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Transgender people in rural America struggle to find doctors


Transgender people in rural America struggle to find doctors

Story by Helen Santoro (20 Jan 2023)

For Tammy Rainey, finding a health care provider who knows about gender-affirming care has been a challenge in the rural northern Mississippi town where she lives.

As a transgender woman, Rainey needs the hormone estrogen, which allows her to physically transition by developing more feminine features. But when she asked her doctor for an estrogen prescription, he said he couldn't provide that type of care.

"He's generally a good guy and doesn't act prejudiced. He gets my name and pronouns right," said Rainey. "But when I asked him about hormones, he said, 'I just don't feel like I know enough about that. I don't want to get involved in that.'"

So Rainey drives around 170 miles round trip every six months to get a supply of estrogen from a clinic in Memphis, Tennessee, to take home with her.

The obstacles Rainey overcomes to access care illustrate a type of medical inequity that transgender people who live in the rural U.S. often face: a general lack of education about trans-related care among small-town health professionals who might also be reluctant to learn.

This article included a link to a '60 Minutes' story about 'Health Care Challenges for Transgender Youth'. In case the link changes, I wanted to include it here:

The segment was produced by E. Alexandra Poolos and presented by Lesley Stahl.

It's not just in rural areas.

I live in suburban NYC, in a county of almost a million people, and as far as I have been able to find out, there's exactly one primary care doctor in our county who does LGBT care.  All the other people I've tried don't know anything about it and aren't all that interested in learning.  (One doctor I asked said, "we don't learn about it in medical school, so you can't expect anyone to know anything about it.")  I have to go to NYC to get any sort of LGBT-aware or LGBT-specific care.  I'm more fortunate than the woman in the news story, since I don't have to drive 170 miles for hormone prescriptions, but it's still a 2+ hour schlepp each way.

And it's not all that great in NYC, either.  The care at the LGBT clinic in NYC that I used to go to has been getting worse: it's harder and harder to get appointments, there's a lot of turnover, so whoever you saw last time won't be working there the next time you come in.  And you can't get hold of anyone there any more by phone or by patient portal.  I was able to find an endocrinologist (in NYC) and have been seeing her every 6 months, and I finally got a recommendation for a PCP (also in NYC) from the surgeon's office where I'm getting my SRS (hopefully!) who looks like she might work out.

A large part of it IMHO is the way the medical profession has been turned into the medical industry, run by large corporations who have been buying up the hospitals and medical practices and who squeeze the providers (doctors, nurses, etc.) and the patients to maximize their profit, while the insurance companies' practices make it practically impossible for smaller medical practices (who can't afford large departments dedicated to fighting with the insurance companies) to survive.  And since there's not much profit in providing medical care in small communities and rural areas, what practices and hospitals there are get closed.  We see that even in the suburbs -- the smaller local hospitals in our area are getting bought up and then closed and patients directed to the larger, more distant and more impersonal (but not necessarily better run) medical centers.

I am from NY and I am surprised. SRS/GRS is performed in the city, so I would think it would be supported in many ways.

In terms of the business side, yes, medicine across the board has gotten worse. It's about metrics and KPIs. It's become how IT support is run. Shift left management. Move duties and responsibilities to cheaper tiers and lean out staffing to optimize profit. Quality is down the list.


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