The out interns.

Increasingly, gay and lesbian interns are making their presence felt in medical programs

Medical school is never easy on anyone, but for some gay men and lesbians who are studying medicine, getting into and through medical school can be a particularly challenging process. And the challenge, it seems, often intensifies in medical residency programs.

Gay men and lesbians considering a career in medicine must make several decisions along the way about how out they want to be--during the interview and selection process and while in school or during residency. Many say they have experienced homophobia on the part of professors, doctors, deans, fellow students, and patients, though the extent seems to vary by specialty and geography. But a growing cadre of gay medical students is working to make the medical school experience more gay-friendly, and the students are meeting with remarkable success.

"When I started medical school, there were no out med students, but the atmosphere has changed substantially in the past seven years," says Giang Nguyen, 29, a resident in the department of family medicine at Thomas Jefferson University, Philadelphia. "Gay issues are much more on the forefront in society as a whole."

Nguyen wasn't open about his sexuality when applying for medical school, he recalls, "but throughout my years there, I gradually became more vocal about gay issues." When it came time to apply for residency, he says, "it seemed almost impossible for me not to be open. But this isn't something I would recommend for everyone. Whether to disclose one's sexuality during the application process is a very personal decision."

Sue Sun Yom, 30, who is studying medicine at the University of Pennsylvania, also in Philadelphia, wasn't out during her application process either. "In part it was because I was not completely sure about sexual orientation at the time," she says. But like Nguyen, she says, "for residency I have decided to be out for two reasons. First, my spouse deserves to be able to call me at work and attend functions with me. Second, I have contributed lots of time to lesbian, gay, bisexual, and transgender activities that are important to note as part of my extracurricular record."

"The sad truth is that homophobia still exists, and the medical community is not immune," says a document for residency applicants published by Lesbian, Gay, and Bisexual People in Medicine, part of the American Medical Student Association. It cites a 1996 study showing that 59% of gay and lesbian physicians and medical students surveyed had experienced job-related discrimination because of their sexuality.

Further, the document warns, "During residency, your personal life becomes more important to your colleagues than when you are a student, since you work with them regularly. This is particularly important in small programs."

Yom edited the October 6, 1999, issue of the Medical Student Journal of the American Medical Association, which focused on gay and lesbian issues. "Many admissions officers and residency directors are less enthusiastic about gay and lesbian candidates than heterosexual candidates," she wrote in her editor's note. "Physicians who disclose a nonheterosexual orientation to colleagues face the potential loss of referrals and privileges."

"Homophobia in medical school is very subtle," says Yom. "It's mostly thoughtless and unintentional. Jokes and derogatory comments, either to or about patients, are probably the most common negative experience." For instance, she once heard a physician comment on the long hair of a male child, saying, "Your mother needs to cut it, or people will think you're a faggot."

"I really struggled with myself at the time," she says. "I desperately wanted to say something, but the moment was gone and the power disparity was too great. I think about that incident a lot. No one else in the room said anything, but from their expressions I could tell that some of them were really turned off. But I didn't say anything either. I was scared. It's such a big deal in medicine to be a team player. In fact, that is part of your evaluation."

Nguyen says that while his experiences have been positive, not everyone has been so lucky. One student, he says, stood quietly by while his teacher made homophobic remarks in the operating room, because "it's difficult to speak up when your grade--and possibly your career--could be jeopardized."

Peter Chien Jr., 25, now in his fourth year in New York University School of Medicine's MD-Ph.D program, was shocked to get a homophobic message via the progressive school's E-mail system. "They made an anonymous, inappropriate slur referring to anal sex and bleeding," he says. He reported it and was surprised by the support he received. The dean wrote a letter "about the school not tolerating this kind of homophobia. It was deposited in every student's mailbox," Chien says.

Chien has also heard horror stories. One student he met lived in a small town "where people know everyone's business. They got wind of [the fact that the student is gay] and put it in the local paper. All the dean told him was, `Keep it under wraps, and we'll protect you.'"

At some schools homophobia is institutionalized. For instance, Loma Linda University, located in Southern California, is run by the Seventh-day Adventist Church. "Their religious beliefs do not allow LGBT people as students or employees," says Ron Tierney, spokesman for the Gay and Lesbian Medical Association, "though they do make it clear that such discrimination has no business in medical treatment. This offers an interesting dilemma."

These days gay students are taking on important battles and winning. Chien helped draft a resolution calling on the American Medical Association to look at nondiscrimination policies when accrediting medical schools. "We asked them to expand the standard to include sexual orientation, and they did," he says. "It was officially adopted last year."

"There are so many difficult decisions during medical school," Yom says. "It is a continual coming-out process. You just have to make the best decisions you are psychologically capable of and to forgive yourself for not always being a homosexual superhero."

Find links to Web sites related to gay and lesbian medical students and interns at www.advocate.com

Kirby is a regular contributor to The New York Times.