For Tammy Rainey, it was difficult to find health care providers who knew about gender-affirmation care in her rural northern Mississippi town.
As a transgender woman, Laney needs the hormone estrogen. But when she asked her doctor for an estrogen prescription, he said he couldn’t provide it.
Elaine Stephens will be screened by medical students in a standardized patient program at the University of Alabama at Birmingham. During the program’s first few years, revealing that she was transgender changed some students’ bedside attitudes. She said student response has improved significantly since the UAB started the program.
Courtesy of UAB Office of Standardized Patient Education/KHN
“He’s generally nice and open-minded. He gets my name and pronouns right,” Rainey said. “But when I asked him about hormones, he said, ‘I don’t feel like I know enough about it. I don’t want to get involved with it.
That’s why Rainey drives about 170 miles round trip every six months to get his supply of estrogen from a clinic in Memphis, Tennessee.
The barriers to access to care that Laney overcome illustrate the kind of medical injustice that transgender people in rural America often face. It is the general lack of education in trans-related care among small-town medical professionals.
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Morissa Radinsky, Ph.D., pediatrician and co-leader of the Interdisciplinary Youth Gender Team at the University of Alabama at Birmingham, said:
The Movement Advancement Project, a nonprofit advocating for LGBTQ+ issues, used data collected from 2014-2017 by the U.S. Centers for Disease Control and Prevention from select zip codes in 35 states to identify adult transgender individuals in the United States. estimated that about 1 in 6 of the population live in rural areas. When that report was released in 2019, there were an estimated 1.4 million transgender people aged 13 and older nationwide. 1.6 million people.
According to MAP’s analysis, one in three rural transgender people experienced discrimination by a health care provider in the year leading up to the 2015 United States Transgender Survey report. A third of her transgender individuals reported having to tell their doctors about their medical needs in order to receive appropriate care, and 62% said they had I am worried about being judged negatively by my healthcare provider. Williams Institute and other organizations.
The lack of transcare-savvy local rural health care providers can mean long drives to gender-affirming clinics in metropolitan areas. are three times more likely than all transgender adults to travel 25 to 49 miles for care.
For example, in Colorado, many transgender people outside of Denver struggle to find adequate care. People with diabetes are more likely to undergo medical examinations, are less likely to delay treatment because of discrimination, and are less likely to attempt suicide.
Much of the lack of care trans people experience 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, released its first Curriculum Guidelines for Care of LGBTQ+ Patients. As of 2018, 76% of medical schools have incorporated her LGBTQ health theme into their curriculum, and half offer his three or fewer classes on the topic.
This is probably why nearly 77% of students in 10 New England medical schools feel “incompetent” or “somewhat incompetent” in treating gender minority patients, according to a preliminary survey in 2018. is. A paper published last year found that even clinicians working in transgender-friendly clinics lack knowledge about hormones, gender-affirming surgical options, proper pronouns and the use of transgender-inclusive language.
Kathy Mourig, founder of Transfamily Support Services, a nonprofit that serves transgender people and their families, said some practitioners don’t take the time to educate themselves about transgender people. Told. They are very well-meaning when it comes to transgender care, but they are uneducated, she said.
Some medical colleges, like UAB, want change. Since 2017, Ladinsky and her colleagues have worked to include transgender people in standardized patient programs. It provides medical students with hands-on experience and feedback by interacting with ‘patients’ in a simulated clinical environment.
This progress has been replicated at other medical schools, Moehlig said. “But it’s a slow start and these are large institutions that will take a long time to move forward.”
Advocates also work outside medical schools to improve care in rural areas. In Colorado, the nonprofit Extension for Community Health Outcomes has been offering monthly virtual classes on gender-affirming care to rural health care providers since his 2020. The class is so popular that in 2021 the organization created his four-week bootcamp for providers to learn about hormone therapy administration. , appropriate terminology, surgical options, and patient mental health support.
Kaiser Health News is a national newsroom that produces in-depth journalism on health issues. KHN is one of his three main operating programs for the Kaiser Family Foundation, along with policy analysis and polls. KFF is a donated non-profit organization that provides information on health issues to the public.
