NHS Workers Who Hide Their Sexual Identity Earn Less Than Those Who Are Out

When researchers study workplace pay gaps, they usually compare groups defined by visible characteristics - gender, race, age. A new study published in PLOS One asks a different question: does it matter whether people disclose a characteristic that is not automatically visible? For LGB+ workers in the UK's National Health Service, the answer appears to be yes - and the direction of the effect may surprise people who assume that being out at work carries professional risk.

The headline finding, and the more interesting one beneath it

The top-line result from researchers based in Germany, the UK, and Australia is that LGB+ NHS workers as a whole do not experience a pay gap compared to their heterosexual colleagues. Taken at face value, that is a relatively reassuring finding for one of the world's largest employers.

But the aggregate conceals a sharp internal divide. When the researchers separated workers by whether they had disclosed their sexual identity in NHS records, the picture changed. Those who had disclosed their identity were found to have higher pay than the LGB+ average - and higher than would be expected by job role and seniority alone. Those who had not disclosed their identity faced a measurable pay penalty relative to their colleagues.

The association between non-disclosure and lower pay does not mean that hiding one's sexual identity causes lower pay, but it does suggest that something systematic is happening that correlates with concealment.

Several interpretations are possible

One possibility is selection: workers who feel secure enough to disclose their sexual identity may be working in departments, teams, or roles where they feel more comfortable - and those environments may also be ones where career advancement is more accessible, where mentorship is available, and where informal networks function more fairly.

Another possibility is that disclosure itself confers advantages in specific contexts - that being openly LGB+ in an NHS workplace can build social capital and professional visibility in ways that contribute to advancement. This would be consistent with some research showing that authenticity at work is associated with better performance outcomes and stronger professional relationships.

A third interpretation involves reverse causality: workers in better-paid positions may feel more secure disclosing their identities because they have less to lose, while those in more precarious employment keep their identities private as a protective measure. In this reading, the pay penalty precedes the decision not to disclose rather than resulting from it.

The study's authors acknowledge the complexity directly. They caution that sentiment towards identity disclosure is a complex behavioral response, and that there are likely additional sociodemographic characteristics they have not been able to account for in their analysis.

Gender intersects with the picture

The research examined both gender and sexuality simultaneously within the NHS pay structure. The NHS is a heavily gendered workforce - the majority of its employees are women - and pay gaps by gender have been documented extensively across the health service. The interaction between sexual identity and gender in shaping pay outcomes adds another layer of complexity that single-variable analyses miss.

The study does not provide enough detail in its published summary to fully quantify the size of the pay differences observed, which is a limitation of the available data. What it establishes is the direction of the effect and the statistical significance of the non-disclosure penalty within the LGB+ group.

What the NHS can do with this

For NHS management and policymakers, the finding creates a specific question: why does non-disclosure correlate with lower pay, and what organizational factors drive that correlation? If the answer is that non-disclosing workers are concentrated in lower-paid roles or departments, the question shifts to why LGB+ workers who are not out at work are systematically positioned in those roles.

The study was funded by the Economic and Social Research Council and published in the open-access journal PLOS One.