Gender and Sexuality Barriers in Canadian Healthcare

“Vancouver School Board Introduces Gender-Neutral Pronouns” – and many similar headlines spanned across website pages and swept newspapers stands just this past summer, surely an indication of progressive politics in action for the queer people of Vancouver. In this case, giving non-binary and gender-neutral identifying students in Vancouver a chance to use gender-neutral pronouns – pronouns that do not make assumptions about a person’s gender. No longer are they stuck having their identities ignored at school: they can be recognized and respected in official records for who they are. This recent event demonstrates how the social barriers that complicate the lives of queer people are disintegrating; however to me, it begs the question: are the same barriers disintegrating within the workplace? Or are they still present and as strong as ever? The barriers in question being a situation or event in which a non-binary gender (transgender) identified individual is treated differently to a non-transgender individual, or if the same discrimination applies to someone because of their sexual preferences (sexuality). It is also important to understand the definition of “queer” and the false negative connotation that society associates with the word. The negativity stems from its original meaning of “bizarre”, “strange”, or “outlandish”; however, the word has evolved over time to now define and encompass people within the lesbian, gay, bisexual, and transgender (LGBT) community. In its essence, the evolution of the word is parallel to societies’ attitudes towards queer individuals – changing rapidly for a virtuous cause. Not only is the discrimination being experienced by queer people unethical, disrespectful, and wrong, but these barriers that Eliason et al., Brewster et al., and others have proven to exist through their research must be preventing a whole range of studies and fields of research from progressing as lawyers, scientists, doctors, and more are not hired solely based on their gender or sexuality (Eliason et al., 1365). It is also evident that many queer people will in fact leave their work place because of the discrimination, or even be fired because of higher management discovering their sexuality or gender (Eliason et al., 1365). In an effort to diminish these clearly existing barriers, the most prominent ones in the field of healthcare will be researched and discussed: What do scholars suggest are some of the key gender and sexuality barriers that exist within healthcare, and prevent others from entering healthcare in 21^st century North America?

Beginning with gender barriers that queer patients face inside the field itself, it is clear that physicians are less comfortable working with male-to-female (MTF) and female-to-male (FTM) transgender individuals than lesbian, bisexual, or gay (LGB) individuals, based on Eliason et al.’s research in 2011. The study spanned 45% of LGBT physicians in the Gay and Lesbian Medical Association and a select number of heterosexual, non-transgender physicians in the American Medical Association (AMM). Of the male physicians in the AMM, only 65% felt comfortable working with MTF patients, and 64% felt comfortable working with FTM patients (Eliason et al., 1363). The female physicians in the AMM came in with slightly elevated numbers: 66% felt comfortable working with MTF patients, and 69% felt comfortable working with FTM patients (Eliason et al., 1363). These numbers are relatively low when compared to comfortableness levels of physicians working with LGB patients. This can generally be expected, as society has had more time to grow accustomed to LGB individuals, and thus most physicians are more comfortable when practicing with LGB patients, with an average comfortableness rate of 92%, 93.5%, and 91.25%, respectively (Eliason et al., 1363). A physician’s uncomfortableness levels with MTF and FTM patients can be related to unacceptable behaviour such as denying of patient referrals and accusation of “unethical behaviour” (Eliason et al., 1365). Non-conventional gender and transgender ideals “[…] challenge prevailing social conventions regarding the expression of gender […]”, according to Brewster et al., who quoted Fassinger and Arsenau in their 2007 study, and are very new to not only the healthcare workplace, but society in general (61). However, according to Eliason et al., queer discomfort with patients stems from not only general unease due to differing societal norms, but the lack of LGBT education within medical schools across the United States. Their study finds that some students are only exposed to as little as one hour of transgender health studies across their whole time spent at medical school. Of which, 56% of the students described the little time they had as “unhelpful”, whereas 76% of the students said that their own “personal experience working with LGBT patients” was very helpful (Eliason et al., 1362). Based on this research, these personal experiences should be cultivated in medical school in order to prepare students for facing real life experiences with LGBT patients when they proceed to become a physician.

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Even after stepping out of the healthcare work environment and looking at entrance to the field of healthcare as an LGB individual, it is apparent that sexuality barriers of entry to healthcare exist during even the earliest stages of education. 15% of students in Merchant’s, Jongco’s, and Artemio’s study were found not to disclose their sexuality during admission interviews to medical school because they felt that they would not be admitted if they did (786). Another 17% of students did not disclose their sexuality because they felt uncomfortable in the interview environment (Merchant, Jongco, Artemio, 786). Based on this evidence, one can extrapolate that a medical school which openly advertises LGBT support and education would essentially disintegrate these problems of interview admission, and also help bridge the apparent “not at all comfortable” gap between physicians and LGBT patients (Eliason et al., 1363). In the bigger picture, a student’s sexuality is of no concern to any admission advisor of any school; students are not admitted, or should have their admission affected by their sexuality or gender identification. Additionally, from an objective point of view, if a medical school were to publicly advertise their openness and accepting nature of LGBT students, they would have more students apply and thus gain popularity, as LGBT students will seek out education in environments in which they are accepted and respected. This is evident in Merchant’s, Jongco’s, and Artemio’s study, which displays a drastic increase in the number of students willing to disclose their sexuality when applying for university residence, as they are aware of the university in question’s advertised “affirming environment”, and that there is no consequence for admitting so (787).

Even after graduating medical school, LGBT physician’s work environments do not seem to improve in any notable fashion. Common experiences amongst colleagues in the workplace consist of 65% of LGBT individuals recall hearing “disparaging remarks”, 22% feeling “socially ostracized”, and 15% being harassed by their fellow coworkers (Eliason et al., 1365). General psychology agrees that this discrimination is mostly due to the simple human nature of pushing away things that do not fit the sociological norm.

Conversely, Brewster et al. present an alternative view on the source of workplace discomfort with LGBT individuals; describing the workplace relationships as being built from “lower job satisfaction and higher anxiety”, using Lyons et al.’s, Smith & Ingram’s, and Waldo’s research to prove their point (61).

Although almost all researchers agree that the negativity towards LGBT patients, LGBT physicians in the workplace, and LGBT students is decreasing, there is a common consensus among gender and sexuality researchers that it is difficult to measure the rate of change in negativity (Burke, White, 61; Eliason et al., 1366). The difficulty arises from having simply too small of a sample size for conducting research at regular intervals of time. Burke and White argue that LGB individuals comprise of roughly 3% of the population (a very “conservative estimate”), and that if these proportions apply to the healthcare field, there would only be 20,000 LGB physicians across the country (61). And of course, not all of these physicians would be willing to participate in a study. This limits a research essay to only having a select few studies available for analysis. Another limitation that exists within queer research is the fact that gender-variant and differing sexualities are very new, and thus have had less time to be observed and addressed. However, as society becomes more accepting over the course of time in the workplace, the barriers of gender and sexuality to healthcare should shatter to give rise to acceptance, and research will hopefully not be in need at all.

Works Cited

Eliason, Michele J., Suzanne L. Dibble, and Patricia A. Robertson. “Lesbian, Gay, Bisexual, and Transgender (LGBT) Physicians’ Experiences in the Workplace.” Journal of Homosexuality 58.10 (2011): 1355-371. LGBT Life with Full Text. Web. 17 Nov. 2014.

Brewster, Melanie E., Velez Brandon, DeBlaere Cirleen, and Moradi Bonnie. “Transgender Individuals’ Workplace Experiences: The Applicability of Sexual Minority Measures and Models.” Journal of Counseling Pyschology 59 (2012): 60-70. PsycARTICLES. Web. 17 Nov. 2014.

Burke, Brian. P., White, Jocelyn C. “The Well-being of Gay, Lesbian, and Bisexual Physicians.” Western Journal of Medicine 174.1 (2001): 59-62. Web. 17 Nov. 2014.

Merchant, Roland C., Artemio M. Jongco, and Luke Woodward. “Disclosure of Sexual Orientation by Medical Students and Residency Applicants.” Academic Medicine 80.8 (2005): 786. PsycINFO. Web. 17 Nov. 2014.