Mapping the Impact of Anti-LGBT Legislation on Graduate Surgical Education

BACKGROUND: LGBTQ medical students and surgery residents face myriad structural barriers. The American Civil Liberties Union (ACLU) reports 492 pieces of state- level legislation targeting Lesbian, Gay, Bisexual, Trans- gender, and Queer (LGBTQ) people in the past year. These bills including bans on medical care, "don't say gay" bills, exclusion from anti-discrimination protections, and more. These bills may limit where medical students pursue surgical training STUDY DESIGN: The Movement Advancement Project and the ACLU legislative databases were consulted to determine whether states (plus Puerto Rico and the District of Columbia) currently had or were actively considering anti-LGBTQ legislation. This information was then mapped against data from the 2023 National Residency Match Program. US News rankings of top surgical training programs were utilized as well. RESULTS: There were 2803 general surgical training spots, of which 1597 (57%) were located in states which currently have anti-LGBTQ legislation in place. 245 (9%) of training spots are in states which do not have such legislation but are currently considering anti-LGBTQ legislation. Of the top 20 residency programs, 11 (55%) were in states with anti-LGBTQ legislation. In affiliated specialties, 50 (54%), 118 (57%), and 24 (49%) surgical training positions for integrated vascular, plastic, and thoracic surgery, respectively, are in states that currently have anti-LGBTQ legislation in place. In total, 63% of fellowship opportunities were in states with Anti-LGBTQ legislation in place CONCLUSION: A majority of graduate surgical education occurs in states with anti-LGBTQ legislation, potentially limiting residency options for people who value protection of LGBTQ rights (J Surg Ed 82:103372. (c) 2024 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights are reserved, including those for text and data mining, AI training, and similar technologies.)