Transgender People in Rural America Struggle to Find Doctors Willing or Able to Provide Care – Tennessee Lookout

For Tammy Rainey, finding a health care provider who knows about gender-affirming care has been a challenge in the rural Mississippi town where she lives.

As a transgender woman, Rainey needs the hormone estrogen, which allows her to physically change and develop a female appearance. But when she asked her doctor to prescribe estrogen, he said he could not give her such care.

“He’s usually a good guy and he doesn’t discriminate. “He gets my name and pronunciation right,” Rainey said. “But when I asked him about hormones, he said, ‘I don’t know enough about that. I don’t want to be involved in that.'”

So Rainey drives about 170 miles round trip every six months to get estrogen from a clinic in Memphis, Tennessee, to take home.

The barriers Rainey faces to access care reflect a type of health care inequality that rural US residents often face: a lack of education about health-related care among small-town health professionals who may no longer want to study.

“Physicians across the country are clearly realizing that there is a knowledge gap in providing acceptable care for men and women,” said Dr. Morissa Ladinsky, a pediatrician who leads the Youth Multidisciplinary Gender Team at the University of Alabama-Birmingham.

An accurate estimate of the transgender population in rural America is hampered by the lack of US census and comparable state data. However, the Movement Advancement Project, a non-profit organization that advocates for LGBTQ+ issues, used 2014-17 Centers for Disease Control and Prevention data from selected ZIP codes in 35 states to estimate that about one in five adults are one in the US lives in rural areas. region. When the report was released in 2019, there were more than 1.4 million people 13 and older nationwide. That number is now at least 1.6 million, according to the Williams Institute, a nonprofit think tank at the UCLA School of Law.

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One in three transgender people was stigmatized by a health care provider in the year leading up to the 2015 US Transgender Survey Report, according to MAP’s analysis. In addition, a third of all people living with HIV say they need to educate their doctor about their health care in order to receive the right treatment, and 62% worry about being misjudged by a health care provider because of their sexuality or sexuality, according to the report. has been collected. and the Williams Institute and other institutions.

A shortage of skilled transcare providers in rural areas could mean pushing out gay-affirming clinics in big cities. Rural residents are three times more likely than all adults to travel 25 to 49 miles for regular care.

In Colorado, for example, many transients outside of Denver struggle to find the right care. Those with mixed support are more likely to receive health screenings, delay care due to discrimination, and attempt suicide, according to the results of the Colorado Transgender Health Survey published in 2018.

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The lack of mainstream care for transgender people is linked to insufficient education on LGBTQ+ health in medical schools across the country. In 2014, the Association of American Medical Colleges, which represents 170 accredited medical schools in the United States and Canada, released its first LGBTQ+ patient care policy. As of 2018, 76% of medical schools have included LGBTQ health topics in their curriculum, and half offer three or fewer classes on the topic.

Perhaps because of this, about 77% of students from 10 medical schools in New England felt “insufficient” or “inadequate” in treating gender minority patients, according to a 2018 pilot study. Another paper, published last year, found that even physicians who work in public health clinics lack knowledge about hormones, gender-affirming surgery procedures, and how to use proper pronouns and inclusive language.

Throughout medical school, primary care was only mentioned briefly in endocrinology class, said Dr. Justin Bailey, who received his medical degree from UAB in 2021 and now lives there. “I don’t want to say the wrong thing or use the wrong pronunciation, so I was a bit hesitant and a little slow when I was interviewing and treating these patients,” he said.

On top of inadequate medical school training, some practicing doctors don’t take the time to educate themselves about transanthus, said Kathie Moehlig, founder of TransFamily Support Services, a non-profit organization that provides a variety of services to transgender people and their families. They are well-intentioned but uneducated when it comes to transgender care, he said.

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Some medical schools, such as UAB, have pushed for change. Since 2017, Ladinsky and colleagues have worked to integrate more people into their patient-centered program, which provides medical students with experience and feedback by interacting with “patients” in simulated clinical settings.

For example, a person pretending to be sick can fake acid reflux by pretending to have stomach and chest pains. Then, during the screening, they will show that they are transgender.

In the early years of the program, some students at the bedside may transition as soon as they identify with gender, said Elaine Stephens, a woman who participates in UAB’s patient-centered program. “Sometimes they start asking about sex,” Stephens said.

Since UAB launched its program, student behavior has changed dramatically, he said.

This progress is being followed by other medical schools, Moehlig said. “But it’s a slow start, and these are big organizations that take time to get going.”

Providers are also working outside of medical schools to improve rural care. In Colorado, the nonprofit organization Extension for Community Health Outcomes, or ECHO Colorado, has been offering monthly classes on gay-affirming care to rural providers since 2020. Providers to learn about hormone therapy management, appropriate terminology, surgical procedures, and patient health support.

Vanderbilt University Medical Center.  (Photo: John Partipilo)
Vanderbilt University Medical Center. (Photo: John Partipilo)

For years, doctors have not recognized the importance of learning about gender-affirming care, said Dr. Caroline Kirsch, director of osteopathic education at the University of Wyoming Family Medicine Residency Program-Casper. In Casper, this led to “a lot of patients going to Colorado for treatment, which is a huge burden on them financially,” said Kirsch, who participated in the ECHO Colorado program.

He said: “The things that have not been taught well in the history of medical school are things that I think many doctors are afraid to worry about. “The earlier you learn about this type of care in your career, the more you can see its potential and stop worrying about it.”

Educating more providers about transition-related care has become more important in recent years as gay-affirming clinics across the country have faced increasing incidents of harassment and intimidation. For example, Vanderbilt University Medical Center’s Transgender Health Clinic was the target of right-wing hate speech on social media last year. After intense pressure from Republican lawmakers in Tennessee, the hospital stopped gay-affirming surgeries for patients under the age of 18, potentially leaving many children without proper care.

Stephens hopes to see more medical schools integrate medical education. They also want doctors to treat people with infectious diseases like any other patient.

“Just provide good medical care,” he tells medical students at UAB. “We need health care like everyone else.”

KHN (Kaiser Health News) is a national news outlet that produces in-depth health journalism. Along with Policy Analysis and Polling, KHN is one of the three major programs of the KFF (Kaiser Family Foundation). KFF is a non-profit organization that provides health information to the nation.

KHN (Kaiser Health News) is a national news outlet that produces in-depth health journalism. Along with Policy Analysis and Polling, KHN is one of the three major programs of the KFF (Kaiser Family Foundation). KFF is a non-profit organization that provides health information to the nation.


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