Roughly a third of tomorrow’s LGBT doctors, surgeons, and specialists fear discrimination, a new study reports.

According to researchers at the Stanford University School of Medicine, about a third of those who responded to an online survey given to all U.S. medical school students during the 2009-10 academic year said they chose not to reveal their sexual identity or orientation. What’s more, 40 percent of those identifying as “not heterosexual” cited fears of discrimination as a reason for not coming out of the closet.

“There is still this huge percentage of medical students who are afraid of discrimination in medical school and how it could affect the rest of their careers,” said Mitchell Lunn, MD, who co-wrote the paper and co-founded Stanford’s Lesbian, Gay, Bisexual & Transgender Medical Education Research Group. “We are supposed to be a field that is accepting of people and one that takes care of people regardless of differences, and yet we can’t even do that for people who are part of our own community.”

Among the reasons given by students for not coming out in medical school, fear of discrimination was the most common. LGBT students worry about being treated differently not only by peers, but also by evaluators and patients. Many respondents said that medical school is stressful enough without dealing with the potential fallout of discussing one’s sexual orientation or preference.

The numbers were most striking for gender minorities, as roughly two-thirds of those identifying as transgender or something other than male or female kept their identity secret.

“Medical school itself is a very intense experience, particularly when you get to be a clinical student switching teams every two to three weeks, working 80 hours a week,” said fourth-year medical student and study lead author Matthew Mansh. “You’re already dealing with enormous pressures.”

Other study participants said they feared losing U.S. Army scholarships (the survey went out prior to the repeal of the “don’t ask, don’t tell” policy), while many believed that coming out could negatively affect their efforts to pursue residencies in rural parts of the United States known to be less accepting of LGBT individuals.

“Students said they worried that ‘because I’m gay, I can’t go back to those rural communities,'” Mansh said. “Sadly, those areas are where sexual minority patients would really benefit from having a sexual minority physician.”

The study was accompanied by a commentary written by three of the authors, and in it was a call for the medical community to step up match the kinds of pro-LGBT recruitment efforts seen in law and business.

“Being LGBT should be a non-issue in medicine and that includes both for patients and medical students,” said Lunn. “If you can improve the educational environment by embracing diversity, broadly defined, it will lead to better care for patients, which is the end goal of all of this.”