Asking about LGBTQ+ identity on secondary application

[RugbyPlayer456]

Hi everyone! I'm a current M1 working with our LGBTQ+ student group and some faculty on revamping our secondary app. For the first time last year we asked about LGBTQ+ identities (1 q about sexual orientation, another about gender identity), both with several options (I don't know specifics, but fairly limited options - I think sexuality just had gay, lesbian, bisexual, straight), "other", and "Prefer not to answer". If people selected a sexual or gender minority answer or "other", another box popped up asking something like, "Would you like us to email you more information on the resources available here?" Next year, we are trying hard to provide a disclaimer as to *why* we ask, to clear up any confusion and maybe quell some fears about being honest. But in talking about it, we realized that many applicants (myself included) do not see themselves reflected in the options we gave. So for that reason, we want to change the question for next year to be more inclusive.
Here is why we ask the question:

• General demographics
• To see how LGBTQ+ applicants are progressing through the admissions cycle (e.g., how many are invited for interview? How many ) to identify gaps, & to better recruit/support LGBTQ+ folks during the cycle
• To provide more info about resources (including to extend an invitation to meet with a current LGBTQ+ student for coffee during the interview, should you be offered one, as well as LGBTQ+-related events during our Second Look-type event)
• To signal that we are an institution that encourages individuals to be honest about who they are, and one that supports the LGBTQ+ community (and I believe we are such an institution - with lots of active groups for students and faculty, great health insurance that covers gender-affirming interventions, many faculty and providers at our affiliated hospital offering those gender-affirming interventions, explicit employment and discrimination protections, LGBTQ+ and trans health clinics, etc.)

We do NOT ask it to:

• Provide automatic interview or acceptance if you're gay
• I don't even think interviewers are privy to this information

We toyed with the idea of just having a basic question like, "Do you identify as a gender or sexual minority?" But then, we wouldn't be able to get specific about cycle tracking (e.g., Are trans folks being treated unfairly in the process? Are gay men more likely than queer women to be accepted, but less likely to come?) which is one of the main goals of asking it. We are also not crazy about the idea of offering 20 million options, because it will *still* leave out some people and probably just dilute the data to such small N's that it would render it meaningless.
Given that info, how would you prefer this question to be asked on a secondary application? Thoughts?
Thank you!

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[deleted972488]

I'm pretty sure I know which school this is by context and y'all are doing a great job as is.

If you want something more open-ended and potentially more inclusive, you could adapt one of Duke's secondary questions (and make it optional):

"Tell us more about who you are. You may provide additional information that expands your self-identity where gender identification, racial and/or ethnic self description, geographic origin, socioeconomic, academic, and/or other characteristics that define who you are as you contemplate a career that will interface with people who are similar AND dissimilar to you. You will have the opportunity below to tell us how you wish to be addressed, recognized and treated."

 

[deleted1001426]

I like the idea of the disclaimer. Without context to why it was being asked I found the question to be a bit intrusive. I think additional info would have made a lot of people more comfortable with answering honestly instead of defaulting to "prefer not to answer".

 

[Matthew9Thirtyfive]

I like the idea of the disclaimer. Without context to why it was being asked I found the question to be a bit intrusive. I think additional info would have made a lot of people more comfortable with answering honestly instead of defaulting to "prefer not to answer".

Agreed. I know people who have opted out of answering class surveys because they asked questions like this and they didn’t feel like they could be honest since they would probably be easily identified.

 

[TwoHighways]

Why is it even a relevant question to begin with? My doctor could identify as an extraterrestrial, but if (insert appropriate pronoun) is a good physician, I wouldn’t care in the slightest if they were charged with my care or the care of anyone I loved.

 

[valkirieas]

Why is it even a relevant question to begin with? My doctor could identify as an extraterrestrial, but if (insert appropriate pronoun) is a good physician, I wouldn’t care in the slightest if they were charged with my care or the care of anyone I loved.

it's relevant because LGBT people still face discrimination. even though, like you said, it has no bearing on their abilities as a physician. and it sounds like op wants to be able to gather data on outcomes for members of the community and to also connect them with the appropriate resources.

I think that asking the same questions you have already and just having an open ended text box instead of multiple choice would probably be beneficial. And also definitely agree the disclaimer is almost needed for anyone to offer up honest information

 

[hydrophobicmed]

Why is it even a relevant question to begin with? My doctor could identify as an extraterrestrial, but if (insert appropriate pronoun) is a good physician, I wouldn’t care in the slightest if they were charged with my care or the care of anyone I loved.

well, it's relevant because if you try to find a gay or gay friendly primary care in a suburban area, you are not likely to find any.

 

[Matthew9Thirtyfive]

well, it's relevant because if you try to find a gay or gay friendly primary care in a suburban area, you are not likely to find any.

Depends on the area I guess. Every place I’ve lived there have been plenty. Now whether or not they are knowledgeable on the unique health issues the community faces is another question.

 

[hydrophobicmed]

Depends on the area I guess. Every place I’ve lived there have been plenty. Now whether or not they are knowledgeable on the unique health issues the community faces is another question.

outside major metropolitan areas, even let's say 30 miles out, it gets exceedingly difficult.

 

[deleted1001426]

well, it's relevant because if you try to find a gay or gay friendly primary care in a suburban area, you are not likely to find any.

idk about you but I'm yet to meet a single person who plans on advertising themselves as "insert sexuality" doctor..I understand why schools might want this info but imo you should never share that level of personal details with patients.

 

[hydrophobicmed]

idk about you but I'm yet to meet a single person who plans on advertising themselves as "insert sexuality" doctor..I understand why schools might want this info but imo you should never share that level of personal details with patients.

It's not about advertising your own sexual orientation. but when we select a primary online, say at blue cross, we can search based on race, language, gender and yada yada of a doctor. I am wondering why we can't have sexual orientation or LGBT-friendliness or knowledgeable in the search option.

 

[Matthew9Thirtyfive]

outside major metropolitan areas, even let's say 30 miles out, it gets exceedingly difficult.

I mean I’ve lived in places like that for most of my life all over the country. But like I said, being gay friendly doesn’t mean you’re aware of the health issues unique to the community.

 

[hydrophobicmed]

I mean I’ve lived in places like that for most of my life all over the country. But like I said, being gay friendly doesn’t mean you’re aware of the health issues unique to the community.

completely agree with you, therefore many schools where I interviewed emphasized the fact the label itself without community involvement is meaningless. Being LGBT alone should not get you preferential treatment, but being LGBT and active in the community should signal that you are committed to the URM group.

 

[deleted1001426]

It's not about advertising your own sexual orientation. but when we select a primary online, say at blue cross, we can search based on race, language, gender and yada yada of a doctor. I am wondering why we can't have sexual orientation or LGBT-friendliness or knowledgeable in the search option.

I'm all for being able to filter by lgbt friendliness but I am completely against them being able to filter by physicians sexual orientation...all that would do is provide unnecessary personal info to pts and likely cause many people to not see said lgbt physicians

 

[hydrophobicmed]

I'm all for being able to filter by lgbt friendliness but I am completely against them being able to filter by physicians sexual orientation...all that would do is provide unnecessary personal info to pts and likely cause many people to not see said lgbt physicians

that's a very good point. We don't need to volunteer that info at the risk of being discriminated against.

 

[SaraTonin_15]

Given that info, how would you prefer this question to be asked on a secondary application? Thoughts?
Thank you!

I love that you are taking the time to ask these questions, even if it is just to get information. LGBTQ+ representation and healthcare was a big part of my med school journey and it really made me feel heard/ seen when I saw questions asking about this stuff on secondaries. I definitely think you should include it. The context of why could be added at the beginning and then nested questions based on previous answers. That way you aren’t asking one specific applicant 10000 questions, but you are creating groups/ categories for your analysis.


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[SaraTonin_15]

idk about you but I'm yet to meet a single person who plans on advertising themselves as "insert sexuality" doctor..I understand why schools might want this info but imo you should never share that level of personal details with patients.

I actually work with a primary care physician who specializes in LGBTQ+ care and providing resources to those who can’t afford them (aka family issues or other). For me, it is also about representation. I know I did not have a ton of LGBTQ+ representation growing up, and my family said specifically that gay men should not be doctors because they’re “pedophiles.” It is important for some of us to help our community as well as fight against the stigma that has been build up for years.

 

[Goro]

We toyed with the idea of just having a basic question like, "Do you identify as a gender or sexual minority?" But then, we wouldn't be able to get specific about cycle tracking (e.g., Are trans folks being treated unfairly in the process? Are gay men more likely than queer women to be accepted, but less likely to come?) which is one of the main goals of asking it. We are also not crazy about the idea of offering 20 million options, because it will *still* leave out some people and probably just dilute the data to such small N's that it would render it meaningless.
Given that info, how would you prefer this question to be asked on a secondary application? Thoughts?
Thank you!

I think that if you try to be all inclusive and capture every possible letter of the sexual minorities, you'll end up with an app that's 60 pages long.

Thus, your bolded question is the simplest and most elegant way of asking the question. Stop worrying about if someone will feel excluded...that's getting into a caricature of what Fox News thinks of people on the left

As an aside, be forewarned that people will see this as a way to game the admissions system, despite your qualifier. Therefore, be on the lookout for people who actually volunteer with and for sexual minorities. Make sure they walk the walk and don't merely talk the talk.

 

[deleted480308]

You need to know if interviewers see the info, “think” they don’t isn’t good enough

 

[Sagebrush]

Absolutely explain upfront why you want the information. I hated outing myself on the secondaries that asked about it, but I felt better if it was explained very clearly that this was only so that we could get connected with the appropriate student groups. In terms of how to structure the question, I would suggest having checkboxes (with the option to mark multiple) for cis male/female, trans male/female, gender non-binary, gay/lesbian/bisexual, other (with option to fill in the blank). This will let you group data in meaningful ways (so vs having a list of every possible iteration and only allowing people to choose one, where you're likely to not have a broad dataset for "gender non-binary pansexual", you can choose to group all people who identify as gay together, or break it out based on trans or cis identification, etc)... I also don't feel like this is an obscenely long list, so it would still be manageable for a secondary.

EDIT: Maybe add straight to the options for sexual orientation. Apparently I forgot that straight people exist while I was typing this out

 

[TwoHighways]

What constitutes “gay friendly” primary care? Does one need to be a homosexual to treat a homosexual with the respect and dignity they deserve as a human being? As a percentage of the US population, how many identify as LGBTQ versus the percentage of physicians that identify as LGBTQ?

 

[deleted972488]

As a percentage of the US population, how many identify as LGBTQ versus the percentage of physicians that identify as LGBTQ?

Why is it even a relevant question to begin with?

That’s part of why these questions are relevant.

 

[TwoHighways]

That’s part of why these questions are relevant.

Why do we have to classify everything and divide people into all of these different subgroups? At what point does it stop?

 

[Sagebrush]

Why do we have to classify everything and divide people into all of these different subgroups? At what point does it stop?

Because it DOES affect patient outcomes to have physicians with similar values/backgrounds, believe it or not.

Crazy, I know. When someone knows where you're coming from they may have a better idea of how to work with you.

Basically, your comments are the exact reason that it is important.

 

[deleted927529]

Echoing other concerns I answered these questions very carefully (i.e. lied) out of fear of discrimination.

The GSM question is fine. Maybe you can send applicants a survey link separate from the admissions process? Something on the portal that isn't part of the application.

 

[Angus Avagadro]

I apologize for my ignorance.I know very little about this. I dont think employers are allowed to ask these kinds of questions. Are you at risk of being subject to complaints if you ask them?

 

[LizzyM]

Imagine if we had specialists such as OB-GYNs who were unwilling to provide services to lesbian couples who were attempting pregnancy or after pregnancy had been achieved.

 

[SaraTonin_15]

What constitutes “gay friendly” primary care? Does one need to be a homosexual to treat a homosexual with the respect and dignity they deserve as a human being? As a percentage of the US population, how many identify as LGBTQ versus the percentage of physicians that identify as LGBTQ?

Primary care that can provide HIV drugs and related symptom treatments, hormone therapy, and other health services that are relative to the sensitive LGBTQ+ population. HIV drugs are unaffordable without insurance. Many transgender people feel they cannot afford or even safely obtain hormone treatment without judgement. It is important EVERY physician knows these health risks, but it is important there are community oriented practices that make people feel safe and understood. One definitely doesn't need to identify as LGBTQ+ to be considered an ally, but it is important from a representation and community outreach stance.

 

[Sagebrush]

Imagine if we had specialists such as OB-GYNs who were unwilling to provide services to lesbian couples who were attempting pregnancy or after pregnancy had been achieved.

Forget specialists, I worked for an IM physician who refused to address sexual health with gay patients - education, STD screenings, PrEP, viagra/cialis prescriptions, you name it. Sexual health concerns did not exist for that group of patients.

 

[TwoHighways]

Because it DOES affect patient outcomes to have physicians with similar values/backgrounds, believe it or not.

Crazy, I know. When someone knows where you're coming from they may have a better idea of how to work with you.

Basically, your comments are the exact reason that it is important.

I’d venture to say that socioeconomic status has more to do with how well you relate to patients than any other factor.

Imagine if we had specialists such as OB-GYNs who were unwilling to provide services to lesbian couples who were attempting pregnancy or after pregnancy had been achieved.

Is this actually a thing, and if so, how frequently does it happen? Do you know of anyone in your extended social network of physicians that would turn away a gay patient? Follow up question. Would you want to force a bigoted physician to care for patients that they didn’t approve of? If I were a homosexual, would I want to be treated by a physician that was a bigot?

 

[Sagebrush]

I’d venture to say that socioeconomic status has more to do with how well you relate to patients than any other factor.


Is this actually a thing, and if so, how frequently does it happen? Do you know of anyone in your extended social network of physicians that would turn away a gay patient? Follow up question. Would you want to force a bigoted physician to care for patients that they didn’t approve of? If I were a homosexual, would I want to be treated by a physician that was a bigot?

You can venture to say whatever you like. That doesn't make it true.

See my reply to @LizzyM. It is a thing that happens.

I'm curious why you find it so upsetting that this question be asked on a secondary to allow applicants to voluntarily respond. What harm/potential harm do you see this question causing?

 

[Matthew9Thirtyfive]

I’d venture to say that socioeconomic status has more to do with how well you relate to patients than any other factor.

I used to play music professionally in New York for a few years. There is a huge transgender (and just lgbt in general) community up there for obvious reasons. I lived with a couple transgendered musicians and played with some more, so I have seen first hand what their healthcare struggles are. They have huge issues getting quality healthcare because most physicians are not well versed in their healthcare needs and the issues that are unique to that patient population. There are some clinics that advertise themselves as knowledgeable, and that is where some people go if they can afford it or make it. The ones who can’t have to go to free clinics near them where they may or may not get proper preventive care either because the providers don’t know or discriminate against them (which happens a lot even in NY).

So yeah, it is a thing.

Edit: and yes, SES can play a factor, but even when that is not an issue, the above still occurs.

 

[TwoHighways]

You can venture to say whatever you like. That doesn't make it true.

See my reply to @LizzyM. It is a thing that happens.

I'm curious why you find it so upsetting that this question be asked on a secondary to allow applicants to voluntarily respond. What harm/potential harm do you see this question causing?

It’s the premise. I don’t subscribe to the idea that we need to divide ourselves into all of these categories. I don’t think it’s even a polite thing to ask. I mean, how often do you ask someone’s gender or sexual orientation in day to day conversation? Oh, and pathology doesn’t care how you identify.

 

[Sagebrush]

It’s the premise. I don’t subscribe to the idea that we need to divide ourselves into all of these categories. I don’t think it’s even a polite thing to ask. And pathology doesn’t care how you identify.

The beauty of the question in this case is that applicants are not required to complete it, ergo if they find it distasteful as you do, they can ignore it.

Pathology may not care how you identify, but there's a ****load more to medicine than pathology.

If you do not feel that such questions are appropriate, decline to answer them. For those of us who do not feel that way, it's nice to be able to gather data on representation and get connected to others who may share experiences with us.

 

[Matthew9Thirtyfive]

Oh, and pathology doesn’t care how you identify.

Pathology doesn’t care how you identify, but if you miss an ectopic because a patient identifies as male and is actually an FTM and looks like a cis-gendered male, then that pathology won’t care and will still kill that patient. Oh, and that is from an actual case.

 

[TwoHighways]

Pathology doesn’t care how you identify, but if you miss an ectopic because a patient identifies as male and is actually an FTM and looks like a cis-gendered male, then that pathology won’t care and will still kill that patient. Oh, and that is from an actual case.

That’s on the patient just as much as it was on the physician. At the very least, the patient should have identified as being transgendered. I can’t imagine the civil liability a physician would take on in this political climate by questioning the gender of their patient that has identified as a male but had a vagina. It wouldn’t occur to me to ask a male patient if he had a vagina or could possibly be pregnant.

 

[Sagebrush]

That’s on the patient just as much as it was on the physician. I can’t imagine the civil liability a physician would take on in this political climate by questioning the gender of their patient that has identified as a male but had a vagina.

The fact that you can't understand why your comment is so wrong is a testament to how much we need to ensure that LGBTQ+ -friendly healthcare is available to all patients and that LGBTQ+ individuals are represented in medicine to share their experiences.

You seem to think you're doing the LGBTQ+ community a favor by being indignant for us regarding this questioning on secondaries. You're not.

 

[TwoHighways]

The fact that you can't understand why your comment is so wrong is a testament to how much we need to ensure that LGBTQ+ -friendly healthcare is available to all patients and that LGBTQ+ individuals are represented in medicine to share their experiences.

You seem to think you're doing the LGBTQ+ community a favor by being indignant for us regarding this questioning on secondaries. You're not.

I’m simply asking questions and sharing my thoughts. I never claimed to be speaking for anyone else.

 

[Sagebrush]

I’m simply asking questions and sharing my thoughts. I never claimed to be speaking for anyone else.

Great, if you're not speaking for anyone else, then surely you understand that you're the only person in this thread who has expressed concern with this question being asked, and that this may indicate a need for some self-reflection as to why you're so strongly opposed when others see it as a non-issue.

 

[deleted480308]

Great, if you're not speaking for anyone else, then surely you understand that you're the only person in this thread who has expressed concern with this question being asked, and that this may indicate a need for some self-reflection as to why you're so strongly opposed when others see it as a non-issue.

actually, I had concerns too. You don't even know who gets to see the information. That's a problem

 

[Sagebrush]

actually, I had concerns too. You don't even know who gets to see the information. That's a problem

Fair enough, I had interpreted your concern as being centered around who gets access rather than asking the question in the first place, but of course I could have misinterpreted!

 

[Matthew9Thirtyfive]

That’s on the patient just as much as it was on the physician. At the very least, the patient should have identified as being transgendered. I can’t imagine the civil liability a physician would take on in this political climate by questioning the gender of their patient that has identified as a male but had a vagina. It wouldn’t occur to me to ask a male patient if he had a vagina or could possibly be pregnant.

That’s exactly the point, and it’s kind of scary that you don’t recognize it.

 

[Matthew9Thirtyfive]

actually, I had concerns too. You don't even know who gets to see the information. That's a problem

That’s a different issue with this whole thing, and I agree with you there.

 

[TwoHighways]

Great, if you're not speaking for anyone else, then surely you understand that you're the only person in this thread who has expressed concern with this question being asked, and that this may indicate a need for some self-reflection as to why you're so strongly opposed when others see it as a non-issue.

The question is based on a what I feel is a faulty premise and that’s why I’ve voiced my objections. My identity is not tied up into my gender or sexual orientation. I choose to be defined by my ambitions, character, passions, and my desire to care for others in all walks of life.

 

[TwoHighways]

That’s exactly the point, and it’s kind of scary that you don’t recognize it.

The difference between sex and gender. Admittedly boneheaded on my part.

 

[Matthew9Thirtyfive]

The difference between sex and gender. Admittedly boneheaded on my part.

I actually don’t think the question is great for a secondary unless they can guarantee that adcoms don’t see it. If they can guarantee adcoms don’t see it AND it’s a non-mandatory question, I wouldn’t have a problem with it.

 

[Sagebrush]

The question is based on a what I feel is a faulty premise and that’s why I’ve voiced my objections. My identity is not tied up into my gender or sexual orientation. I choose to be defined by my ambitions, character, passions, and my desire to care for others in all walks of life.

The point of the question isn't to generate some all-encompassing identity for LGBTQ+ applicants. It's to (if they wish to share) allow applicants to provide insight into a small piece of who they are that may or may not represent an important contribution to their class, as well as allowing them to connect with other people with whom they may share some common experiences. I don't think anyone has tried to claim that this question somehow sums up the entirety of someone's identity.

 

[LizzyM]

It’s the premise. I don’t subscribe to the idea that we need to divide ourselves into all of these categories. I don’t think it’s even a polite thing to ask. I mean, how often do you ask someone’s gender or sexual orientation in day to day conversation? Oh, and pathology doesn’t care how you identify.

Physicians can advertise their specialties and their areas of interest. Some physicians or group practices/clinics interested in serving the LGBTQI community may advertise in publications specific to that community or in places frequented by that population. They may be engaged in LGBTQI community groups and thus become known to others in the community. It is similar to wanting to find a doctor who speaks your mother tongue rather than imperfectly communicating with a doctor in English or needing to use an interpreter. People would like to find a doctor who will understand their way of life and they will seek them out.

In some ways, it is similar to racial/ethnic minorities wanting to see physicians (and other professionals, such as lawyers and judges) who look like them.

 

[sm96]

The question is based on a what I feel is a faulty premise and that’s why I’ve voiced my objections. My identity is not tied up into my gender or sexual orientation. I choose to be defined by my ambitions, character, passions, and my desire to care for others in all walks of life.

I won't assume anything about your own sexual orientation but its a huge luxury to be able to NOT have your identity tied up into your gender or sexual orientation. For many LGBT people, their gender/sexual identity determines a lot about their life whether their like it or not (ex. social + financial support being withdrawn by unsupportive family, or disproportionate violence against trans women of color) <- imagine living in one of these situations and trying to not let your gender/sexual orientation get "tied up" in your identity...

 

[deleted1001426]

I actually don’t think the question is great for a secondary unless they can guarantee that adcoms don’t see it. If they can guarantee adcoms don’t see it AND it’s a non-mandatory question, I wouldn’t have a problem with it.

Something just irks me about filling out an app which details the sum total of all of my accomplishments and all of the events which helped to shape me into the person I am today, only to go to the last page where you’re essentially asked “after a few too many margaritas who do you bring home”, albeit in a more elegant manner