Local trans people talk access, competence in health care

Local trans people talk access, competence in health care

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Philadelphia is home to the largest trans wellness conference in the world, Mazzoni’s Philadelphia Trans Wellness Conference, a transgender fellowship training program and, soon, two LGBTQ-focused health care centers — the Mazzoni Center and a new Jefferson-sponsored center to open in 2020. 

But many trans folks in the greater Philadelphia area are waiting weeks for appointments for basic medical care.

“My access to health care has been up in the air and unstable for the last two years,” said Nathan Rodriguez, a 29-year-old trans man who lives in South Jersey. 

When Rodriguez moved from North Jersey to South Jersey, he transferred his medical care to the Mazzoni Center. He said at first the care was “OK” but over the last year he has struggled to get an appointment. 

Rodriguez occasionally experiences UTIs, which he contributes to his phalloplasty, surgery to construct a penis.  Familiar with UTI symptoms, Rodriguez called Mazzoni and booked an appointment in May. As the appointment neared, however, he received a call from Mazzoni to reschedule his appointment for the end of June because his doctor was unavailable. Rodriquez said he treated the symptoms with over-the-counter medications but the symptoms continued until his June appointment.

At the June appointment, a rapid test result indicated he had a severe UTI. The doctor said they would call in two prescriptions to Rodriquez’s pharmacy — one antibiotic and testosterone. Rodriquez went to pick up the prescriptions at his pharmacy 24 hours later and they had not been called in. He called Mazzoni and was told this issue would be marked urgent. After more than a week of back and forth with the pharmacy and Mazzoni, Rodriquez received his testosterone prescription but never the antibiotic. He gave up on getting the prescription and continued to treat the UTI with over-the-counter remedies. 

Gabrielle Gibson, a 35-year-old trans woman, has also struggled to receive consistent care at Mazzoni.

Gibson has been receiving care at Mazzoni since 2014. She indicated that in the last couple of years, “Mazzoni has got kind of confusing.”

“I called for an appointment in June, and they had to make my appointment for September. It boggled my mind because when I started going there I could write an email and get in. It gets really intense when I’m running low on my hormones. I wonder — will they refill them in time?” 

Mazzoni’s 2015 annual report indicated the health care services saw a dramatic 77 percent increase in overall patient visits from 2012 to 2015. In the 2016 report, 35 percent of the patients were transgender or genderqueer. However, patient visits have remained at around 22,000 from 2015 to 2018. It appears the trans patient population has also remained around 3,000 from 2015 to 2019. But trans-specific reporting and research are limited.

“Last time I called for an appointment at Mazzoni, they offered other places for me to go,” said Shayne Malcolm, a 35-year-old trans man who lives in Philadelphia. Malcolm has been receiving care at Mazzoni since 2009 and said, “They seemed less booked up then.” 

A 2015 study in the American Journal of Public Health that assessed U.S. academic facilities to determine if they had procedures to identify LGBT-competent doctors found that only 9 percent had such procedures and only 16 percent reported having comprehensive LGBT-competency training. This year, four providers left Mazzoni.

Recently, several providers have left Mazzoni Center to pursue other opportunities or for personal reasons. As a result, waiting times for nonemergency care, including care for new trans patients is currently 90 days. Because of the population we serve, we hire with care to ensure new clinicians are fully LGBTQ competent and a good fit with our patients and the community. Thus, bringing new providers takes a little longer. However, we are actively recruiting and have hired two new providers who will start this month. Our goal is to hire a full complement of providers by the end of the winter season,” said Mazzoni’s Director of Communication Larry Benjamin. 

Outside of Mazzoni, trans patients often experience different issues.

Gibson went to Cooper Hospital in New Jersey due to asthma-related issues, and she said she had no issues navigating their care. The staff used the correct pronouns and made sure to ask her name since her identification had not been updated. 

In contrast, she went to a doctor at Jefferson and felt he was asking unnecessary and inappropriate questions. She asked to see a different doctor. She said the second doctor was very excited to treat her because she was his first transgender patient.

“I didn’t feel uncomfortable about being the first. We are in this period of time where people are starting to understand,” said Gibson. 

Richard J. Webster, president of Thomas Jefferson University Hospitals, said, “Jefferson’s mission is to improve lives in the communities we serve. We are committed to providing the most comprehensive and competent care to the trans community and are proud to partner with many community organizations to meet that goal. Recently, Dr. Kathy L. Rumer began providing surgical services to the trans community at Jefferson Methodist Hospital. In collaboration with Dr. Rumer, a holistic LGBTQ health and wellness center is in the early stages of development.” 

Rodriguez said he doesn’t like to see doctors that aren’t well versed in trans-related care. He has traveled to Philadelphia for emergency room visits instead of going to closer ERs near his home in New Jersey. 

“I navigate a little better than the average trans person because I work in the insurance industry. I’ve helped people navigate what will be covered and how to get things covered. If I’m having this trouble, I can imagine what others are going through,” Rodriquez said.

Rodriquez said he is actively looking for a new general practitioner with greater availability. Living in South Jersey, he is willing to travel for care but only recently found one practice, PROUD Family Health in Somerville, NJ, under three hours away.

Liz Anastasi-Scott, a 42-year-old trans woman living in Philadelphia, recently moved her care from Mazzoni to a new practice. “I’ve been with Mazzoni three and a half years and just recently switched to Rittenhouse Women’s Wellness Center because of the inability to get an appointment,” said Anastasi-Scott.

She began going to Mazzoni when she started her transition and needed more specific trans-related care such as hormones. She felt like the doctors there were collaborative and open to the patient guiding their treatment, which she greatly appreciated. But she said she doesn’t need as much trans-centered health care now, and it’s not as critical to continue at Mazzoni.

Trans folks often have to choose between trans-competent care and local and immediate care. According to Mazzoni, some patients they serve travel up to eight hours for an appointment.

Updated 09/05/19 at 4:31 p.m.

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