LGBTQ+ Inclusivity in Neurosurgery: Exploring Physicians’ Knowledge, Experience, and Competence

Introduction: LGBTQ+ individuals frequently face discrimination based on sexual orientation in healthcare, which can lead to avoidance or delays in seeking care. As the LGBTQ+ population in the U.S. continues to grow, it is increasingly important to ensure that neurosurgeons provide affirming and well-informed care. Addressing these disparities is crucial for fostering an inclusive healthcare environment that improves patient outcomes.

Methods: A survey was distributed to neurosurgeons from 10 major U.S. academic centers, focusing on three main domains: training, preparation, or knowledge (4 questions); clinical practice experience (2 questions); and comfort or competence in LGBTQ+ care (7 questions). Responses were measured on a 5-point Likert scale. Linear regression was used to assess the relationship between knowledge and comfort/competence. Additionally, we performed a mediation analysis to determine the extent to which clinical practice modified this relationship.

Results: A total of 87 neurosurgeons (35 residents and 52 attendings) completed the survey (response rate of 28.7%). For every 1-point increase in training, preparation, or knowledge, there was a 0.31-point increase in perceived comfort and competence [95% CI 0.24–0.39, p< 0.01]. Clinical practice experience mediated the relationship between physician training and knowledge and the perceived competence and comfort [Sobel test, 2.62; p< 0.01]. Additionally, physicians rated their knowledge (3.68 vs. 3.38, p< 0.01), perceived comfort/competence (4.41 vs. 4.29, p< 0.01), and clinical experience (4.41 vs. 4.11, p< 0.01) in caring for LGB individuals significantly higher than that of transgender individuals.

Conclusion : Our study highlights a significant gap in neurosurgeons’ comfort and competence in providing care to LGBTQ+ patients, particularly transgender individuals. To create an inclusive and equitable healthcare environment, we need to strengthen training programs that better prepare neurosurgeons for affirming LGBTQ+ care.