Decreasing Disparities & Increasing Access for Transgender Patients

Led by then PA student Bethany Hart, a team from UT Southwestern Medical Center in Dallas, Texas, conducted a study of PA, medical and clinical nutrition students’ attitudes, clinical knowledge and clinical skills regarding transgender patients. The study raised awareness of health disparities for transgender persons and is poised to expand access to care.

A major barrier to health among transgender patients is limited access to clinicians who are willing to provide basic primary care services. Approximately 20-30% of transgender persons have no primary care provider, and, in Texas, transgender individuals are a marginalized population at high risk of adverse health outcomes.1

Be the CHANGE grantee Bethany Hart saw the lack of access firsthand.  Hart shared:  “Working as a Medical Assistant in a Family Medicine clinic that provided hormone therapy (HRT) to transgender patients, I saw the need for primary care providers who are comfortable caring for transgender patients. The few patients whose insurance would cover HRT management by an Endocrinologist could rarely afford the specialty copays and deductibles. Thus, our transgender patients usually established care seeking HRT alone but inherently gained a primary care provider as well.”

With no known studies on this topic regarding PA students or on implementing a transgender curriculum into PA programs, the team at UT Southwestern sought to close this gap.

They surveyed 1,000 medical students, 180 PA students and 40 clinical nutrition students at UT Southwestern using validated questions regarding transgender care attitudes, knowledge, and skills. They also held three focus groups to gather qualitative data.

In addition, the team provided a two-hour transgender health lecture for PA and nutrition students that focused on barriers to health, epidemiological trends, history and physical exam skills, and medical and surgical treatment options for gender dysphoria.

A post-lecture survey found students held overall positive personal views toward transgender patients and expressed desire for the addition of a transgender curriculum. PA students who attended the lecture reported higher levels of clinical skills and knowledge in the post survey compared to the pre survey.

Hart, now a Certified PA, and her team hope to use the study results to increase transgender patients’ access to both primary care and gender-transition care through improvements in education of future providers.  Further, their data may inform the development of a PA curriculum on transgender healthcare.

To share their findings, Hart and her team were accepted to present their work at the 2020 TEACH-S Educational Symposium and the 2020 World Professional Association for Transgender Health’s (WPATH) 26th Scientific Symposium.  WPATH is one of the foremost gatherings within the field of transgender health and showcased the team’s research as well as the role and contributions of PAs to transgender health experts. Check out her presentation below.

In addition, the study was subsequently published in the Journal of Physician Assistant Education.

This project was supported by the nccPA Health Foundation’s Be the CHANGE Grant.

1Korpaisarn, S., & Safer, J. D. (2018). Gaps in transgender medical education among healthcare providers: A major barrier to care for transgender persons. Reviews in Endocrine and Metabolic Disorders. doi:10.1007/s11154-018-9452

Related Resources