While notable progress has been made regarding medical care for transgender individuals, there remains a significant health disparity among this population. Harvard Pilgrim would like to highlight the work being done at Boston Medical Center’s (BMC’s) Center for Transgender Medicine and Surgery to diminish this disparity by providing high-quality, comprehensive care to the transgender patient population — as well as employing an evidence-based approach to educating medical students and physicians in transgender medicine.
The current status of care
Barriers to quality care for transgender patients include financial support from payers, institutional workplace discrimination resulting in less income and less access to medical resources, and stigmatization. Yet, according to Dr. Josh Safer, an endocrinologist and the Medical Director for the Center for Transgender Medicine and Surgery, “While that’s all true, despite the often-egregious examples of real discrimination they face, polls of transgender individuals still indicate that the primary barrier to good care for transgender patients remains a knowledgeable clinical workforce. Physicians may be welcoming and respectful, but they haven’t been taught even the basics of trans-friendly care, so they are not comfortable or confident in providing it.”
Many medical training programs focus heavily on creating a welcoming environment for transgender individuals. Dr. Safer believes this is important and a very positive step, but it’s not enough without real knowledge about gender incongruence (when one’s gender identity does not match his/her external anatomy), data, and exposure to transgender people and interventions.
BMC’s education-driven approach
“I consider myself lucky because I actually am in a position to make some sort of incremental change,” says Dr. Safer. Through his curriculum at BMC-affiliated Boston University (BU) School of Medicine, as well as his work with medical residents at the hospital, Dr. Safer uses an evidence-based approach to teaching transgender medicine.
“One thing I do is speak ‘doctor speak,’ and I focus on things doctors want to know. What are the data that this treatment works, or that it’s safe? What is the evidence for harms, and for how we can protect people from these harms? I started with this approach at BU at the medical school level, and have since applied it to the residency level — and I think it’s definitely scalable to the practice level.”
BMC has drawn from its mission of taking care of underserved populations to be a leader in providing trans-friendly care for decades, through an interdisciplinary program that is administered within all existing departments. But with the recent creation of a dedicated Center for Transgender Medicine and Surgery and the Transgender Patient Task Force, transgender patients have a unified point of contact to help them navigate the system, while maintaining their relationship with their PCP, and the list of trans-friendly services continues to grow as gaps in care are identified.
Current services include hormone therapy, behavioral health support and primary care, plastic surgery procedures such as facial feminization and mammoplasty, dermatological care, and male-to-female gender affirmation/genital surgical procedures.
Boston Trans Health Institute in May
The Center for Transgender Medicine and Surgery, BU, and Rush University Medical Center have partnered to host the Boston Trans Health Institute on Friday, May 12. Registration for this event is free. For information about Harvard Pilgrim’s coordination of care for transgender patients, refer to this article from the August 2015 issue of Network Matters.