Access to Primary Care Physicians for Lesbian and Gay Patients

Abstract Access to primary care is associated with reduced morbidity and mortality and lower lifetime healthcare costs but lesbian and gay individuals are disadvantaged in accessing healthcare since they are less likely to have insurance coverage than heterosexual individuals and face social stigma in medical settings. Research that examines the ways in which physician attitudes towards lesbian and gay individuals influence access to primary care is limited. Also unknown is the way that race/ethnicity, sex, age and social class intersect with lesbian and gay identity in influencing access to primary care. Using a field experiment, trained research assistants called a nationwide sample of primary care physicians’ offices in 2022 and 2023 to request new patient appointments on behalf of 133 simulated patients identified as lesbian (~ 50%) and gay (~ 50%). The call script referenced lesbian and gay identity; and employed racially and ethnically distinctive first and last names; and indicated the patient’s insurance type. Calls were made to a control group consisting of 589 simulated patients for whom sexual orientation was not signaled in otherwise identical call scripts. Overall, there is no evidence that lesbian or gay potential patients face barriers to access in primary care. Black lesbians were offered more appointments (31.1 percentage points (95% CI: 0.033 to 0.590; p = 0.03)) but with significantly longer wait times (45.3 days (95% CI: 4.9 to 85.7; p = 0.03)). Female physicians had less overall availability, but offered longer appointments to gay and lesbian patients (17.2 minutes, 95% CI: 5.4 to 29.1, p = 0.005).