Key Points Question What is the association of sexual orientation and gender minority (SGM) status with burnout, professional fulfillment, and intent to leave among academic physicians and trainees? Findings In this cross-sectional survey study of 10 940 academic physicians and trainees, SGM status was associated with burnout and lack of professional fulfillment. SGM attendings expressed a higher intent to leave than their non-SGM peers, but SGM trainees did not.