My partner and I moved to Maine last July, settling into life in the greater Portland area more completely than anywhere we've lived since college a decade ago. We have a nice group of local friends, an apartment within our budget, and have been really happy here. Except for one thing.

As someone living with a complex set of health issues, this is the longest I've ever gone without a nearby physician. Moreover, my partner recently got both health insurance for the first time in five years, and his letter to start transition hormones. I'm a sexuality/BDSM educator and an LGBT activist, my partner is a trans* person just starting out on the journey of medical transition, no matter how you look at it, we really need to have LGBT friendly medical care.

But despite living near a very LGBT accepting city, we just haven't had any success in finding it.

A huge part of the problem is that it is a rare medical practice that will say they aren't LGBT friendly. There is a local clinic that came well recommended by some of our straight/cis neighbors. I called them and asked if they considered themselves to be familiar with LGBT health concerns and was given the standard "we treat all our patients equally here" line. Being convenient to our house, I decided to give them a try, only to find that their waiting room literature included pamphlets from Focus on the Family, a notorious and far reaching anti-LGBT organization.

Stanford University's LGBT Medical Education Research Group published a study of more than 132 medical schools in the Journal of the American Medical Association, which found that on average, the unique healthcare needs of LGBT people amounted to only around five hours of the undergraduate medical student's education. Although there is a growing awareness of the need for greater coverage of our health needs in medical education, it does little good for our community now.

Additionally, much as I've found in my experience educating on Tourette Syndrome, acceptance and knowledge has to go beyond the immediate provider. In the case of a general practitioner, training in working with the LGBT community has to extend to the nurses, receptionists, accounts receivable department and other people in authority within the practice. I know someone who sees a doctor who himself is trans*, and yet the nurses and receptionists in the practice can't seem to get my friend's pronouns correct.

The experience of seeing a doctor is a complex one, and ideally all aspects of that experience should support and validate our lives. A glitch in one area can make someone less likely to seek out care in the future, and leave someone feeling negatively towards their own healthcare in a way that can prove destructive.

And I have literally no idea how to go about finding someone for my family.

My queer/LGBT friends in the area fall into two categories. Some have simple medical needs and given a limited relationship with their doctor, don't worry overmuch about LGBT knowledge or acceptance. The rest, including all of our trans* and genderqueer friends, see the same, quite wonderful physician, who unfortunately does not accept insurance.

I'm an itinerant sexuality educator, freelance writer, and event coordinator for BDSM conferences. My partner is hoping to be made full-time at Home Depot soon. Back in the days when we owned a moderately successful product design firm, maybe we could have payed for doctor visits out of pocket, hoping for some reimbursement from insurance. But not today. The prevailing attitude among my friends is that this is price you pay in Portland for being queer or trans*.

Don't get me wrong, I completely respect that there are a lot of good reasons why a medical practice might choose not to take insurance, and support their choice. What doesn't make sense to me is the idea that in a Combined Statistical Area with half a million people in it, there is precisely one medical practice that could work with our needs. Of course, don't forget that on top of being queer/LGBT friendly, we also need a medical practice that is good. The worst doctor I ever had was a gay man. Sure he was fine when it came to my needs as a queer guy, but he was crap when it came to the rest of my medical care.

It's tribalism to say that as queer/LGBT people, we should only see other queer/LGBT medical professionals for our healthcare, although I know a lot of people who take that route as an understandable shortcut. But as I become more and more frustrated by the entire prospect of finding the care we need, I can't help but wonder if those five hours of education are the best we can expect to get.