Primary Care Clinicians’ Willingness to Care for Transgender Patients

Deirdre A. Shires; Daphna Stroumsa; Kim D. Jaffee; Michael R. Woodford

doi:10.1370/afm.2298

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Table 1

Clinician Characteristics, Exposure to Transgender Individuals, Barriers and Facilitators Related to Caring for Transgender Patients, and Willingness to Provide Care (N = 140)

Clinician characteristics	n (%)
Age (mean, SD)	39.7 (13.4)
Sex
Male	58 (41.4)
Female	82 (58.6)
Continent of origin
North America/Caribbean	91 (65.5)
Other	48 (34.5)
Political views
Liberal	66 (47.1)
Moderate	51 (36.4)
Conservative	23 (16.4)
Specialty
Internal medicine	97 (69.3)
Family medicine	43 (30.7)
Clinician type
Resident	73 (52.1)
Advanced practitioner	3 (2.1)
Attending physician	64 (45.7)
Exposure
Ever met a transgender person
Yes	106 (75.7)
No	34 (24.3)
Treated transgender patient in past 5 years
Yes	75 (53.6)
No	65 (46.4)
Empathy (mean, SD)a	5.4 (1.5)
Transphobia (mean, SD)^a	3.2 (1.1)
Barriers and Facilitators
Lack of training on transgender health^b
Yes	67 (47.9)
No	73 (52.1)
Lack of exposure to transgender patients
Yes	52 (37.1)
No	88 (62.9)
Lack of knowledge about transgender care among staffb
Yes	45 (32.1)
No	95 (67.9)
Lack of familiarity with transition care guidelines^b
Yes	73 (52.1)
No	67 (47.9)
Capable of providing routine care to transgender patients^b
Yes	96 (68.6)
No	44 (31.4)
Willingness to provide care
Willing to provide routine care for transgender patients^b	120 (85.7)
Willing to provide Pap tests for transgender men^b	104 (78.6)

Pap = Papanicoulou.
↵a Theoretical range 1–7. Higher score represents greater empathy or transphobia.
↵b Originally measured on a 7-point scale. Dichotomized for analysis (1-4=no, 5-7=yes).

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Table 2

Factors Associated With Primary Care Clinicians’ Willingness to Provide Routine Care for Transgender Patients and Pap Tests for Transgender Men (N = 140)

	Routine Care for Transgender Patients		Pap Test for Transgender Men

	No. (%)	P Value	No. (%)	P Value
Clinician characteristics
Age (mean, SD)		.042		.246
Willing	38.7 (13.2)		39.0 (13.4)
Not willing	45.3 (13.5)		42.2 (13.3)
Sex		.262		.511
Male	89.7		75.9
Female	82.9		80.5
Continent of origin		.002		.044
North America/Caribbean	92.3		83.5
Other	72.9		68.8
Political views		.379		.101
Liberal	89.4		86.4
Moderate	80.4		72.5
Conservative	87.0		69.6
Specialty		.940		.020
Internal medicine	85.6		73.2
Family medicine	86.0		90.7
Clinician type		.156		.165
Resident	90.4		83.6
Advanced practitioner	100.0		100.0
Attending MD	79.7		71.9
Exposure
Ever met a transgender person		.020		<.001
Yes	89.6		85.8
No	73.5		55.9
Transgender patient in past 5 years		.022		.012
Yes	92.0		86.7
No	78.5		69.2
Barriers & facilitators
Empathy (mean, SD)		.035		.083
Willing	5.5 (1.4)		5.5 (1.3)
Not willing	4.8 (1.6)		4.9 (1.8)
Transphobia (mean, SD)		.007		<.001
Willing	3.1 (1.0)		3.0 (1.0)
Not willing	3.8 (1.3)		3.8 (1.1)
Lack of training on transgender health		.240		.006
Yes	82.1		68.7
No	89.0		87.7
Lack of exposure to transgender patients		.022		.013
Yes	76.9		67.3
No	90.9		85.2
Lack of knowledge about transgender		.018		.018
care among staff
Yes	75.6		66.7
No	90.5		84.2
Lack of familiarity with guidelines		.782		.027
Yes	84.9		71.2
No	86.6		86.6
Capable of providing routine care		<.001		.043
Yes	99.0		83.3
No	56.8		68.2

Pap = Papanicoulou.

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The Article in Brief

Primary Care Clinicians' Willingness to Care for Transgender Patients

Deirdre A. Shires , and colleagues

Background Transgender patients report negative experiences in health care settings, but little is known about clinicians' willingness to care for them. This study surveyed primary care clinicians in an integrated Midwest health system.

What This Study Found Most, but not all, family medicine and general internal medicine clinicians are willing to provide routine care for transgender patients. The survey of 308 primary care clinicians found that 86 percent of respondents (n = 140) were willing to provide routine care to transgender patients and 79 percent were willing to provide Pap tests to transgender men. Willingness to provide routine care decreased with age. Willingness to provide Pap tests was higher among family physicians, those who had met a transgender person, and those who measured lower on a transphobia scale.

Implications

These findings, according to the authors, underscore the importance of integrating personal exposure to transgender individuals into medical education.