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For Ryan Rasdall, a Black transgender man who works as an associate at Boston law firm Goulston & Storrs, picking Fenway Health for health care was the obvious choice.
“I purposefully sought to get my primary care at Fenway Health because of their reputation for LGBTQ+ centered care,” says Rasdall, who has been a patient since 2017.
“As a Black transgender man, I have a history of negative interactions with medical providers that have questioned my gender and made me feel unwelcomed. These experiences have left me with residual anxiety and fear of engaging with health care professionals who are not explicitly providing LGBTQ+ culturally competent care,” Rasdall says. “Fenway Health provides a space where that burden is removed.”
Josh Linder, a gay man who has been a Fenway Health patient for more than 20 years, agrees. “[Fenway Health] has always felt like a safe space for all of my specific needs as a queer individual,” he says. “I have heard many horror stories over the years from friends seeking medical attention from other providers who have been made to feel ‘less-than’ when just asking for the most basic needs required for our community. It is a relief to know I will always be heard, understood, and treated with thoughtful care and respect.”
For more than 50 years, Fenway Health in Boston has flourished as an institution dedicated to health care as a right, not a privilege. They provide care to those who identify as lesbian, gay, bisexual, trans, queer, questioning, intersex, and asexual, as well as many people of color and others in the community. As of 2019, Fenway Health reports that it serves 33,613 patients from more than 1,296 zip codes.
Family planning and reproductive health
According to the Family Equality Council, more than 10.7 million adults identify as lesbian, gay, bisexual, transgender, or queer (LGBTQ) in the U.S. (and that number has only increased since the Family Equality Council’s 2017 report). Between 2 and 3.7 million children under age 18 have at least one LGBTQ+ parent. These individuals make up families that, like others, span the gamut of married, unmarried, cohabitating, separated, divorced, blended, and more.
But LGBTQ+ individuals often face unique challenges navigating the health care system, especially when it comes to family planning. Fenway Health offers resources for couples and single parents planning to start a family, whether they’re hoping to carry a child, use a gestational carrier, or adopt.
Some of these resources include at-home inseminations and support groups for those struggling with infertility, and drop-in groups for parents and prospective parents who are transgender, gender nonconforming, or non-binary to discuss gender and parenting.
Reproductive health is another specialty area where Fenway Health goes the extra mile to ensure the highest quality care for LGBTQ+ and gender-diverse patients. “There is no one way to provide reproductive health care services,” says Chris Viveiros, director of communications at Fenway Health. “We allow patients to be in the driver’s seat of their care while providing support and education along the way.”
Overall, “when patients come to Fenway Health, we understand that they expect a safe space where their identity is understood, and their needs are listened to,” Viveiros says. “We seek to normalize many of the ‘specialized’ services many of our patients seek: gender-affirming surgery, family building using donor sperm, and contraception for cycle control while recognizing that patients may not have had access to this care and knowledge the way so many others have had throughout their life.”
Setting the standard across care
When health care providers like Fenway Health, insurers, and community health care centers can collaborate to deliver high-quality care, everyone benefits — especially the patient — no matter the area of care.
“Point32Health recognizes the importance of identifying doctors’ offices and individual practitioners who specialize in LGBTQ+ care and possess the medical knowledge to treat and screen for conditions that are more common in the LGBTQ+ population. For those who may not have easy geographic access to a provider skilled in their needs, we offer virtual solutions, like Doctor on Demand, one of our telehealth care services providers. Now part of Included Health, the organization offers an innovative health care navigation platform for LGBTQ+ community health needs,” says Claire Levesque, Point32Health’s chief medical officer of commercial products. “Our goal is to ensure that LGBTQ+ individuals receive respectful care. We recommend that providers participate in continuing education on health equity. We also support efforts in this regard, such as the recent requirement that all physicians in Massachusetts complete training on implicit bias in health care for license renewal.”
At the Fenway Institute, the educational arm of Fenway Health, “we teach colleagues that a patient’s pronouns (such as she/he/they/ze) and [titles] (such as Ms./Mx./Miss/Mr.) are terms that signify gender,” says Brittany Charlton, ScD, associate professor at Harvard Medical School and the Harvard Pilgrim Health Care Institute as well as adjunct faculty member at the Fenway Institute.
The Fenway Institute teaches providers to default to using first and last name without a title in verbal and written correspondence with patients to avoid making any assumptions, Charlton explains. “Pronouns and [titles] are a sign of respect and can be important for affirming a person’s gender identity and helping a person feel seen by others. The provider should not assume a person’s pronouns and [titles] based on appearance or behavior … Lastly, we teach providers to correct other people when pronouns and [titles] are used incorrectly, to remove the burden from the patient to make the correction.”
Such attention will benefit many future patients. In early August, the American Medical Association Foundation picked Fenway Health and Harvard Medical School as the sites of their National LGBTQ+ Fellowship Program, which will provide a pipeline of health care providers who specialize in LGBTQ+ health, says Charlton.
How to learn from Fenway Health’s model
“The Fenway Institute offers national webinars, interactive learning modules, best practice guidelines, virtual learning collaboratives, national continuing education conferences, and customized technical assistance on all aspects of health care for LGBTQIA+ people,” says Alex S. Keuroghlian, MD, MPH, director of the Division of Education and Training at The Fenway Institute and principal investigator of the National LGBTQIA+ Health Education Center.
There are education and training programs and free resources, with continuing education credits, for those who want to learn more about education, training, technical assistance, and implementation services so other health care companies can learn how to offer high-quality, culturally responsive care for LGBTQIA+ people. “This includes staff training in foundational concepts and terminology, stigma and health inequities, mitigating implicit bias, sensitive and effective communication, and sexual orientation and gender identity data collection in electronic health records,” Keuroghlian says.
It is training that is sorely needed everywhere, according to Rasdall.
“I receive my primary care at Fenway Health and I only go to specialists that Fenway Health has recommended as transgender-friendly,” Rasdall says. “I experience anxiety when I am out of town or out of the country and in need of care. Sadly, the world is not set up to meet the needs of the LGBTQ+ population everywhere we go for care. I have put off getting care or avoided care altogether when I’ve needed it when I am away from Fenway Health. I think many cisgender and straight people can take it for granted to be able to walk into a doctor’s office and receive competent care — I do not take that for granted. Fenway Health is a lifeline in the heart of Boston.”
Although individual health centers, such as Fenway Health, have structured their care to include the LGBTQ+ community, there are still great strides to be made in the pursuit of health equity. Perhaps one day all providers will be trained to respectfully and compassionately treat the needs of the LGBTQ+ population. Until then, Levesque says, she and her team at Point32Health will continue to ensure that they support members in their quest for the high-quality care that everyone deserves.
Point32Health is a nonprofit health and wellbeing organization, guiding and empowering healthier lives for all. Bringing together over 90 years of combined expertise and the collective strengths of Harvard Pilgrim Health Care, Tufts Health Plan and our family of companies, we help our members and communities navigate the health care ecosystem through a broad range of health plan offerings and tools.
Sponsored by Point32Health
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