For Tammy Rainey, finding a healthcare provider who knows about gender-affirming care is a challenge in the rural town north of Mississippi where she lives.
As a transgender woman, Rainey needs the hormone estrogen, which allows her to physically transform by developing more feminine features. But when she asked her doctor to prescribe an estrogen pill, he said he couldn’t provide that kind of care.
“He is generally a good guy and doesn’t act prejudiced. He got my name and pronouns right,” Rainey said. “But when I asked him about hormones, he said, ‘I just feel like I don’t know enough about it. I don’t want to be part of that.’”
Related: Transgender care and abortion bans test government’s role in clinical care
So Rainey drives about 270 miles round-trip every six months to take home an estrogen supply from a clinic in Memphis, Tennessee.
The obstacles Rainey overcomes to access care illustrate a type of medical inequality commonly encountered by transgender people living in rural America: the general lack of education about care-related care. transgender among small-town medical professionals, who may also be reluctant to inquire.
Morissa Ladinsky, pediatrician who co-leas the Youth Multidisciplinary Gender Group at the University of Alabama-Birmingham, said: “It is clear to the medical communities across the country that there is an antagonism gap. knowledge in the delivery of sex-determined care.
Accurate counting of transgender people in rural America is hampered by the lack of U.S. census data and uniform state data. However, the Movement Progress Project, a nonprofit that advocates for LGBTQ+ issues, used the Centers for Disease Control and Prevention 2014-2017 data from ZIP codes selected at 35 states to estimate that about 1 in 6 transgender adults in the United States live in a rural area. area. When that report was released in 2019, there were an estimated 1.4 million transgender people ages 13 and older nationwide. That number is now at least 1.6 million, according to the Williams Institute, a nonprofit consulting organization at UCLA School of Law.
According to an analysis by MAP, one in three transgender people in rural areas was discriminated against by a healthcare provider in the year leading up to the 2015 Transgender American Survey Report. In addition, one-third of all transgender people said they must tell a doctor about their health care needs in order to receive appropriate care and 62% are worried about being treated by a provider. health care services rated negatively because of their sexual orientation or gender identity, according to data collected by the Williams Institute and other organizations.
The lack of local rural providers with knowledge of transgender care can mean that it takes longer to get to gender support clinics in urban areas. Rural transgender people are three times more likely to travel 25 to 49 miles for routine care than all transgender adults.
Not a Modern Healthcare subscriber? Sign up today.
In Colorado, for example, many transgender people outside of Denver struggle to find appropriate care. According to results from the Colorado Transgender Health Survey released in 2018, people with transgender service providers are more likely to receive a medical check-up, less likely to delay getting married. care due to discrimination and less likely to commit suicide.
Much of the lack of care for transgender people is related to inadequate LGBTQ+ health education in medical schools across the country. In 2014, the Association of American Medical Colleges, representing 170 accredited medical schools in the United States and Canada, issued the first curriculum guidance on caring for LGBTQ+ patients. As of 2018, 76% of medical schools included LGBTQ health topics in their curriculum, with half offering three or less classes on the topic.
Perhaps because of this, nearly 77% of students from 10 New England medical schools feel “incompetent” or “incompetent” in treating minority patients, according to one study. pilot 2018. Another paper, published last year, found that even clinicians working in transgender-friendly clinics lacked knowledge about endocrinology. factors, gender-affirming surgical options as well as appropriate pronoun use and language that integrates transgender people.
Dr Justin Bailey, who received his medical degree from UAB in 2021 and is now a resident there, said that throughout medical school, transgender care was only briefly mentioned in endocrinology class. “I didn’t want to say the wrong thing or use the wrong pronouns, so I was hesitant and a little timid in my approach to interviewing and treating this group of patients,” he said.
Kathie Moehlig, founder of TransFamily Support Services, a nonprofit organization that provides a variety of services to transgender people and their families, said that due to inadequate training in medical school, some practicing physicians The profession doesn’t take the time to teach itself about transgender people. “They are well-intentioned but uneducated when it comes to taking care of transgender people,” she said.
Some medical schools, like the one at UAB, have spurred change. Since 2017, Ladinsky and her colleagues have been working to include transgender people in their standard patient program, which gives medical students real-world experience and feedback by interacting with them. interact with “patients” in a simulated clinical environment.
For example, a transgender person playing a patient would simulate acid reflux by pretending to have pain in the abdomen and chest. Then during the test, they will reveal that they are transgender.
Elaine Stephens, a transgender woman who participates in UAB’s standard patient program, said that in the early years of the program, some students’ bed styles would change after the patient’s gender was determined. disclosure. “Sometimes they immediately start asking about sexual activity,” says Stephens.
She said that since UAB launched its program, student response has improved significantly.
Download Modern Healthcare’s app to stay informed when there’s breaking industry news.
This progress is being replicated by other medical schools, Moehlig said. “But it was a slow start and these are large organizations that take a long time to grow.”
Advocates are also working outside of medical schools to improve care in rural areas. In Colorado, the nonprofit Extension for Community Health Outcomes, or ECHO Colorado, has been offering monthly online classes on gender-based care to rural providers since 2020. This class became so popular that the organization created a 4-week training program in 2021 for providers to learn about hormone therapy management, proper terminology, surgical options, and more. and support patients’ mental health.
For years, doctors failed to recognize the need to learn about confirmatory care, says Dr. Caroline Kirsch, director of osteopathic education at the University of Wyoming-Casper Family Medicine Residency Program. gender determination. In Casper, this has resulted in “some patients coming to Colorado for care, which is a huge financial burden on them,” said Kirsch, who participated in the ECHO Colorado program.
“Things that haven’t been thoroughly taught historically in medical school are things that I think a lot of doctors get worried about at first,” she said. “The earlier you know about this type of care in your career, the more likely you are to see its potential and the less you worry about it.”
Educating more providers about transgender-related care has become increasingly important in recent years as gender-affirming clinics across the country experience increased harassment and intimidation. . The Vanderbilt University Medical Center Transgender Health Clinic, for example, was the target of far-right hate on social media last year. After growing pressure from Tennessee’s Republican lawmakers, the clinic halted sex reassignment surgeries for patients under 18, potentially leaving many transgender children unattended. necessary.
Stephens hopes to see more medical schools including courses in transgender healthcare. She also expects doctors to treat transgender people like any other patient.
“Just provide quality healthcare,” she told medical students at UAB. “We need health care like everyone else.”
Kaiser Health News is a national health policy news service. This is an editorially independent program of the Henry J. Kaiser Family Foundation not affiliated with Kaiser Permanente.
