While much has been written about discrimination against transgender people by health providers, there is little data on the professional experiences of transgender and gender expansive physicians.
Now, a study published in the Journal of the American Medical Association JAMA Network Open looks specifically at those professional experiences. Entitled “Experiences of Transgender and Gender Expansive Physicians,” the article is written by lead author Lauren M. Westafer, DO, MPH, MS (a doctor in the Department of Emergency Medicine at Baystate Medical Center and a researcher in the Department of Healthcare Delivery and Population Sciences, UMass Chan Medical School – Baystate) and was initiated and authored by Baystate physicians.
EXPERIENCES OF TGE PHYSICIANS
Although approximately 1.2% of medical students in 2021 identified as transgender and/or gender expansive (TGE), there is little understanding of the experiences of TGE physicians, as most studies include few to no TGE individuals or provide only superficial information.
“As a medical student I witnessed the ‘jokes’ that the care team, including the physicians, made about a transgender patient. Although there were curtains around the patient, the patient could certainly hear the comments – that patient who was sick and vomiting and seeking care from us. I felt sick, but I was a medical student in the rural South. I was terrified that if I spoke up, I would receive a bad evaluation or potentially ‘out’ myself,” says Dr. Westafer, who identifies as a lesbian.
“Now, in a position of authority, I wanted to be able to stand up and be a true ally for this community,” she adds about using her position as an attending physician and researcher to conduct research to help mitigate injustice.
TGE PHYSICIANS NATIONWIDE
In this seminal study, the authors conducted a rigorous qualitative study of TGE physicians to characterize their experiences. This qualitative study used semistructured interviews and was conducted among 24 TGE physicians from across the United States from April 1 to December 31, 2021. The study authors analyzed the data for common themes.
Although most physicians receive education on the treatment of LGBTQIA+ patients and many institutions employ some form of diversity training, this study found that most TGE physicians experienced deep and overt transphobia within their hospital systems. All participants described emotional distress stemming from transphobia, feelings of isolation, and repeated effects of misgendering – described by one participant as “death by 1,000 cuts.”
“This results in lack of safety/perceived safety with an end result of burnout, distraction, stunted professional development, and continued lack of representation of gender minorities among the physician workforce,” says Dr. Westafer.
She notes a few things underpinned these results – the dominance of the binary paradigm (men vs women) and socially engrained gendered expectations rather than a more nuanced understanding of gender. They also found that structural factors were key, and largely modifiable. Things like the traditional hierarchy of medicine, policies, and physical spaces (bathrooms, surgical changing rooms). One surgeon shared, “explaining to the entire operating room that ‘excuse me, I need 5 extra minutes to go find a bathroom that’s a single stall, that’s not being occupied’ is not something I should have to do a couple of times a day.”
SURPRISED BY RESPONSES
Dr. Westafer said she was surprised by some of the responses they received.
“I was shocked by how common it was that physicians were ‘outed’ as transgender by faculty and administrative procedures – things like welcoming new residents to a hospital using pre-transition names and photos,” she said. “This is one of the most sensitive bits of information about a person and once a person is seen as transgender, the data shows people have a really hard time using the right name, the right pronouns, and just treat them differently. And it seems that most hospital programs across the country haven’t gotten this right.”
The authors identified critical steps that individuals and institutions could and should take to mitigate the stigma and transphobia present in hospitals and clinics. At the individual level, and most fundamentally, study participants sought colleagues that would speak up against mistreatment. For example, one participant shared: “We can’t do it alone. We, as transgender humans, nonbinary individuals, historically have been so low on the social ladder—and we're gaining. But at the same time, we can’t do it alone. We can’t necessarily purely advocate for ourselves. And even [if] we do, we need allies. And we need people that, you know, to stand with us and say, ‘Hey, this is not okay.’”
Additionally, institutions can provide administrative assistance with transitioning, gender neutral bathrooms and changing spaces, and examine the trainings they provide and focus on implicit biases. Most importantly, the study findings clearly demonstrate that institutions must not be reactive. That is, they must not wait until a transgender or gender expansive person comes to them to troubleshoot these items, as that forces individuals to reveal that they are transgender.
Co-author and Emergency Medicine resident at Baystate Medical Center, Dr. El Ragone, who also identifies as gender expansive, reflected on the study.
“Although significant work remains to be done to improve the experience of transgender and gender diverse physicians, Baystate’s support of studies like this one demonstrates its ongoing commitment to improving care and well-being not only for its patients but for its employees as well,” said Dr. Ragone.
FULL STUDY TEXT AVAILABLE
To access full text of the article, visit the JAMA website.
Learn more about Research and Diversity, Equity & Inclusion at Baystate Health.
See MassLive's coverage of this story: "Study on transgender physicians shows lack of professional support"