Philly hospitals lack formalized training for providers who designate as LGBTQ-affirming

For years, Dan Stewart desperately looked for affirming health care to support his transition. Stewart, a transgender man, said finding doctors who were not only equipped to handle his medical needs, but respectful of his identity was no easy task. Stewart recalls jumping from doctor to doctor, and even switching entire clinics.

Now as an associate director who oversees health-care equality efforts at the Human Rights Campaign, Stewart helps others in the LGBTQ community navigate care in Philadelphia and elsewhere. But, Stewart said, it hasn’t become that much easier over the years.

Hospital networks have started creating designations on doctors’ profile pages that identify providers as “LGBTQIA+ friendly,” or “LGBTQ affirming.”

The Inquirer looked at Penn Medicine, Temple Health, Jefferson Health, and Cooper University Health Care to figure out what training is required for providers to get this designation and whether the LGBTQ community can trust it.

Penn’s LGBTQ designation program was created nine years ago.

The “LGBTQ Treatment Team” tag listed on providers’ bios are completely self-designated, according to Rose Thomas, the director of operations for Penn Medicine Center for Health Equity Advancement and the Program for LGBTQ Health. There is no required training in order for providers to designate themselves as part of the “Penn LGBTQ Health Program.”

The health network does offer optional resources for providers who have self-designated as an LGBTQ-affirming provider, including virtual training videos, one-on-one meetings with other affirming providers, and helping the providers better develop their LGBTQ referral pathways.

There is not any formal difference in patient-care procedures or protocols for a provider designated as LGBTQ affirming, Thomas said.

Thomas said the program is looking into developing a more “formalized” process that would include required training for the designation. Thomas said she hopes that Penn will move away from the self-designation process by the fall.

“I think that we recognize that this is not the state that we want to be in, but I think that we are moving toward a more discreet and patient centered way of designating this and I’m hopeful that it will just enhance all the good work that we are trying to do here,” Thomas said.

Temple Health physicians can opt to be labeled as “LGBTQ Affirming Doctors.”

Temple requires those doctors to have at least one hour of continuing medical education credits related to LGBTQ care. The network also requires that providers sign an attestation that they will honor and tell a certifying doctor why they want the designation included on their profile.

Jennifer Aldrich, a professor of clinical medicine at Temple’s Lewis Katz School of Medicine, said Temple is adding more training for those joining the health network, and provides optional shadowing for medical residents who want more training in LGBTQ care.

“I think that there needs to be a reconciliation and have the administration recognize that this is a big component of our population and we are not being as inclusive as we can be, and then make steps to fix that, and that’s what I am working towards,” Aldrich said.

At Jefferson, providers can self-designate as an “LGBTQIA+ affirming and trained provider.” Jefferson does not require specific training in order for a provider to add this phrase to their bio page.

Todd Levin, medical director of Haddonfield Primary & Specialty Care, an LGBTQ+ Affirming Practice at Jefferson Health, said Jefferson does provide some optional resources, including cultural sensitivity training. Levin added that most designated providers have some training they acquired on their own.

The program started in 2021, and Levin said they are “working on standardizing” the process and he believes “asking those interested to self-attest” was a good start.

“But now that we’re moving along, I think we would like to try to strengthen a little bit and look at the criteria and see what we can do better to enhance the program,” Levin said

At Cooper, providers can self-designate as a “Caring Expert in LGBTQ+ Health,” on the Cooper LGBTQ care website. Those who do have a call or meeting with Justin Schweitzer, medical director for LGBTQ+ health and primary care at Cooper Care Alliance, to discuss their training, experience, and goals as an LGBTQ-affirming provider.

Schweitzer said he is trying to incorporate more training options for Cooper providers. The hospital also has an LGBTQ+ steering committee that deals with complaints, concerns, or suggestions regarding LGBTQ care services, and works to provide more LGBTQ requirements for those with the designation.

None of the hospital networks’ websites tell patients that doctors are self-designating as LGBTQ-affirming, without any required training.

In Jefferson’s case, their website listing LGBTQ-affirming doctors indicates the physicians have indeed received specific training

“We probably could do more to be sure they are, but in general, if someone self designates that they have this interest, then they probably have had the training and the vast majority, I’m sure, have had a training check, but we don’t check for that at this point,” Levin said.

There are a number of reasons for the lack of formalized training. In some cases, such as Temple, Aldrich said there’s a lack of funding, citing times where she has put in money to support LGBTQ training for others from her own pocket.

“I think that hospital systems need to put their money where their mouth is,” Aldrich said. “I, as a medical provider, would like to see more robust funding efforts into making sure that what we’re saying on our own websites is the truth.”

Penn, Jefferson, and Cooper cited a lack of standardized training on a national scale and a lack of LGBTQ-specific fellowships.

Levin said he doesn’t see self designations as a “risk” to patients, but acknowledged Jefferson’s choice to not verify training “probably will be changing as we move forward.”

Stewart said the new trend of hospitals designating some providers as “LGBTQIA+ friendly” or “affirming” should be taken at a “surface level.”

He suggested people continue to use LGBTQ support systems and rely on “word of mouth” to find providers.

“There can be well-intentioned folks, people who think that they may know how to treat this population,” Stewart said. “But if you don’t really go through any sort of training or substantial training, right, you can really miss out and do a disservice.”