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State Policy Environment and Geographic Practice Preference Among Sexual and Gender Minority Medical Students
Brototo Deb1, Oliver Toscano2, Carl Streed2,3
1Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
JAMA Network Open
|August 3, 2026
Summary
State policies impact where medical students choose to practice. Sexual and gender minority (SGM) students prefer states with more equitable policies, influencing future physician distribution.
Area of Science:
- Health Policy
- Medical Education
- Sociology of Health
Background:
- Geographic preferences of medical school graduates influence patient access to care.
- The relationship between state policies and physicians' practice location choices is not well understood.
Purpose of the Study:
- To examine the association between state policies affecting sexual and gender minority (SGM) individuals and health care services with medical students' preferred practice locations.
- To understand how state-level policies may shape the future physician workforce distribution.
Main Methods:
- Cross-sectional analysis of 2020-2024 questionnaire data from US medical students.
- Primary outcome: self-reported preferred state for practice.
- Statistical analysis using proportional odds ordinal logistic regression, adjusting for demographics and career factors.
Main Results:
- Sexual and gender minority (SGM) status was associated with a preference for states with higher equality policies (aOR, 1.56).
- Preference for rural practice was linked to lower preference for higher-equality states (aOR, 0.76).
- Emphasis on social change correlated with preference for higher-equality states (aOR, 1.16).
Conclusions:
- State-level policies are significantly associated with medical students' anticipated practice locations, especially for SGM students.
- These findings suggest policy environments may meaningfully influence the geographic distribution of physicians.
- Understanding these associations is crucial for addressing healthcare access and workforce planning.
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