American doctors report lacking training in transgender-specific care

(Reuters Health) - Most primary care physicians in the U.S. are willing to provide routine care to transgender individuals, but that doesn’t mean they are well prepared to do so, a small study suggests.

Overall, 86 percent of doctors who responded were willing to provide routine care to transgender patients and 79 percent were willing to give Pap tests to transgender men to screen for cervical cancer, according to the results reported in Annals of Family Medicine.

Many physicians, however, reported a lack of familiarity with transgender transition care guidelines, lack of training in transgender-specific care, lack of exposure to transgender patients, and lack of knowledge about transgender patients among office staff, medical assistants or nursing staff.

These barriers suggest that willingness is not necessarily equivalent to competence, study leader Deirdre Shires of Michigan State University in East Lansing told Reuters Health by email.

“A number of studies have shown that transgender people often have negative experiences when they try to access healthcare services, including experiencing bias, harassment and even being denied care altogether,” Shires said. “What we realized is that no one had really gotten the perspective of providers to find out why this was happening.”

Shires’ team sent surveys to 308 internal medicine and family practice doctors in a large Midwest health system and had evaluable responses from 140 of them.

Doctors who had met transgender people were more willing to provide Pap tests to transgender men, the researchers found. And older doctors in the survey were less willing than their younger peers to provide routine care to transgender patients.

“Medical knowledge and clinical experience may be less important than personally feeling comfortable with transgender people,” Shires said. “Therefore, it is important for medical education to address not only clinical knowledge but also personal biases and attitudes as well.”

John Ayers, a public health researcher at the University of California, San Diego, agrees.

“A lack of training was not associated with a willingness to provide care, instead the more important factor is having experience with transgender people,” said Ayers, who was not involved in the study.

“During the 80’s and early 90’s some doctors were unwilling to care for AIDS patients, but as familiarity with HIV grew this problem abated.”

The study was restricted to only one medical system, so the findings might not be widely applicable, the researchers point out.

Another limitation, notes Dr. Janelle Downing of the University of South Carolina in Columbia, who was not involved in the study, is that so many of the doctors invited to participate declined to do so.

For that reason, the responses are “likely an overreport of willingness to provide care,” because clinicians who felt uncomfortable with transgender populations may have declined to respond to the survey, Downing said.

“As more individuals are identifying as a gender other than that assigned to them at birth, younger providers are more likely to know transgender individuals and therefore more comfortable providing care for them,” Dr. Carl Streed, Jr. of the Center for Transgender Medicine and Surgery at the Boston Medical Center, suggested in an email.

Streed, who was not involved in the study, said, “Given the significant lack of training in sexual and gender minority health in medical schools, it is no surprise that providers are unfamiliar with transgender health issues and primary care needs.”

“This is also rooted historically in the shuttering of transgender clinics across the United States in the late 1970’s and 1980’s,” Streed added.

A 2016 study by The Williams Institute at the UCLA School of Law estimated that 0.6 percent of American adults, or 1.4 million individuals, identify as transgender.

Our Standards: The Thomson Reuters Trust Principles.