Representation at entry-level specialty training, or ST1, was highest in community sexual and reproductive health, where sexual minority applicants made up 9%, followed by public health at 7% and histopathology at 6%. The lowest ST1 proportions were recorded in cardiothoracic surgery and general practice, both at 2%, and clinical radiology at 3%. At the higher ST3 stage, the highest proportions occurred in psychiatry subspecialties, at 7%, and anaesthetics, at 5%. Acute internal medicine and trauma and orthopaedic surgery had the lowest ST3 proportions, both at 1%. These contrasts describe differences in the composition of applicants across training routes rather than changes over time within each specialty.

Recruitment equity was evaluated by comparing the odds of receiving an offer for sexual minority and heterosexual applicants, with statistical significance defined as p less than 0.05. Sexual minority applicants were not disadvantaged overall in obtaining offers. At ST1, they had significantly higher odds of receiving offers in several specialties. One notable result was core psychiatry training, where the odds ratio was 3.4 and the 95% confidence interval was 3.0 to 4.0. At ST3, significantly higher odds were also reported for acute internal medicine, haematology, trauma and orthopaedic surgery and clinical oncology. The results therefore do not support a uniform, system-wide offer disadvantage for sexual minority applicants in the 32 specialties that met the inclusion threshold. They also do not establish that every specialty or training stage was free of disparities.

The authors said that marked variation in representation suggests cultural perceptions or self-selection may influence career choices, pointing to a need to investigate possible structural barriers in specialties where sexual minority representation is comparatively low. Those influences were not established by the analysis itself, which examined recruitment records rather than applicants’ motivations or the causes of specialty choice. The study also has important scope limitations: it was based on NHS recruitment data, excluded specialties with fewer than 500 total observations, and did not establish whether recruitment procedures or workplace conditions produced the observed differences between specialties. Even so, the central finding is clear within the dataset: across 214,415 applications from 2021 to 2024, sexual minority applicants received 5% of offers and 5% of accepted posts, and were not disadvantaged overall in obtaining offers across the included specialties. The uneven proportions across training routes show why equal offer rates and equal representation are distinct measures of equity, while the reasons behind lower representation in some specialties remain unresolved.

Subject of Research: Sexual minority representation and offer outcomes in UK medical specialty recruitment, 2021–2024

Article Title: Sexual minority representation and recruitment success across medical specialities in the United Kingdom: a longitudinal analysis of NHS England data (2021–2024)

Article References: Green, T., Jasek, J. T., Tulloch, J., Blore, N., & Hum, R. M. (2026). Sexual minority representation and recruitment success across medical specialities in the United Kingdom: a longitudinal analysis of NHS England data (2021–2024). BMC Medical Education. https://doi.org/10.1186/s12909-026-10246-2

Image Credits: AI Generated

DOI: 10.1186/s12909-026-10246-2

Keywords: NHS recruitment, sexual minority doctors, medical education, diversity, healthcare workforce, specialty training, employment odds, United Kingdom, Sexual, minority, representation, recruitment