In an impromptu listing of all the diseases his children had, I never would have guessed that the next word to come out of my attending’s mouth was “gay.” As an LGBTQ+ medical student with scars on my chest to prove it, this encounter only added to the collection of instances where I felt the weight of being underrepresented in medicine. Or am I?
Each year, the Association of American Medical Colleges (AAMC) publishes a report, the U.S. Physician Workforce Data Dashboard, that details the demographics of the physician workforce across all specialties. In 2023, 11.9% of our almost 990,000 physicians self-identified as being one of the following races/ethnicities: American Indian or Alaska Native; Black or African American; Hispanic, Latino, or of Spanish origin; or Native Hawaiian or Other Pacific Islander. The AAMC labels these groups of people as underrepresented in medicine (URiM), a definition strictly reserved for the discussion of race and ethnicity, a definition last revised in 2004.
In further studying the data in this report, we see that the percentage of female physicians is prominently displayed alongside the breakdown of races and ethnicities; however, there is a complete absence of any other demographic data on the sex, gender, and sexual orientation of American physicians. Upon review of the AAMC’s 2019 Diversity in Medicine: Facts and Figures, we also see a total lack of data of gender and sexual orientation–only the sex of physicians and students as male or female is reported. Importantly, sex and gender are two separate things, often mistakenly interchanged: Sex is a biological classification, whereas gender is a social construct that exists on a spectrum. By reducing down a spectrum into a binary for ease of thought or data analysis, physicians’ identities are lost in the process, particularly those who are transgender. What data is out there to quantify the number of LGBTQ+ physicians in the workforce?
We are fortunate to have some data from the American Academy of Family Physicians to draw from: 3% of their members identified as lesbian, gay, or bisexual. Although, there was no opportunity for transgender individuals to identify themselves in this survey. Compare this to the nearly 9% of the U.S. population that identifies as LGBT, according to the U.S. Census Bureau’s Household Pulse Survey.
While data is limited, what we do know seems to point towards LGBTQ+ individuals being underrepresented in medicine proportionate to their percentage of the general population. And yet, the AAMC does not formally consider the LGBTQ+ community as URiM.
Why does it matter to be labeled URiM? Importantly, this is not a competition for who is most marginalized in medicine. The recognition of certain racial and ethnic groups as being underrepresented in the physician workforce through the creation of “URiM” was undoubtedly a critical step in further the diversification of medicine. Stances from large medical organizations like the AAMC matter … and the money follows. We see the good works of this through the development of numerous much-needed visiting student scholarships, mentorship programs, and research opportunities specifically designated for URiM students. At the same time, however, to exclude other groups of individuals from this formal designation who are also underrepresented–by data and lived experience alike–is grossly negligent. Many of these aforementioned programs and opportunities use the AAMC URiM definition and strictly exclude anyone outside of the definition, often without realizing it. In an era of homophobia and transphobia where transgender/nonbinary medical students face discrimination throughout their training, where LGBTQ+ medical students are experiencing more burnout than their peers, and where LGBT physicians are harassed by their colleagues, are LGBTQ+ medical students not deserving of that same mentorship, of those same programs?
Moreover, in a time where LGBTQ+ community continues to face significant health disparities, and where 40% of transgender individuals attempt suicide, it is more important than ever that medicine is made more diverse by the inclusion of LGBTQ+ individuals. LGBTQ+ patients desperately deserve the empathetic understanding of a LGBTQ+ physician. Furthermore, it is imperative that efforts to do so be deliberate and in the same vein as the numerous opportunities available to support AAMC-defined URiM students along their path to physicianhood.
The same argument can be made for other groups who are underrepresented in the physician workforce but are excluded from URiM classification, such as individuals with disabilities. According to the U.S. Census Bureau, around 13% of the civilian noninstitutionalized population has a disability; yet, the prevalence of physicians with disabilities is estimated at only 3%. Much evidence exists about the long-standing history of ableism in medicine and the numerous health disparities that people with disabilities face. We need more physicians with disabilities. The same question can be asked: Are these students not deserving of the same mentorship, of those same programs, as well?
We could continue to expand this discussion with mention of medical students who are immigrants, first-generation college students, so on and so forth.
With this, we humbly ask that the AAMC Executive Committee reflect on what the word “underrepresented” truly means–how the current URiM definition gatekeeps–and consider modification of the definition to be more inclusive of groups of individuals who are also minoritized in medicine.
Mel Ebeling is a medical student. Cortlyn Brown is an emergency physician.