Creating an Inclusive Surgical Community: Association of Out Surgeons & Allies

When I was asked to write a piece describing who the Association of Out Surgeons & Allies (AOSA https://www.outsurgeons.org/) is for the Association of Women Surgeons (AWS) blog, I paused. I hesitated because the answer seemed so simple, but complex. Members of AOSA are your: fellow surgeons, patients, mothers, fathers, sisters, brothers, and friends. We represent an often overlooked minority group that faces discrimination for our lesbian, gay, bisexual, transgender, queer (LGBTQ+) identities but also cumulatively experience gender discrimination, sexual harassment and encounter unique vulnerabilities within healthcare. Many of us belong to more than one marginalized group, and most have encountered discrimination throughout our lives, during surgical training, and in our careers.

The AOSA is a group of LGBTQ+ surgeons and LGBTQ+ allies of our community, who are connected to support one another and to try to close the existing knowledge and discrimination gap. The need for such an organization has been apparent for years but even today some of our members feel a strong need for anonymity. In 1998 one of the first surveys of physician attitudes toward gay and lesbian medical students, house officers, and colleagues was published and it revealed the difficulties such individuals faced within healthcare.1 One-thousand-forty-five practicing physicians in New Mexico were polled and found that 16.2% were opposed to gay and lesbians seeking training in surgery and 10.1% objected to OB/Gyn training.1 It wasn’t until 2014 that surgery residents were surveyed about their attitudes and perceptions of sexual orientation during the training experience2. Of the 388 general surgery residents studied, 11% identified as LGBTQ, but 1/3 kept their sexual orientation secret during residency. The same study reported that more than half of LGTBQ+ residents reported witnessing or experiencing homophobic remarks during their training, that 54% concealed their sexual orientation from attendings, and 42% were uncomfortable bringing their spouse/partner to departmental events.2

Workplace and training discrimination are not the only problems faced by LGBTQ+ surgeons. In the same year of 1998 that the first survey of physician attitudes was published, the horrific anti-gay hate crimes occurred in Laramie, Wyoming, the most notable being the assault and murder of Matthew Shepard. Violent anti-gay crimes increased over the next ten years until 2009, when the Matthew Shepard and James Byrd Jr. Hate Crimes Prevention Act was passed in order to limit biased crimes directed at the LGBTQ+ community. It was only 8 years ago, in 2015, that the US Supreme Court ruled that the Constitution guaranteed the right to same-sex marriage, thus opening the door of opportunity for the LGBTQ+ community to advocate for equality. 

In 2021, nearly 5.6% of the overall US population identified as members of the LGBTQ+ community, with a much greater proportion among generation Z (15.9%) and Millennials (9.1%).3  While the numbers in the US grow, surgery has maintained a conservative culture and work environment, thus driving many to continue to conceal their sexuality. A survey distributed in 2019 to 6381 general surgery residents taking the American Board of Surgery In-service Examination showed that 305 respondents (4.8%) identified as LGBTQ+. Of the 305 LGBTQ+ participants, 191 (62.6%) identified as gay or lesbian, 98 (32.1%) as bisexual, 15 (4.9%) as other sexual orientation, and 16 (5.3%) as transgender or other gender identity. Highlights from this study showed the greatest prevalence of LGBTQ+ residents were in the Northeast and the West. These surgery residents also reported experiencing greater mistreatment and discrimination based on gender, gender identity, or sexual orientation, as well as harassment and bullying, with the highest incidence being noted by female residents.4 Although statistics like the 2020 census suggest we are taking steps forward, the pendulum has recently swung in the other direction. Violence towards the LGBTQ+ community continues to increase. During 2022, more than 240 anti-LGBTQ+ bills were filed nationwide. Today, a total of 413 anti-LGBTQ+ bills exist, and while many will not pass into law, they pose harm to persons of all ages. The need for our organization is apparent and undoubtedly long overdue. We founded AOSA to be a place of acceptance that fosters open communication and learning while providing education and collaboration to promote inclusion among students, residents and attendings. Surgery needed to have a welcoming place where surgeons could be themselves and AOSA is that place for LGBTQ+ surgeons and allies. We are confident that the AOSA community will find innovative ways to educate and support the surgical community and work towards achieving a safer, more inclusive, society. (https://www.outsurgeons.org/join-aosa)

References 

1. Ramos M.M., Tellez C.M., Palley T.B., Umland B.E., Skipper B.J.: Attitudes of physicians practicing in New Mexico toward gay men and lesbians in the profession. Acad Med 1998; 73: pp. 436-438.
2. Lee K.P., Kelz R.R., Dubé B., Morris J.B.: Attitude and perceptions of the other underrepresented minority in surgery. J Surg Educ 2014; 71: pp. e47-e52.
3. LGBT identification rises to 5.6% in latest U.S estimate. GALLUP® https://news.gallup.com/poll/329708/lgbt-identification-rises-latest-estimate.aspx
4. Heiderscheit E.A., Schlick C.J.R., Ellis R.J., et. al.: Experiences of LGBTQ+ residents in US general surgery training programs. JAMA Surg 2022; 157: pp. 23-32.

 

Dr. Moren is a Trauma, Critical Care & Acute Care Surgeon at Salem Health in Salem, Oregon and an Assistant Professor of Surgery at Oregon Health & Science University. Dr. Moren received her fellowship training in Trauma & Critical Care at the University of Pennsylvania. She completed her General Surgery Residency at Oregon Health & Science University and received her MD/MPH from St. George’s University in Grenada, West Indies.

Her interests include Violence and Injury Prevention, Trauma Informed Care, massive transfusion, global health and creating a more equitable and inclusive environment in the surgical setting. She enjoys traveling and learning about other cultures as she strives to understand health disparities throughout the world. She is a founding member of the Association for Out Surgeon’s and Allies. When not working she spends her time exploring the outdoors with her family of 3 kids, 4 dogs and a cat.