LGBTQIA+ Residents: Pride, Policy, and Burnout

What We Face When DEI Disappears

By Shereese Maynard and Loren Deutsch

Recent legislative environment changes in the U.S. have put LGBTQIA+ medical Residents in a precarious position. Across several states, dismantling Diversity, Equity, and Inclusion (DEI) programs, especially those tied to federal or state funding, has removed once-reliable institutional safety nets. According to a 2024 study published by NIH, LGBTQIA+ trainees report higher rates of mistreatment, isolation, and attrition in medical education than their cisgender, heterosexual peers. Without DEI-backed mentorship, many find themselves vulnerable and unsupported during the most demanding years of their careers.

So, what happens when you strip away systemic support but still expect peak performance? You either watch your residents sink or introduce alternatives that let them swim.

The Systemic Squeeze: When Policy Becomes Personal

Let’s start with the obvious: medical training is a high-pressure experience, and with the added weight of discriminatory laws and vanishing institutional allies, LGBTQIA+ Residents not only have to navigate pre-rounding and rounds, they have to determine who it is safe to be around.

Systemic Pressures:

• Loss of formal affinity groups: With DEI programs being defunded, LGBTQIA+ affinity spaces often vanish. These were once places for advocacy, community-building, and accessing career guidance.
• Hostile legislative climates: States that pass anti-LGBTQIA+ laws often see trickle-down effects within healthcare institutions. Even if hospital policies remain inclusive, community culture influences workplace dynamics.
• Bias in patient care assignments: Anecdotal reports and internal surveys show LGBTQIA+ Residents sometimes receive fewer procedural opportunities or are misgendered by patients, with little recourse for reporting.

Pro tip: If your institution operates in a DEI-hostile state, create a “Code of Safety” agreement for departments to voluntarily support LGBTQIA+ faculty and staff through alternate channels (anonymous reporting, peer mentors, private check-ins).

The Personal Toll: Isolation, Burnout, and Identity Suppression

The erosion of institutional protection leads to more than a professional disadvantage. It chips away at self-worth. Many LGBTQIA+ Residents begin self-editing to “fit in”, but that comes at a psychological cost.

Common Challenges Include: 

• Identity-based discrimination: Misgendering, deadnaming, or microaggressing can be accidental or intentional, but regardless of intent, it can cause distress and contribute to a non-inclusive or hostile environment. When inclusion programs disappear, LGBTQIA+ residents are more likely to encounter discrimination and, without institutional support for recourse and affirming mentorship, more likely to feel excluded or, worse, be subjected to a hostile work environment.
• Social isolation: With limited time to study, do laundry, or eat a healthy meal, residency can be lonely, and without friendly faculty or peers, the residency experience can be further isolating.
• Mental health erosion: Rates of depression, anxiety, and suicidal ideation are higher among early career physicians than in the general population, and higher among LGBTQIA+ individuals than the general population. Without a supportive environment, LGBTQIA+ students and residents will be at greater risk of mental health problems and burnout.

According to the AAMC, LGBTQIA+ students are less likely to report harassment or seek help when mistreated. Why? They’ve learned the system doesn’t always have their back.

Pro tip: Program directors should appoint a wellness point person (outside the formal DEI chain) to field anonymous concerns and address them. It signals support, even if DEI budgets are gone.

The Professional Detour: When Career Paths Become Obstacle Courses

Even with skills, talent, and training, LGBTQIA+ residents hit subtle (or not-so-subtle) roadblocks. Some of these barriers involve the practice of medicine, but some don’t. Some are about identity politics.

Barriers include:

• Networking gatekeeping: LGBTQIA+ trainees may lack representation, particularly without access to mentors or sponsors in leadership roles who share their identity.
• Selective evaluations: Bias in performance reviews, intentional or not, can affect recommendations for fellowships or faculty roles. Whether deliberate or not, bias in performance reviews can impact recommendations for fellowships or faculty positions, stemming from selective evaluations.
• Publishing prejudice: Queer medical professionals encounter excessive criticism when publishing on health equity or social justice topics, hindering their academic progression and perpetuating prejudice.

Private Support Systems: When Institutions Drop the Ball, Coaching Picks It Up

When traditional DEI structures are gutted, private-sector support becomes crucial. One of the strongest emerging alternatives? Among the strongest alternatives are private medical coaching, educational therapy, and training-the-trainer. Enter LorenAcademic.com (LAS), a company designed to fill the professional, academic, and emotional support gap for high-achieving, underserved learners, including LGBTQI+ students, residents, and faculty.

LAS Offers:

Identity-Affirming Coaching

• Coaches who are trained in inclusive language and culturally competent mentoring.
• Coaches who provide customized strategies for coping and flourishing to residents impacted by microaggressions or struggling with underperforming reviews.

Academic Strategy and Board Prep

• One size does not fit all! Loren Academics (LAS) offers one-on-one coaching services to upgrade study skills, leverage intellectual strengths, reinforce individual learning styles, and provide executive functioning support and burnout recovery in measurable ways.
  • Designed for institutions that lack integrative support and wellness options, particularly those that do not support underrepresented students, residents, and faculty.
  • Provided to institutions that do offer one-on-one support but may not know how to design individualized options.
  • Coaching and Consulting services provide students, residents, and faculty with individualized, one-on-one coaching, consulting, and training options.
  • LAS offers integrative coaching and support with a system-based approach to support professionalism, core competencies, and test preparation, including the USMLE and COMLEX Licensing Exams, NBME and NBOME Clerkship Exams, and In-Training and Board Certifying Exams.

Safe-Space: Educational Therapy

• Integrative support that goes beyond tutoring. Loren Academic Services offers one-on-one Medical Coaching and Educational Therapy. Both services provide support for test preparation and core competencies, and both provide support for executive functioning and emotional wellness. Educational Therapy includes support for diagnosed learning challenges and psychological stressors, with specialized support for those seeking or granted accommodations, including diagnoses of ADHD or processing issues, all from an affirming perspective.

“The difference between coaching and institutional advising is simple: one sees you as a whole person, the other sees you as a score report.”

Privacy and Flexibility

• Coaching with Loren is tailored to your rotation schedule. While it isn’t bound by an academic calendar, clear deadlines remain essential to achieving your coaching goals.
• Coaching and consulting services are fully private. LAS follows FERPA and HIPAA guidelines, so no one will know you’re seeking support unless you share it.

Leading the Change: Best Practices to Bridge the Residency Training Divide

Not every program can fund a wellness center or DEI revival. But that doesn’t mean you’re powerless. Here are five best practices to support LGBTQIA+ residents even in restrictive environments:

1. Create an opt-in mentorship matching
    Let Residents select mentors confidentially based on identity preferences.
2. Use outside coaching as an extension of your wellness program.
    Partner with a private coaching company, such as Loren Academic, to offer stipends or reimbursement.
3. Build anonymous channels for feedback and reporting.
    Residents need safe places to flag issues without fear of retaliation.
4. Host community office hours
    Even a once-a-month, off-the-record support session hosted by a faculty ally can change the game. Loren Academics can host these sessions or train your faculty and staff to do the same.
5. Champion LGBTQIA+ visibility in medicine
    Elevate queer voices during grand rounds, speaker events, or faculty spotlights, especially if DEI departments are restricted in doing so.

Q&A

Q: Isn’t private coaching expensive?
 A: Compared to the cost of resident attrition and mental health leave? It’s an investment, so explore your options, such as a monthly rate with a guaranteed number of hours or a subscription model, to determine the most cost-effective choice.

Q: What if my institution bans any form of “identity-based” support?
 A: Use general terms like “academic wellness” or “performance coaching” in your documentation and allow residents to self-select affirming coaches.

Contact Loren Academic Services for more information.

References

1. Danckers, M., Nusynowitz, J., Jamneshan, L., Shalmiyev, R., Diaz, R., & Radix, A. E. (2024). The sexual and gender minority (LGBTQ+) medical trainee: the journey through medical education. BMC Medical Education, 24(1), 67. https://doi.org/10.1186/s12909-024-05047-4. 
2. Rosecrance K, Archibald A, Victor R, Lasso ET, Nore C, Barrios C. Medical Student Perspectives on Sexual and Gender Minority Acceptance in Surgical Specialties and Sexual and Gender Minority Education. J Surg Res. 2023 Sep;289:121-128. https://doi.org/10.1016/j.jss.2023.03.027. Epub 2023 Apr 24. PMID: 37099822.
3. Sitkin, N. A., & Pachankis, J. E. (2016). Specialty choice among sexual and gender minorities in medicine: The role of specialty prestige, perceived inclusion, and medical school climate. LGBT Health, 3(6), 463–470. https://doi.org/10.1089/lgbt.2016.0053
4. Sorgini A, Istl AC, Downie ML, Kirpalani A. Pride & prejudice: A scoping review of LGBTQ + medical trainee experiences. Med Teach. 2024 Jan;46(1):73-81. https://doi.org/10.1080/0142159X.2023.2229503. Epub 2023 Jul 7. PMID: 37418565.