“你是肤浅的，”课程的院长在我们坐在一个空的演讲厅里向我解释说。当他把我拉到一边分享他对我作为学生的进步的评估时，我刚刚完成了一次演讲。到了我的第二年医学院，我已经更加专注于女同性恋，同性恋，双性恋，变性者和酷儿[LGBTQ]人和社区的健康和福祉，并告诉我我是肤浅的。解决重要的问题disparities experienced by LGBTQ peoplewas a punch to the gut.
I had not planned on being focused on LGBTQ health as part of my training. But, asLGBTQ issues were glaringly absentfrom my training，我变成了student advocate.And despite becoming the go-to person on LGBTQ issues for some faculty, focusing on population health and social determinants of health was not of value to some in my school’s administration. As I concluded my exchange with the dean of our curriculum, I realized charting a career in LGBTQ health was going to be a turbulent journey.
It comes as no surprise that as an out gay man crafting a career that addresses the health of LGBTQ communities is motivated by personal experiences.Having had a physician walk out on me when I came out to her，我要亲身了解歧视LGBTQ人甚至在获得医疗保健方面面临。Before returning to school to become a physician, I worked at a federally qualified health center providing care for our overlooked and marginalized communities. Seeing compassionate physicians addressing the varied needs of LGBTQ folks, such as gender-affirming care for transgender patients or cancer screening for bisexual women, I wanted to join their ranks. But nearly every step of my medical training provided unique challenges to have a career in LGBTQ health.
In addition to experiencing discrimination, LGBTQ people in medicine are discouraged from pursuing careers that are connected to their identity.The absence of LGBTQ content and/or presence of anti-LGBTQ sentiment in the pre-clerkship, clerkship, and hidden curriculum of clinical training in particular sets the tone for how LGBTQ health is viewed in our profession。此外，隐藏课程的影响普遍存在和阴险。只要我们一直在调查LGBTQ患者，医学生，居民和医师教育工作者的治疗主题，报告见证同事对LGBTQ患者发表贬义的评论或对他们的治疗不佳。整个培训中的这些互动都影响了职业选择，并为医师如何将其身份与职业联系起来奠定了基础。It is why some specialties are considered “friendly” or “unfriendly” towards LGBTQ applicants。It is not surprising that most LGBTQ students applying for medical school do not disclose their sexual orientation or gender identity for fear of discrimination，近一半在申请居留权时没有披露。尽管有些人可能会判断这种行为过于谨慎，但studies suggest that fears of disclosure are valid。Perhaps most importantly is that beyond the personal risk of being out as LGBTQ, there are a dearth of out mentors,害怕任何专业伤害。
尽管拒绝管理，但我很幸运能够完成居住，重视我的身份和对LGBTQ健康职业的渴望，涵盖了教育，研究和倡导。尽管我的居住计划中的一些人不确定我的轨迹，但没有一个让我沮丧。随着我的职业道路将我进一步进入人口健康和差异研究，我发现自己面临着寻找奖学金培训以获得基本技能的。不幸的是，在居住的支持环境之后，奖学金搜索感到沮丧。Beyond facing faculty who actively tried to redirect me away from LGBTQ health as a research topic, I encountered out LGBTQ faculty who stated they did not “understand how LGBTQ health is a relevant career” or noted that “you won’t receive any funding or grants.” These encounters were both disappointing and informative. Disappointing because there were so few mentors in LGBTQ health to offer training or even serve as examples of success, and informative because I knew which programs to avoid; if they could not even imagine such a career how would they advise me? I could only wonder what barriers these LGBTQ faculty had faced to internalize such dispassionate assessments of my interests to discourage my career trajectory.
支持LGBTQ健康职业的研究和培训机会正在迅速出现。2016年，国立卫生研究院将LGBTQ指定为研究目的的健康差异人群。除了明确寻求针对LGBTQ健康的研究建议外，NIH通过建立SGM研究办公室，为LGBTQ健康提供了资源。除研究职业外，许多奖学金机会，包括由美国医学协会基金会, have emerged to train anyone interested in pursuing a career in LGBTQ health.
I would like to thank Jessica Halem, MBA for her years of mentorship and editorial guidance on this article. I would also like to thank my husband, Chad Rubalcaba, JDg for over a decade of support as I navigated this relatively uncharted career path.