SPRINGFIELD — A study is calling for both “structural and interpersonal changes” to promote inclusion of transgender physicians in the workplace and to address what it calls “emotional distress associated with overt and subtle transphobia throughout the spectrum of medical training and practice.”
The study, “Experiences of Transgender and Gender Expansive Physicians,” was initiated and authored by Baystate Medical Center physicians to address what it calls a “paucity of data” on physicians who identify as transgender and/or gender-expansive, defined as an “umbrella term encompassing individuals and gender identities that may exist beyond the binary framework.”
It highlights a range of abuse experienced by the two dozen physicians interviewed, from the incorrect use of pronouns to conflating their gender identity with mental illness, as well as the difficulty some of them have had finding their own gender-affirming care. It was published June 29 on the JAMA Network of the American Medical Association. The network is a consortium of peer-reviewed, top-ranked medical publications.
The study reports that many of those interviewed “noted that nonbinary gender identities were poorly understood by fellow physicians and patients,” mirroring a similar lack of understanding that Dr. Lauren M. Westafer, lead author and Baystate emergency department physician, agrees is found in society.
“People perceive gender as being a man versus being a woman and that holds a lot of problems because gender is a lot more complicated than that at every level,” said Westafer, also a researcher in the Department of Healthcare Delivery and Population Sciences at the UMass Chan Medical School-Baystate Campus.
“Transgender people are people whose gender identity and/or expression is different than the cultural expectations based on what they were assigned at birth, and gender expansive encompasses those beyond man and woman. These are individuals who may identify as non-binary or genderqueer.”
Westafer said she hopes colleagues will start to speak up when they hear a transgender or gender-expansive physician called by incorrect pronouns, something referred to as “misgendering,” followed by institutional changes.
“My first hope is that the study will motivate people to take individual-level steps,” Westafer said. “A lot of what those interviewed talked about was whether people around them chose to stand up for them or chose to treat them with disrespect.”
She added that “people really need to pay attention to language and approach things in a more inclusive manner.”
“If I say my name is Lauren and you were to call me Sheila or Kelly or Joe, I would not take it, and we need to transfer that same respect to people who identify as transgender or gender expansive,” Westafer said.
She said institutions could help foster such respect by having a plan in place when “someone does transition.”
“They should not wait for an employee to come and say they are transgender and ask what should they do or face going through changing insurance paper work, ID badges or log-ons and emails by themselves,” Westafer said. “The institution should be able to prepare the community all at once and say the name of the person is this, and these are the pronouns they use and this is how they should be addressed.”
Westafer said she began the the study thinking people might be “less transphobic and better educated about gender” in the medical community where diversity training, patient respect and knowledge about discrimination faced by certain patient populations in health care is built into the curriculum.
“It wasn’t the case and I think it is because delivering a seminar on gender identity does not get at the root which is transphobia,” Westafer said. “You can stuff in as much new knowledge as you want, but unless you change the core attitude which is bias discrimination, you cannot change that person.”
She said some steps that can be taken toward building more gender-inclusive institutions is to have a “zero-tolerance policy if someone engages in transphobia, for example, refusing repeatedly to use someone’s right name or pronouns” and “during orientation tell people where the gender-inclusive spaces are located without anyone having to ask.”
The study reports a lack of workplace policies to address what to do when a patient exhibits bias and discrimination against a physician on the basis of gender identity or gender expression, and a continuation of policies that make it uncomfortable for a physician to disclose their gender identity in the workplace.
Westafer said Baystate approved the national study being undertaken and at least one of its departments has begun to implement some of the study’s recommendations.
The mean age of the 24 physicians interviewed was 39. Eight identified as transgender women, seven as transgender men, four as nonbinary, three as transgender and nonbinary, and 2 as genderqueer. Fifty percent of the study team members identified as LGBTQIA+, including members who identified as transgender and gender-expansive.
Those interviewed represent a variety of fields in medicine from family medicine to surgical specialties, practice in a variety of settings and are at different points in their career.