LGBT residents provide insights to Match applicants

Matching for residency programs can be stressful for LGBT applicants. Is it okay to be out? How much should I reveal about my LGBT advocacy work? What should I do if an interviewer tries to determine my sexual orientation indirectly? Five LGBT residents, including one couple, recently took part in a webinar to share their experiences and answer these and other questions LGBT students commonly have before and during the Match.

The webinar, Navigating the Residency Match as an LGBT Applicant, co-hosted by the AMA and the Association of American Medical Colleges in August, addressed the rules governing questions that can be asked of program applicants and the concerns related to openly sharing one's identity during the interview process.

It begins with what many applicants might not be aware of in detail. The National Residency Matching Program (NRMP) has established a Match Communication Code of Conduct for all program directors and other interviewers. In summary, it specifies that they must commit to:

• Respecting an applicant’s right to privacy and confidentiality. Program directors and other interviewers are not allowed to ask identifying information about other programs you’ve applied to.
• Accepting responsibility for the actions of recruitment team members. Program directors assume responsibility for the actions of the entire interview team. Anyone who is a part of the interview selection process is representing the entire program, and responsibility goes all the way up to the program director.
• Refraining from asking illegal, coercive and non-job-related questions. Interviewers can’t ask questions about age, gender, religion, sexual orientation or family status, and they have to ensure that communication with applicants remains focused on whether the applicant fits within their program.
• Declining to require second visits or visiting rotations. Program directors can’t require visiting rotations—second visits—or imply that second visits are used in determining applicant placement on a rank order list. 
• Discouraging unnecessary post-interview communication. Interviewers aren’t allowed to solicit or require post-interview communication from applicants or engage in post-interview communication that is disingenuous for the purpose of influencing applicants’ ranking preferences.

So while some questions are off limits, sensitive subjects still come up. Many LGBT applicants look to the advice and anecdotes of other members of the LGBT community who have experienced the Match.

Kaitlyn McCune, MD, an obstetrics and gynecology resident at Wake Forest Baptist Medical Center in North Carolina, recently applied for a military residency through the Air Force. She decided to be out from the start, and she took three main lessons away from the experience.

“My first lesson is not to be afraid to be yourself,” Dr. McCune said. “I put the activities on my resume and was told by family members that I was waving my pride flag in people’s faces, and that I shouldn’t put my advocacy work that I had worked so hard on in medical school on my application.”

But she decided to use it as a probe.

“I sort of said, ‘Forget that,’” she said. “Because the Defense of Marriage Act and Don’t Ask Don’t Tell had been overturned, I took the stance that legally no one could touch me. They couldn’t discriminate against me. In reality, when I think back now, I realize that could have been a very bad move. It could have been very naïve, because these program directors in your interviews really carry a lot of weight in the military, so they could have rated me really poorly.”

Dr. McCune took that approach in her civilian applications as well. She was proud of what she had done in advocacy and felt she shouldn’t have to omit it.

“I was asked quite often about it,” she remembers. “One person…asked me, ‘What is your specific interest in LGBTQ health advocacy?’ And while he didn’t specifically ask me if I was gay, he sort of asked me the question that forced me to come out, and I did and it was fine. So I encourage you to take that risk if you’re comfortable with it.”

Dr. McCune’s second lesson: Scope out the residents.

“Those dinners beforehand are so incredibly important,” she said. “They’re your time to ask all the questions that you may be afraid to ask in an interview or wouldn’t be appropriate to ask in an interview. I always used that as my best resource for the feel of the program. I would drop my significant other status into casual conversation or ask residents about their significant others so that I could bring up my own.”

The third lesson: Be honest and realistic about where you want to end up.

“The military is a little bit different [from civilian programs], in that all the program directors get together,” she said. “So unlike civilian residency, you can’t tell every single one of them that that’s where you want to end up. If you were to [do that], when they all got together and talked about you, there would be a discrepancy.

“They really encourage you in the military to be honest about whether you want a military residency, which [one] you want, and if you want a civilian residency, to ask for it. And that’s what I did. Civilian residency made the most sense for my life and my situation, and I asked for it and was logical and reasonable about my reasons for wanting it and was awarded it in the end.”

Among the many other points Dr. McCune made, she noted that just two weeks after she matched at Wake Forest, North Carolina’s House Bill 2, the so-called “bathroom law,” passed.

“I remember emailing my fantastic program director and program coordinator … just very upset, wondering how this was going to affect the program and how this was going to affect my situation,” she said. “They were wonderful and said, ‘This is not going to affect [you]. The university has come out and said they that do not support this and they support diversity and inclusion.’

“So don’t be afraid to ask about those things. If you have concerns and the interview has gone well … and you see these concerning things either in hospital policy or in state laws, don’t be afraid to ask, ‘Hey how does this law affect this institution? Does it affect it at all?’”

The webinar also features presentations by:

• Dre Irizarry, MD, surgery resident at Beth Israel Deaconess Medical Center. At the time of interviews, Dr. Irizarry had begun transitioning and was continuing to present as a female with a female partner.
• Chelsea Dawn Unruh, MD, chief family medicine resident at Providence St. Peter Family Medicine. Dr. Unruh was an IMG who had studied in Poland and wasn’t out during Match.
• Jeffrey Eugene, MD, pediatrics resident at University of Pittsburgh Medical Center, and Joseph Langham, MD, pediatrics resident at University of Pittsburgh Medical Center. Drs. Eugene and Langham met during medical school. They would be the first same-sex couple from their school to go through Match.

It also includes a robust question-and-answer session. Among the many topics explored: What happens if things go wrong?

• Review the student’s fourth-year essential checklist
• See 4 tricks to a successful residency program search
• How many residency programs do students really apply for?
• Read about the record Match rate for 2016