# Specialty Preferences and Intentions to Work in High-Need Contexts Among Graduating Sexual and Gender Minority Medical Students

## TL;DR

Sexual and gender minority medical students are more likely to choose specialties like family medicine and psychiatry and to work in underserved areas compared to their cisgender and heterosexual peers.

## Contribution

This study reveals how sexual and gender minority students' specialty preferences and intentions to serve underserved populations differ from their non-minority peers.

## Key findings

- Gender and sexual minority students are more likely to intend to work in underserved areas and with underserved populations compared to their cisgender and heterosexual peers.
- Family medicine and psychiatry are the most popular specialties among gender and sexual minority students.
- Gender and sexual minority students are less likely to pursue surgical specialties than their cisgender and heterosexual peers.

## Abstract

Introduction: Sexual minority (SM) and gender minority (GM) students make up a growing portion of medical student bodies and face unique challenges that shape their career decisions. Identifying what specialties draw interest from SM and GM medical students is crucial for anticipating the composition of an increasingly diverse clinical workforce and understanding what contribution these students could make to addressing health disparities faced by LGBTQIA+ patient populations.

Aim and objective: To study specialty choices and intent to work in underserved contexts among graduating SM and GM medical students in the United States and determine whether these differed from their heterosexual and cisgender counterparts.

Methods: We completed a secondary analysis of data from the 2022-2024 American Association of Medical Colleges’ Graduation Questionnaire (GQ), which included responses from 50,185 graduating allopathic medical school students. Respondents were stratified by gender identity, as well as sexual orientation and sex. Descriptive statistics were calculated to examine the specialty choices of SM and GM students. χ2 tests were used to compare intention to pursue primary care or surgical specialties and intention to work in underserved areas or with underserved populations.

Results: GM and SM medical students were more likely to intend to work in underserved areas (GM: n = 241/473, 50.95% vs. cisgender: n = 13,378/46,413, 28.82%; p < 0.001; SM: n = 2,205/5,713, 38.60% vs. heterosexual: n = 11,308/40,796, 27.72%, p < 0.001) and with underserved populations (GM: n = 326/473, 68.92% vs. cisgender: n = 18,454/46,409, 39.76%, p < 0.001; SM: n = 3,070/5,719, 53.68% vs. heterosexual: n = 15,563/40,787, 38.16%, p < 0.001) than their cisgender and heterosexual peers. GM and SM students were also less likely to pursue surgical specialties than their cisgender and heterosexual peers (GM: n = 96/469, 20.47% vs. cisgender: n = 12,120/46,117, 26.28%. p < 0.01; SM: n = 1,312/5,660, 23.18% vs. heterosexual: n = 10,812/40,553, 26.66%, p < 0.001). Family medicine (n = 93, 19.70%) and psychiatry (n = 69, 14.62%) were the most popular preferred specialties among graduating GM students, while internal medicine (n = 848, 14.85%) and psychiatry (n = 685, 11.99%) were most popular among SM students.

Conclusion: These results illustrate how GM and SM medical students are drawn toward specialties such as family medicine and psychiatry, which may be informed by these fields' perception as inclusive spaces. In addition, our findings demonstrate a decreased interest in surgical fields among GM and SM medical students. GM and SM students showed a greater propensity for intending to work in underserved clinical contexts and may become a core part of the clinical workforce supporting communities in need, such as LGBTQIA+ patients.