Transgender health care bans are sweeping across America. So are the repercussions
The 11th Circuit Court of Appeals recently allowed Florida’s ban on gender-affirming care for transgender youth to go back into effect.
In a dissenting opinion, Judge Charles Wilson stated, “This matter is a medical issue, where patients are best left to make decisions alongside health professionals, with access to complete, unbiased information, as needed.”
Wilson’s words demonstrate how bans like the one in Florida not only affect transgender individuals, but also disrupt health professionals’ ability to communicate with patients about evidence-based care.
While we should not forget transgender youths and their families are the central target of these bans, the legislation also interferes with healthcare providers’ ability to do their jobs. The systemic impact of these providers’ moral distress, and the medical brain drain and burnout that follows, means that these bans affect every single person in this country seeking health care.
As an LGBTQ health researcher, one of my current projects is interviewing gender-affirming care providers across the country to understand the impact of legislation on their practice. One thing has become abundantly clear: providers of gender care also provide other types of essential care to the general population.
While it’s true that a small number of provider specialists work solely at gender health clinics, the majority of people who provide gender-affirming care work in diverse fields of medicine, including pediatrics, adolescent medicine, family medicine, obstetrics and gynecology, and endocrinology, and are critical to providing lots of other types of care to all types of patients.
For example, one family medicine provider in the Midwest which provides gender-affirming care is also a key provider in a rural medicine clinic that serves multiple counties. That provider delivers babies, prescribes antidepressants, diagnoses acute health incidents and provides general primary care to people of all ages. Should the state pass a ban and cause this provider to move to a permissive state, the entire patient population will suffer.
Even someone like a pediatric endocrinologist typically has a large patient panel of youth with diabetes or thyroid conditions. When these providers leave a banned state because they feel targeted and cannot provide this medically necessary care the state loses these critical services. This leaves a large patient population without an essential healthcare provider.
An increasing number of clinicians are moving to other parts of the country due to gender-affirming care bans and the politicization of medicine. Laws banning essential care for transgender patients interfere with providers’ medical judgment and ability to make healthcare decisions with patients and families. Additionally, providers must take on heavy administrative and financial burdens to stay up to date on the legal landscape. Together, these conditions often are the cause of medial brain drain.
Medical brain drain has traditionally been used to describe physicians fleeing developing parts of the world in favor of practicing in developed countries. Healthcare professionals seek employment with greater technological advancement and higher salaries, leaving communities in developing countries without access to care. However, this drain can also be used to describe providers’ migration from banned states to states with legal protections. We’ve already seen medical brain drain happening to providers in states with abortion bans.
Moreover, medical students, residents and fellows are electing not to attend training programs in states where they cannot learn to provide gender-affirming care. Pediatrics residency programs and adolescent medicine fellowship programs are not filling in states like Iowa, Alabama and Texas because learners want a comprehensive education. If pediatric training programs aren’t filled, there will be shortages of providers for children and adolescents in these areas. This will lead to access issues and higher healthcare costs, and will disproportionately impact states in the South and large rural areas where significant health disparities already exist.
Health care is one of our most universal needs as a country, but the bans on medical care for transgender youth are making it harder for all children and adolescents, trans or not, to access the care they need. We all need access to well-trained and compassionate healthcare providers.
As we look ahead to the coming months, the Supreme Court will be deciding whether these bans are constitutional. We should all pay attention to that case, and speak out against legislation that negatively impacts our collective health system.
Laura Stamm, Ph.D., is an assistant professor and director of DEI at the University of Rochester Medical Center, and specializes in research on LGBTQ health.