BOSTON, September 16, 2022—A Viewpoint published in JAMA Pediatrics asserts that the numerous bills filed in 2021 and 2022 seeking to block access to gender-affirming care for transgender and gender diverse (TGD) adolescents have far-reaching repercussions for clinicians who work in gender-affirming care and for the broader medical community. The potential effects on clinicians include decline in personal health and well-being in addition to professional implications ranging from loss of licensure and income to criminal prosecution. The broader medical community faces the prospect of seeing fewer clinicians enter the field of transgender health as well as a sharp reduction in the current workforce dedicated to providing gender-affirming care.
“Much of the response to these bills, which includes advocacy to defeat them, rightly focuses on the devastating effects they are having on TGD youth and their families,” said senior author Dr. Alex S. Keuroghlian, who directs the National LGBTQIA+ Health Education Center at The Fenway Institute and the Massachusetts General Hospital Psychiatry Gender Identity Program. “In addition, the potential for personal and professional harm to clinicians is significant and should also be a part of this conversation.”
The professional implications of these bans, and the hostile climate they foster, includes harassment and threats of violence. Other professional concerns include the potential for criminal prosecution if clinical practice violates the legal bans on gender-affirming care, the need to hire legal counsel to ensure that clinical care is provided within legal boundaries, potential loss of professional licensure, and loss of income for having to curtail clinical practice or close it altogether.
The greatest effect on clinicians, however, is the moral distress engendered by being constrained from providing care that follows widely accepted pediatric guidelines and knowing that the failure to provide care will likely result in acute mental health crises among their patients.
“Bringing political ideology into clinical practice puts providers in a position of having to violate the most basic standard of care, which is to do no harm,” added Keuroghlian. “Following these laws will require clinicians to violate professional codes of ethics and take action that will almost surely harm the health of their young patients.”
“This push to block access to gender-affirming care may cause some clinicians to leave the field of transgender care altogether and discourage current medical and nursing students, residents, fellows, and other trainees from pursuing careers in transgender health,” said lead author Allysa Warling, B.A. of Harvard Medical School.
The Viewpoint offered three actions to mitigate the potential damage of bills and laws that seek to block access to gender-affirming care:
- Standardize training in gender-affirming care across undergraduate and graduate medical education and all health care professional curricula;
- Disseminate comprehensive, evidence-based clinical guidelines for increasing access to adolescent gender-affirming care; and
- Advocate for protection of adolescent gender-affirming care through state and federal policies beyond the necessary, yet insufficient, statements by health care professional associations.
“Clinician-Level Implications of Bans on Gender-Affirming Medical Care for Youth in the US” was published online by JAMA Pediatrics on August 8, 2022. It is available here.