Why Transgender Representation and Inclusion Matter

Laer Streeter, MD, MPH (they/them)

In 2021, I published a perspective piece in the New England Journal of Medicine about my experience not matching into obstetrics and gynecology during the 2019–20 cycle¹. I argued that although not blatant, subconscious transphobia and racism contributed to my outcome. Some may ask why—other than the heartbreak by any one unmatched individual—this might matter on a larger scale. However, my inclusion in the medical field, along with all other transgender-identifying health care professionals, is all the more essential when we have strong evidence demonstrating that the presence of physicians who share the same marginalized identity as their patients ultimately improves health outcomes².

The number of young people who identify as part of the transgender community has nearly doubled within the past few years^3,4,5, which experts anticipate will only continue to increase in part due to greater understanding of gender-inclusive language, acceptance of nonbinary identities, and increased visibility of the transgender community on social media. Given this data, residencies should anticipate receiving more applications each year from medical students who identify as transgender or nonbinary—and caring for greater numbers of patients who identify as transgender or nonbinary.

Limited research currently exists on transgender-identifying health care professionals, and many within the community continue to express lack of support and discrimination^6,7. My experience in obstetrics and gynecology—as someone who identifies as Black, queer, and transmasculine/nonbinary—is no exception. Despite the clear need for further data, none of the published studies on transgender diversity and inclusivity that currently exist have explored obstetrics and gynecology programs. Obstetrics and gynecology programs, even if well intentioned, may not have the resources and knowledge needed to incentivize and match transgender applicants into their programs.

To help understand the gaps in providing a more gender-inclusive workplace culture, I have created a needs assessment that has been distributed to obstetrics and gynecology programs across the country. The information gathered will be used to develop a best practice guide that programs can reference to help diversify and improve the working environment for transgender residents. Any health care professional affiliated with an accredited obstetrics and gynecology residency can help me make our field more inclusive by taking the needs assessment survey.

Transgender representation matters, but inclusion is essential as well. Only once we begin including transgender and nonbinary people in our training programs, residencies, and workplaces can we improve upon gender-affirming patient care.

References

1. Streeter LH. Holding Open the Door for Others Like Me. New England Journal of Medicine. 2021;385(7):e27. doi:10.1056/nejmpv2111269
2. Silver JK, Bean AC, Slocum C, et al. Physician Workforce Disparities and Patient Care: A Narrative Review. Health Equity. 2019;3. doi:10.1089/heq.2019.0040
3. Herman JL, Flores AR, O’neill KK. HOW MANY ADULTS AND YOUTH IDENTIFY AS TRANSGENDER IN THE UNITED STATES? EXECUTIVE SUMMARY. Published online 2022. doi:10.15585/mmwr.mm6803a3
4. Medical School Graduation Questionnaire: 2022 All Schools Summary Report.; 2022.
5. Matriculating Student Questionnaire. Published online 2018. Accessed May 31, 2023. www.aamc.org/data/msq.
6. Kvach EJ, Weinand J, O’Connell R. Experiences of Transgender and Nonbinary Physicians During Medical Residency Program Application. J Grad Med Educ. 2021;13(2):201-205. doi:10.4300/JGME-D-20-00384.1
7. Dimant OE, Cook TE, Greene RE, Radix AE. Experiences of Transgender and Gender Nonbinary Medical Students and Physicians. doi:10.1089/trgh.2019.0021

For more information, please refer to ACOG’s Frequently Asked Questions on Health Care for Transgender and Nonbinary Adults.

This June, ACOG wants to hear from members about what the Human Rights Campaign’s theme of Without Exception means to them in 2023. Email [email protected] to share your thoughts.

Disclaimer: Published submissions reflect the experiences of individual ACOG members and may not represent official organizational opinions of ACOG.