A newly published study from researchers at Yale University and New York University reveals that medical students who identify as lesbian, gay, or bisexual (LGB) are significantly more likely to drop out of medical school than their heterosexual peers. The findings raise concerns about persistent inequities in medical education and the challenges facing students with marginalized identities.
The study, published in JAMA Network Open, analyzed data from 45,296 students who matriculated at U.S. medical schools between 2014 and 2017. Researchers found that 2.5% of all students left medical school during that time, but LGB students faced notably higher rates of attrition. Bisexual students experienced the highest rate—4.2%—with an adjusted odds ratio (AOR) of 1.99 compared to non-LGB peers. Gay and lesbian students had a 3.7% attrition rate (AOR of 1.47) versus 2.4% among those who were non-LGB.
Although the specific reasoning for the attrition for the attrition is undetermined in the study, the researchers cite other works that suggest discrimination may play a role.
“The findings highlight the importance of intersectionality in understanding attrition from medical school,” the authors wrote. “Although future studies need to examine the cause of these disparities in attrition, LGB students experience discrimination within medical training environments, which may lead to risk of attrition.”
Attrition disparities extended across racial and ethnic lines as well. Black and Hispanic students each had attrition rates of 4.7%, significantly higher than the 2.0% rate for white students. Adjusted odds ratios for Black and Hispanic students were 1.42 and 1.53, respectively.
The analysis also uncovered stark differences when identities intersect. Among the most vulnerable were LGB Hispanic students—both male and female—with the highest risk of leaving school. LGB Hispanic female students had an AOR of 3.52, and males had an AOR of 3.11, compared to an AOR of 1 among non-LGB white males. In contrast, non-LGB Asian, Black, and Hispanic males also had elevated odds of attrition, as did LGB white females.
Researchers used multivariable logistic regression to control for factors such as age, MCAT scores, and undergraduate GPA, ensuring that disparities were not simply the result of academic differences.
The study posits that cultural and social factors may play a significant role in the higher attrition rates among Hispanic LGB students in particular. The authors noted that “members of both the LGB and Hispanic communities may encounter less supportive attitudes toward homosexuality,” particularly among recent immigrants or within traditional family structures. “Trends in medical education have not explicitly included Hispanic-specific discrimination issues, inadvertently reducing social support for Hispanic students,” they added.
While the research offers crucial data on attrition, it also acknowledges limitations. Sexual orientation data was self-reported, and the study could not assess outcomes for students with other marginalized identities, such as transgender or pansexual. Furthermore, attrition was more common among those who did not respond to the survey, suggesting disengagement itself may be a risk factor.
As calls to diversify the physician workforce continue, the findings underscore the need for more inclusive, culturally responsive support systems in medical education. Without addressing the unique challenges faced by LGB and racial minority students, the medical profession may continue to lose talented individuals who could serve increasingly diverse patient populations.
