Instead of viewing being female, Latina, and LGBTQ+ as a hindrance in the realm of surgery, Julie Ann Sosa, MD, MA, FACS, instead proudly asserts that they are actually “superpowers.” And she is determined to harness those powers so that future generations will have an easier path.

Pursuing a career in medicine is no easy accomplishment, but when faced with discrimination because of your sexual identity, the road to success is even more difficult. For persons who

identify as lesbian, gay, bisexual, transgender, queer, or other sexual and gender minority (LGBTQ+), a prominent endocrine surgeon and educator aims to make the path in one specialty a smoother one.

Julie Ann Sosa, MD, MA, FACS, is the Leon Goldman MD Distinguished Professor of Surgery at the University of California San Francisco (UCSF) and has served as Chair of UCSF’s Department of Surgery since 2018. With a clinical interest in endocrine surgery and a focus in thyroid cancer, Sosa has authored more than 400 peer-reviewed publications and 80 book chapters and reviews, all largely focused on outcomes research, healthcare delivery, hyperparathyroidism, and thyroid cancer.

Two of Sosa’s articles published in 2022, however, were of a much more personal nature to Sosa and have garnered the attention of many. The articles in The American Surgeon and JAMA Surgery focused not on the endocrine specialty but on the environment in the surgical community for LGBTQ+ surgical residents and Sosa’s career as LGBTQ+ medical professional.

“In the end, our legacy is measured not by citations, publications, and presentations, but rather by people whose lives we impact. If I can share my life experience and others can learn from my mistakes without having to make them, I will have had lasting impact, hopefully.”

Julie Ann Sosa, MD, MA, FACS, Leon Goldman MD Distinguished Professor of Surgery; chair, Department of Surgery, University of California San Francisco, San Francisco, Calif.

In The American Surgeon article, “Path to Academic Success: Perspectives of a LGBTQ+ Chair of Surgery,” Sosa and her co-author examined the challenges faced by those who identify as LGBTQ+. The article cited her JAMA Surgery study “Experiences of LGBTQ+ residents in US general surgery training programs,” that surveyed 6,381 general surgery residents, in which the learners who were LGBTQ+ reported higher rates of discrimination, harassment, and bullying than their non-LGBTQ+ peers. The survey revealed that 4.8% of the residents identified as LGBTQ+,  and of those, 59% experienced discrimination, 47.5%  sexual harassment, and almost 75% experienced bullying. LGBTQ+ women were targeted more than their male counterparts. This mistreatment, of course, has a significant impact on young residents in an already stressful learning environment.

“LGBTQ+ residents experienced more discrimination, harassment and bullying, and almost certainly as a result, more frequently considered leaving their training programs and contemplating suicide,” Sosa explains. “This is beyond distressing, and it should be a call to action for all, especially since attending surgeons were the most common overall source of mistreatment. We need to work on repairing our culture and ensuring an inclusive and welcoming community.”

The discrimination problem is not limited to general surgery, however. A recent literature review in the January issue of BMC Medical Education by Mauricio Danckers, et al., revealed that general surgery was among several specialties viewed by LGBTQ+ trainees as being less inclusive. Other specialties on the list were orthopedics, neurosurgery, thoracic surgery, and colorectal surgery. According to the review, the surgical field has traditionally been perceived as a training field with a predominantly white heterosexual trainee population that lacks diversity. Some medical trainees described the surgical field as a “boys club” or “fraternity.” For comparison, the specialties perceived as more inclusive were psychiatry, family medicine, pediatrics, preventative medicine, and internal medicine.

Sosa writes about how closeted LGBTQ+ friends and colleagues feel estranged inside and outside the classroom. Declining invitations to social events to avoid uncomfortable discussions that might expose your sexual identity can be the norm for many. All of this can create loneliness and isolation. Sosa says she, too, was not open about her sexuality early in her school career but doesn’t like to wonder if she’s experienced any delays in her career success due to her now-open sexuality.

“I was not open early in my career, but I tend to not look backward a lot since I can’t change the past,” she says. “I really think that we need to be squarely focused on the present – and more important, the future. I feel blessed to be where I am, with the friends, colleagues, and collaborators that I have, doing my dream job as the chair of the Department of Surgery at UCSF!”

Finding a Safe Place

For any student pursuing a medical degree, factors to be considered when choosing a medical school includes geography, finances, and lifestyle. But for many LGBTQ+ trainees, finding a welcoming and diverse school community is also crucial to their application.

LGBTQ+ learners may be more limited in personal and professional growth opportunities in more conservative states that have supported anti-LGBTQ+ laws in recent years. Florida, for example, passed the “Don’t Say Gay” bill in 2022 that now bans any classroom discussion on sexual orientation and gender identity up to the 12^th grade. The BMC Medical Education article reported that the law has raised concerns due to its “implications that threaten to worsen an existing hostile school climate for LGBTQ+ youth.”

The article makes the point that restrictions like those within the “Don’t Say Gay” law and similar legislations send a message that being LGBTQ + is wrong and stigmatizes both LGBTQ + youth and the community at large. LGBTQ + students in states like Florida may choose to pursue their medical education in a traditionally more accepting location rather than save money with in-state tuition costs.

Sosa encourages LGBTQ+ students, residents — and even faculty — to be open about their identities during the admissions and recruitment processes. She says it is better to know before accepting a position whether you may experience belonging or bullying in a potentially new professional home.

“It is not uncommon now for me to get emails from trainees and junior faculty members around the country asking for advice,” says Sosa. “In the fall, for example, I receive questions from residency applicants asking if they should be truthful about their identities during interviews. Some say they have been advised by mentors and senior colleagues to even lie about their identities.”

Sosa, instead, tells them to be honest and ask questions.

“If a community is unwelcoming, it is important to know that before becoming a member of it for five to seven years, which is the length of general surgery residency training,” she explains. “At the same time, if the culture fosters personal and professional belonging, that might be a priority that trumps other factors when deciding how to rank programs.”

Sosa is grateful that the climate towards LGBTQ+ people in her home state of California is an accepting one.

“I’m very glad that I live and work in San Francisco, and that UCSF is a culture that abides by the PRIDE values of professionalism, respect, integrity, diversity, and excellence,” she says. “I’m not sure what it is like to live elsewhere, but when I moved to California [from Duke University in North Carolina], it definitely felt like we had ‘come home,’ personally and professionally.”

“To be successful professionally, you have to be happy personally,” Sosa adds. “Increasingly, I hear from young and old recruits that living in a place where women’s rights, reproductive rights, and indeed, human rights, are best protected is very important if not the most important factor they and their families weigh when considering a place to work and live.”

For the LGBTQ+ members of the surgery specialty, the future for looks brighter as there is a growing number of leaders in the field who are now open to their LGBTQ+ identity. The Association of Out Surgeons and Allies (AOSA) was founded with a mission that “promotes acceptance, inclusion, and equity in the surgical specialties to further learner engagement, support individual clinicians and researchers, and build a community.”

“If a community is unwelcoming, it is important to know that before becoming a member of it for five to seven years, which is the length of general surgery residency training. At the same time, if the culture fosters personal and professional belonging, that might be a priority that trumps other factors when deciding how to rank programs.”

Julie Ann Sosa, MD, MA, FACS, Leon Goldman MD Distinguished Professor of Surgery; chair, Department of Surgery, University of California San Francisco, San Francisco, Calif.

“AOSA is vibrant and growing, with a large and diverse leadership team, mission statement, and expanding membership,” Sosa says. “There are 26 institutional members, a website with job board, and secure membership access to foster support, networking, and discussion. I’m proud that UCSF was the inaugural institutional sponsor for AOSA.”

Paying it Forward

Sosa says a lot of progress has been made in making work and learning environments more accepting to the LGBTQ+ community. She notes that it was not until June 2020 did the mistreatment of LGBTQ+ Americans in the workplace become illegal when the Supreme Court ruled in the Bostock v Clayton County decision, that the 1964 Civil Rights Act protects employees against discrimination because of sexuality or gender equality. The 6-3 ruling has been hailed as one of the most important legal decisions regarding LGBTQ rights in the U.S.

To extend the progress on creating more inclusive and safe spaces, Sosa suggestions including following:

• Use pronouns (e.g., she/her/hers) to introduce yourself to colleagues and patients.
• When talking to friends, colleagues, or patients ask about “partners” rather than assuming there is a wife or husband.
• Enforce healthcare institutional systems for confidential reporting and addressing instances of mistreatment.
• Work to create educational content and a curriculum around LGBTQ+ health that is mandatory for learners as well as staff and faculty at all levels.

Sosa hopes to persuade other senior faculty in the surgical specialty at institutions across the country to mentor junior colleagues.

“Mentorship and, perhaps even more important sponsorship, are critical,” she says. “It is something that I didn’t have a lot of when I was a trainee and junior faculty member. And now I see my role as one driven by ‘paying it forward.’”

“Being a woman, a Latina, and LGBTQ+ in surgery is potentially a superpower, so hopefully there are a number of trainees and junior colleagues whose lives I can understand a little more and with whom I can connect,” Sosa adds. “In the end, our legacy is measured not by citations, publications, and presentations, but rather by people whose lives we impact. If I can share my life experience and others can learn from my mistakes without having to make them, I will have had lasting impact, hopefully.”

There’s no debate on whether Sosa’s career and life successes have made an impact. Ascending the position of chair of a major medical department is no small feat. Sosa is also happily married to her co-author on The American Surgeon article, Sanziana A. Roman, MD, FACS, a fellow surgeon. They share that they both were told “innumerable times” by supervisors and bosses that they would never make it in surgery or in life.

“After 20 years together, we can proudly say, we are courageous. We have persevered in living our truth and have pushed forward even when we were afraid,” they write.

—Glenda is a freelance writer based in Carmel, Ind. She’s a regular contributor to Endocrine News and writes the monthly Lab Notes column.