In Reply to Cummings and Kumar

We thank Cummings and Kumar for their comments on our article and for recognizing the importance of an intersectional framework. Regarding individual barriers, many of the 10 items reflected on our survey captured participants’ (in)ability to meet their health care needs, including due to finances, such as “not filling a prescription for medicine because of the out-of-pocket cost.” The root causes of these access disparities are socioeconomic and driven by racism, biphobia, and homophobia. Although socioeconomic differences accounted for the majority of the racial/ethnic access disparities we observed, socioeconomic disadvantage was prevalent among sexual and intersectional minorities. Structural-level housing, employment, income, and educational discrimination are rampant. Gentrification and redlining, the discriminatory practice of limiting housing access based on race, continue to displace Black and Brown people from equitable housing and education. Sexual minorities are routinely forced into homelessness by unsupportive families, and it is still legal to fire someone for being lesbian, gay, bisexual, transgender, and queer (LGBTQ+) in a large portion of the United States. These structural factors require targeted intervention to improve access to care for these populations.

We also greatly appreciate Cummings and Kumar’s discussion of the importance of the visibility, recruitment, and retention of racial/ethnic and sexual minorities within academic medicine. Despite an increased recognition of the importance of diversity for cultural competency efforts, diversity has not been as prioritized at the faculty and leadership levels. Racial/ethnic and sexual minority diversity at every level is necessary for culturally competent care. To this point, survey items, such as “How satisfied are you with the health care you received during your most recent medical care visit?” captured cultural competency in interactions with providers. Equitable hiring criteria are critical, like not limiting high-level positions to graduates of predominantly White institutions and both identifying and addressing aversive racism during the hiring process. It is also important to evaluate practices and develop structural supports to help retain and advance underrepresented practitioners and educators. This involves redefining institutional measures of success to include efforts that increase diversity, promote equity, engage the community, and support retention and advancement of racial/ethnic and sexual minority practitioners. To achieve such a cultural shift, it is exceptionally important to hire and empower equity officers to change institutional policy.

We cannot agree more that diversifying the workforce at all levels, particularly within an intersectional framework, is necessary for creating a medical community prepared to care for an increasingly diverse nation. This, coupled with broader health system policies to address structural issues that disadvantage LGBTQ+ people of color, is a necessary strategy to achieve health equity.