As the Supreme Court makes a pair of historic same-sex marriage rulings, lesbian, gay, bisexual, and transgender providers discuss sexuality and their careers.
[Editor’s Note: This story has been updated and corrected since its original post date of June 26]
Nurse practitioner Teri Bunker, who opened her own medical practice 10 years ago, recalls several patients not returning after learning that she was a lesbian.
Today, 48-year-old Bunker, who runs the five-provider, Portland, Ore.-based Bridge City Family Medical Clinic, says that’s rarely the case anymore. In fact, her sexual orientation, as well as her practice’s open-arms acceptance of - and marketing toward - lesbian, gay, bisexual, and transgender (LGBT) patients has helped her carve out a unique niche in her community. This is especially important for transgender patients, whom she says are often mocked and misunderstood by healthcare providers.
“It’s been a lot easier lately, definitely,” Bunker told Physicians Practice. “I have an HRC [Human Rights Campaign] sticker on my front door to this clinic. I have Advocate magazines in my waiting room, and I advertise on my website as having a special interest in gay, lesbian, and transgender issues. I’m known as a provider who takes care of [these] patients. So there has been more comfort to come out in that regard.”
Just as it’s becoming easier for LGBT physicians to experience a life of equality - just a few hours ago, the Supreme Court struck down the Defense of Marriage Act and upheld California's same-sex marriage law - times are changing for LGBT physicians and other healthcare providers, too.
As recently as the 1990s and 2000s, LGBT physicians remember lack of acceptance by major medical organizations. Others remember the issue of sexuality being mocked during medical school, and fearing discrimination while undergoing their residency training.
But while the way LGBT physicians are being treated has improved, organizations such as GLMA: Health Professionals Advancing LGBT Equality (formerly the Gay Lesbian Medical Association) are still fighting hard to ensure all physicians have the same professional opportunities and privileges, from the time they enter medical school to the end of their professional careers.
How Times Have Changed
Family medicine physician Ted Eytan, who has known he was gay since childhood, hasn’t forgotten the fear he felt of being bullied when he applied to medical school. Although the 44-year-old’s father was a physician, he had no LGBT physician role models in Phoenix, where he grew up. Eytan spent the 1990s in medical school, a time when he believes some medical associations were denying membership to lesbian, gay, bisexual, and transgender physicians.
Perhaps most illustrative of the challenges LGBT physicians faced in the 1990s are Eytan’s recollections of a class he took on LGBT issues in medical school.
“Every medical school at some point has a class on ‘dealing with LGBT,’” says Eytan. “And ours was an absolute disaster. The faculty person came in, was clearly uncomfortable having the conversation … and the students were just throwing stuff out, like, ‘What about the gerbil and Richard Gere?’ sort of questions. I’m watching, I’m looking at the faculty member, and he’s not coming back at them, he’s allowing it.”
What Eytan learned from that experience was that one day, when he would become a med school faculty member, he would teach the class differently. “Later on, at University of Washington, I did lead that class, 10 years later and it was awesome,” says Eytan. “I walked in, and said, ‘whether or not you know it, 10 percent of you are LGBT and here’s how it’s going to be.’ It was a wonderful experience. We set a different norm.”
Eytan works fulltime as the physician director for the Kaiser Permanente Center for Total Health in Washington, D.C., a high-tech meeting and event space designed to spark conversations about health.
Today, healthcare organizations such as Kaiser Permanente are setting a new tone. The company has key sponsorship roles in both Capital Pride, a Washington, D.C., non-profit organization that serves the LGBT community through educational events, entertainment, and community outreach, and Capital Transpride (a subset of Capital Pride). The AMA has taken huge steps to show its support for LGBT physicians - even creating a gay, lesbian, bisexual, transgender (GLBT) advisory committee and welcoming GLMA into its House of Delegates earlier this month.
“The AMA’s GLBT Advisory Committee is very active, and has played a very critical role in laying the foundation for a lot of policy the AMA has with sexual identity and non-discrimination,” says 64-year-old Desi Bailey, a Seattle-based anesthesiologist who is president of GLMA.
But there is still more work that needs to be done on the part of healthcare organizations to recognize the unique needs of LGBT physicians and patients, she says.
“We hope to improve education and training in LGBT health issues, to improve curricula in the medical schools [and] the training that medical school students get,” says Bailey, who draws parallels between LGBT discrimination and the discrimination she experienced as a female in medical school in the 1970s, years before she came out as a lesbian. “Residents get little training on LGBT issues; 40 percent of physicians receive no training at all.”
Coming Out to Patients - or Not
While discrimination against LGBT patients has eased, the decision of whether to come out to patients is a multifaceted one. First, there’s the issue of whether and to what extent it’s necessary.
“I think the sexual orientation of the practitioner is not necessarily that pertinent to the care he or she provides to the patient,” says Bailey, adding that an exception is patients who actively seek an LGBT or LGBT-friendly physician. “I have a colleague who is a cardiologist. There is no reason for her to be out as a lesbian or a transgender person or whatever to her cardiology patients. In my own practice as an anesthesiologist, I may disclose more often to a patient that I’ve had breast cancer than I would that I’m a lesbian, because in those circumstances, when you’re talking to a patient, you’re trying to establish a bond or trust so they’re willing to let you take care of them.”
While Bunker actively markets her openness toward LGBT patients, she says she will only mention her wife, life, or her sexuality when asked a question that elicits a response inclusive of these things.
“I try to just be open and honest,” says Bunker. “I don’t flaunt it and say, ‘I’m Teri Bunker, your gay family nurse practitioner.’ I don’t hide who I am, but I don’t just talk about it a lot.”
Eytan says physicians shouldn’t feel they need to hide or purposefully swap words in conversation - for example, by saying “my spouse” instead of “my husband” - to hide their sexual orientation.
“I don’t like saying things like ‘be aware of your surroundings, know when to come out’ because I don’t to like perpetuate the idea that you can’t be who you are,” says Eytan. “I would say, once you get your [medical degree], they can’t take it away. Be a role model when you can be to your patients and to your colleagues because your patients are depending on that. Sometimes they don’t have the opportunity to advocate for themselves when you can.”