Q&A: How to Create a Nationally Recognized LGBTQ+ Clinic

A student-sponsored seminar held in 2011 that was attended by a senior physician who graduated from medical school in 1982 and another who had just completed residency sparked a professional partnership that led to the opening of a clinic specialist and national recognition of the academic training of doctors. health system 10 years later.


The chance encounter between internist Nicole Nisly, MD, and family medicine resident Katherine Imborek, MD, on a show produced by a group of transgender students led to the founding of the University of Iowa (UI) LGBTQ Health Care Clinic. At first, the clinic was only open one evening a week. But now it offers a full range of services delivered in a welcoming and nurturing environment to some 14,000 patients LGBTQ+ communitymany of whom travel long distances to get there.

The clinic serves as a catalyst for efforts to advance the equitable treatment and inclusion of LGBTQ+ patients, visitors, and employees across the University of Iowa’s healthcare enterprise, which includes University of Iowa Hospitals and Clinicsmember of the AMA Health System Program.

These efforts have been recognized by the Human Rights Campaign Foundation, which Named UI Health Care One of the Top LGBTQ+ Artists in Health Care Equality for having obtained a score of 95 (out of 100) on his Health Care Equity Index 2022.

The index measures the LGBTQ+ inclusiveness of a system’s patient, visit, and employee non-discrimination policies. It also requires staff training on LGBTQ+ cultural competency and includes bullet points on whether there are equal health insurance benefits for employees, employee resource groups, LGBTQ+ inclusive hiring efforts, and support. to transgender transitioning employees.

Three other members of the AMA Health System program—Atlantic Health, Henry Ford Health and Virginia Mason Franciscan Health— also received the honor from the Human Rights Campaign Foundation. The AMA Health System program provides leaders, physicians, and care teams with resources to advance programs to contribute to the future of medicine. Also, find out about the AMA LGBTQ Advisory Committeewhich addresses many important issues of interest to LGBTQ+ medical students, residents and fellows, LGBTQ+ physicians, patients, and their heterosexual allies.

Dr. Imborek, co-director of the LGBTQ+ Clinic and Clinical Professor of Family Medicine at the University of Iowa, took time to reflect on the clinic’s success, the growth of gender-affirming care that has created more options and access for transgender patients, and the political climate that threatens to reverse these gains.

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WADA: Can you explain the importance of the recognition of the Human Rights Campaign Foundation?

Dr.Imborek: Our clinic gives us a lot of momentum as an organization and is, in some ways, the driving force, but this recognition extends to our entire University of Iowa healthcare business. This makes it more meaningful because it is clear that UI Health Care – from all of our individual clinics to all of our individual units in the hospital – that we have people from top to bottom who have embraced our position and our commitment to providing a home and an affirmation to care.

WADA: Can you tell the story of the origins of the LGBTQ Clinic and how you and Dr. Nisly joined forces?

Dr.Imborek: It was a chance meeting. Dr. Nisly is quite humble, so I’m going to yell at him. Dr. Nisly is an exemplary ally of this community. You can ask, “How does an idea become a reality?” Sometimes it’s having those allies in positions of privilege or power who come forward as champions and make things happen.

This is the role played by Nicole. She had been a general practitioner in internal medicine for, oh my, over 20 years at the time we met, and had a panel of probably over 2,000 patients. She had a patient who identified as a transgender woman. And Nicole felt personally ill-equipped to deal with this patient, and because of this patient, she went to this program to learn more.

I went to this panel because I identify as a lesbian, and I had just completed my residency and knew that I was joining the faculty here and starting my own practice in one of our outlying clinics. I went to the source to determine what kind of admissions demographic questions we should ask all of our patients. We both went to the mic during the Q&A, and she grabbed me afterwards and said, “Hey, I’m thinking of opening an LGBTQ+ clinic. Would you like to do this with me? As someone who hadn’t joined the faculty yet, who hadn’t even gotten his residency degree, I was skeptical if that could happen because college is a big, slow machine.

You need perseverance, diligence and support to make things happen. I had no idea how much political capital and personal effort Nicole was willing to put in. I think we made a great team in that they knew how to navigate the system and I had had experience as a member of the queer community group and also had the time and energy that goes with it with the fact of being fresh out of residence.

WADA: Dr. Nisly said the operation of the LGBTQ clinic is to ask patients what they want to hear from their doctors. What have you heard from patients that you didn’t learn about in residency or medical school?

Dr.Imborek: The most important thing we learned was the power of language and the intentionality that needs to be done from the start with the training of all your staff – it really needs to go beyond doctors. A patient can finally get to the part of the visit where they are face to face with their doctor or other healthcare professional, who may be passionate, educated, and ready to give that patient a wonderful, respectful, expert medical , culturally appropriate visit.

But the patient has already had to interact with three to four other members of the healthcare team. And if they haven’t had some basic training in LGBTQ+ terms, the use of pronouns, and calling patients by the name they identify with, then this whole encounter could already be ruined. Some of the important things we learned were about how traumatic it can be for patients – especially those who identify as transgender or non-binary – to be misgendered by being referred to by the wrong pronouns or being referred to by what is called their “death”. Name.” This is usually their first name, which is not the name they use.

We knew how important it was to make sure we had cultural competency training for all of our staff, but we also knew how important it was to put things in place to operationalize some common things that we do . We knew we had to get the preferred name on the labels we use at the different places you go through the healthcare system. We were able to do things like that across the company, which was a game changer. We were able to embed someone’s preferred name and pronoun, as well as information about sexual orientation or gender identity, or “SOGI”, directly into the medical record. This information about pronouns, preferred name, gender identity and sex assigned at birth is captured as discrete data fields in the electronic medical record and follows patients through their journey through the system. health. , Doctors and other clinical staff can quickly access information such as whether a person has ovaries and a uterus, where you need to worry about whether they are pregnant. These things are important not only for building a relationship and being respectful, but also for making medical decisions.

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WADA: Where do your patients live?

Dr.Imborek: The majority of our facilities are located in Johnson County and I would say the majority of our patients come from outside of that county. So people think of course an LGBTQ+ clinic will work in Iowa City because it’s full of all these queer people.

But there are also many queer people in rural Iowa who have not been able to reliably receive gender-affirming and/or LGBTQ+ care, so they come into our system. Before COVID they were driving, and now that we, like many other places, have incorporated telemedecine— we were able to offer this option.

It’s something that, specifically, our LGBTQ+ patients really love. About half of my patient visits are done by video.

WADA: How has this field of medicine changed?

Dr.Imborek: When we started 10 years ago, we were probably one of the first academic institutions to set up an LGBTQ+ clinic. Since then, there have been more and more clinics started, both inside and outside universities, which is wonderful.

There has been growing acceptance, and we have many more doctors prescribing hormones and more surgeons providing gender-affirming care. We have seen more insurance companies cover these procedures and line up with what the AMA said years ago: that gender-affirming care – including hormones and procedures – was medically necessary.

Then, at the same time, we have recently seen an exponential and horrific increase in the number of anti-LGBTQ+ and, in particular, anti-trans and anti-trans youth bills being proposed and passed in state legislatures.

There are some really scary ones doing things like criminalizing the care of transgender children. This is a scary trend and one where science and proven medical evidence on the benefits of gender-affirming care prevail.

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