful inclusivity for all LGBTQ+ surgeons and other healthcare providers, it is essential to cultivate an intersectional approach to policy development, recruitment, and training that takes into consideration the complex challenges of all marginalized individuals.

Primary Aims of the AOSA

The AOSA, which currently has 200 members, has four main objectives:

• Reduce explicit and implicit bias
• Enhance systemic support
• Foster mentorship
• Support leadership opportunities and promotion

“In the short term, we want to grow our membership and raise awareness and visibility about who we are,” explained Dr. Goulet. “And secondarily, a key component of our short-term goal is to provide advice, guidance, and education to other surgical organizations and societies.”

One example of educational outreach that could immediately enhance the narrative around LGBTQ+ individuals in the healthcare setting: The use of correct terminology, including pronouns.

In general, asking others their pronouns and names is a good place to start, according to Drs. Goulet and Mogal. It is recommended that surgeons and other healthcare providers avoid assuming individuals are cisgender and heterosexual and find teachable moments to advise colleagues in using appropriate and inclusive language if such a situation occurs⁸ (see Table 1).

“Asking what people’s pronouns are, or introducing yourself with that information, helps to normalize this process,” said Dr. Goulet. “As we start building that culture of having this be the norm, it creates an open conversation for everyone you work with and for our patients as well. Patients are going to hear these conversations and will, hopefully, be more likely to share things with you as their provider that they wouldn’t have shared otherwise.”

As for AOSA’s long-term goals, developing a robust mentorship network is a benefit that will continue to evolve as membership numbers tick upward.

“Our members are really looking for a mentor they can reach out to if they are having trouble with their program or if they have questions about how to apply for a job if they are out,” Dr. Goulet said. “We have a lot of people in the AOSA who are very comfortable with where they’re at with being out, and they can provide advice to help others along their surgical career path.”

“It is meaningful for LGBTQ+ trainees to be mentored by LGBTQ+ faculty because it’s important to see yourself mirrored in someone who is successful and continuing to succeed.” —Dr. Harveshp Mogal