Introduction: Program diversity impacts rank-list creation for emergency medicine (EM)-bound applicants, but how lesbian, gay, bisexual, transgender, queer or questioning, intersex, asexual, and other sexual and gender minorities (LGBTQIA+) identities influence residency selection is unknown. This study investigates general patterns in EM applicant LGBTQIA+ identities, disclosure of those identities, and how LGBTQIA+ factors impact residency selection. Additionally, we present data exploring the relationship between medical school location and the location of top-ranked programs for LGBTQIA+ and non-LGBTQIA+ identifying applicants.
\nMethods: We surveyed 2,287 EM-bound United States MD/DO applicants who applied to one of five author EM programs and programs affiliated with the Emergency Medicine Education Research Alliance from May 16–June 30, 2024. The survey included multiple-choice, free-text, and Likert scale questions. Data were explored with descriptive statistics, and we used chi-square and Fisher exact tests to compare differences in proportions. We also analyzed applicants’ medical school state and a graphical representation of the top three positions on their residency rank lists, using inverse-proportional weighting.
\nResults: Of 445 respondents (19.4%), 59 (13.3%) identified as LGBTQIA+. Gender identities included 173 cisgender men (38.9%), 254 cisgender women (57.1%), one transgender man (0.2%), one transgender woman (0.2%), four non-binary (0.9%), one genderqueer (0.2%), and seven “preferred not to answer” (1.6%). Among LGBTQIA+ respondents, seven (11.9%) disclosed their status within the application, nine (15.3%) during the interview, 18 (30.5%) in both, and 25 (42.4%) did not disclose. Among 56 respondents, 36 (64.3%) supported adding LGBTQIA+ status to the residency application; 20 (35.7%) did not. Of the program factors considered, program diversity (91.1%) and commitment to underserved communities (96.4%) were significantly more important for LGBTQIA+ respondents (P < .01), while proximity to partner(s) (64.3%; P < .01) and program length (66.1%; P = .02) were significantly less important compared with non-LGBTQIA+ respondents. Additional factors that influenced LGBTQIA+ applicants’ rank list included political environment, friendliness of the learning environment, and presence/absence of anti-LGBTQIA+ laws.
\nConclusion: Many LGBTQIA+ applicants do not disclose their identities when applying for residency. LGBTQIA+ respondents value program diversity and commitment to underserved communities, and they consider LGBTQIA+-specific factors such as the presence of anti-LGBTQIA+ legislation. These insights can inform residency programs and recruitment practices.
","language":"eng","license":{"name":"Creative Commons Attribution 4.0","short_name":"CC BY 4.0","text":"Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.","url":"https://creativecommons.org/licenses/by/4.0"},"keywords":[],"section":"Emergency Medicine Workforce","is_remote":true,"remote_url":"https://escholarship.org/uc/item/561893ht","frozenauthors":[{"first_name":"Kayla","middle_name":"","last_name":"Iuliucci","name_suffix":"","institution":"Johns Hopkins University School of Medicine, Department of Emergency Medicine, Baltimore, Maryland","department":""},{"first_name":"Lea","middle_name":"","last_name":"Moujaes","name_suffix":"","institution":"Johns Hopkins University School of Medicine, Department of Emergency Medicine, Baltimore, Maryland","department":""},{"first_name":"David","middle_name":"","last_name":"Rudolph","name_suffix":"","institution":"Johns Hopkins University School of Medicine, Department of Emergency Medicine, Baltimore, Maryland","department":""},{"first_name":"Peter","middle_name":"","last_name":"Fredericks","name_suffix":"","institution":"Johns Hopkins University School of Medicine, Department of Emergency Medicine, Baltimore, Maryland","department":""},{"first_name":"Blake","middle_name":"","last_name":"Denley","name_suffix":"","institution":"Ochsner Health, Department of Emergency Medicine, New Orleans, Louisiana","department":""},{"first_name":"Samuel","middle_name":"","last_name":"Paskin","name_suffix":"","institution":"Larner College of Medicine at the University of Vermont, Department of Emergency Medicine, Burlington, Vermont","department":""},{"first_name":"Arlene","middle_name":"","last_name":"Chung","name_suffix":"","institution":"Larner College of Medicine at the University of Vermont, Department of Emergency Medicine, Burlington, Vermont","department":""},{"first_name":"Jaime","middle_name":"","last_name":"Jordan","name_suffix":"","institution":"Oregon Health & Science University, Department of Emergency Medicine, Portland, Oregon","department":""},{"first_name":"Edgardo","middle_name":"","last_name":"Ordonez","name_suffix":"","institution":"Baylor College of Medicine, Department of Emergency Medicine, Houston, Texas","department":""},{"first_name":"Laura","middle_name":"","last_name":"Smylie","name_suffix":"","institution":"Wayne State University School of Medicine, Department of Emergency Medicine, Detroit, Michigan","department":""},{"first_name":"Simiao","middle_name":"","last_name":"Li-Sauerwine","name_suffix":"","institution":"The Ohio State University College of Medicine, Department of Emergency Medicine, Columbus, Ohio","department":""},{"first_name":"P. Logan","middle_name":"","last_name":"Weygandt","name_suffix":"","institution":"Johns Hopkins University School of Medicine, Department of Emergency Medicine, Baltimore, Maryland","department":""}],"date_submitted":"2025-08-08T19:34:08.073000Z","date_accepted":"2026-01-24T17:10:33.915000Z","date_published":"2026-05-18T11:35:00Z","render_galley":null,"galleys":[{"label":"PDF","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/50598/galley/50424/download/"}]}