Conscientious Objection to Gender-Affirming Care in United States Pediatric Residencies

This study aims to characterize physician objections to the provision of gender-affirming care within accredited US pediatric residencies and to explore the relevance of institutional conscientious objection policies.

A cross-sectional electronic survey was distributed by the Association of Pediatric Program Directors to pediatric residency program leadership representatives from September to October 2023. Responses were compared using descriptive statistics and bivariate/multivariate analyses (P < .05).

In total, 84 of 182 (46%) pediatric residencies completed the survey. Most programs engaged in formal didactic training (n = 66, 79%) and direct clinical exposure (n = 57, 68%) to gender-affirming care, yet few programs (n = 7, 8%) endorsed having institutional objection policies. Four programs (5%) reported trainee (n = 3, 75%) or faculty (n = 1, 25%) objections to gender-affirming care, none of which had formal objection policies in place. Leadership at programs with objection policies (n = 7, 8%) reported increased confidence in addressing future objections, as compared to those without (P < .01).

Objections to gender-affirming interventions are rare, but plausible within pediatric residency programs; thus, programs should consider anticipatory policies that balance trainee beliefs, required competency training, and safe, equitable patient care.