Medicine Made LGBTQ+ Health the Problem. Medical Schools Can Help Course Correct.

In our recent piece in the New England Journal of Medicine (NEJM), we trace the long history of cruelty perpetuated against sexual and gender minority groups (LGBTQ+ people) in the 212-year history of the NEJM. This is just one small part of a much larger story that must be grappled with if we are to truly heal the suffering too many LGBTQ+ people have sustained at the hands of our healthcare system.

Unfortunately, medical schools have always been part of the problem. The many doctors who have written in the NEJM were also pillars of medical education. They taught and wrote the textbooks and research used to rationalize institutionalization and criminalization of gender nonconformity and same-sex relations.

Today, more than 7% of Americans identify as LGBTQ+, and for younger people that number is over 20%. But many doctors practicing today say they are under-prepared to care for the unique needs of this patient population. LGBTQ+ people live in every state, in both rural and suburban neighborhoods, and carry many other intersecting identities that deserve to be understood. We hear over and over that the care out there today is inadequate, out of reach, and even more concerningly, outright hostile.

As we uncovered in our NEJM piece, medicine has spent more time trying to change LGBTQ+ people than accepting and helping them. This stigmatization by doctors leads to bad healthcare; it’s no wonder that LGBTQ+ patients suffer from certain outsized health disparities. This is an emergency that medicine created and medicine must fix. But instead of repairing the damage, medical schools continue to ignore LGBTQ+ patient care.

In 2011, a groundbreaking study found that medical schools included a median of just 5 hours of LGBTQ-related education throughout the entire curriculum. Medical schools and the Association of American Medical Colleges (AAMC) took notice of the study, and in 2014, the AAMC came out with “Implementing Curricular and Institutional Climate Changes to Improve Health Care for Individuals Who are LGBT, Gender Nonconforming, or Born with DSD: A Resource for Medical Educators.” A few high-profile examples of the integration of this work from University of Louisville and Harvard Medical School followed. Yet, no widespread adoption occurred.

We recently undertook and published the newest study on LGBTQ+ medical education, which showed that the time invested has risen to a median of 11 hours. For those schools that didn’t participate, we wonder what — if anything — is being taught. In some places, the misinformation being championed by politicians and online about transgender health may be the only message young medical students are hearing. It would be a grave mistake for medical schools to allow this to go unchecked, just as they did in the past.

While some progress is better than none, 11 hours is a modest amount by any measure, and nothing compared to the number of hours it takes for any new competency to be learned and mastered. We’ve heard every excuse from medical school leaders and faculty about the lack of LGBTQ+ issues reflected in their current curriculum. “There isn’t enough time.” “It isn’t required on the exams.” “This is covered in residency. Or fellowships.” “We don’t have the faculty to teach this.”

We learned from our survey that too many schools still rely on students and faculty who are LGBTQ+ to provide lectures and workshops without compensation or support. Students are there to learn, and faculty identity does not equal expertise. LGBTQ+ healthcare has a body of evidence that requires proper training — just like everything else.

LGBTQ+ people continue to be denied the basic right of accessing safe and affirming healthcare. A recent report found that the ongoing experience of discrimination in healthcare is causing LGBTQ+ people to delay or avoid care altogether. And when avoiding care is no longer an option, LGBTQ+ people feel they have to guard themselves against insults from healthcare professionals or staff, and need to be careful about their appearance to be treated fairly when seeking care. All of this is leading to worse health for our patients and communities.

America’s physicians deserve to be trained in the decades of research and best practices in clinical care that now exist for LGBTQ+ patients. Medicine has a long history of treating us poorly, but we’re finally seeing a recent story of change. It’s time for medical schools to be part of that change.

Jessica Halem, MBA, spent 10 years in academic medicine at the University of Pennsylvania and Harvard Medical School and now serves as a strategic advisor to healthcare leaders. Carl Streed Jr., MD, MPH, is an associate professor of medicine at Boston University Chobanian and Avedisian School of Medicine, and research lead in the GenderCare Center at Boston Medical Center.