Celebrating Pride Month: PAEA President Kara Caruthers in Conversation with Fellow PA Leaders

June is Pride Month, which was organized to commemorate the actions and fortitude of LGBTQ+ people in opposition to police harassment. While the confrontation at the Stonewall Inn on June 28, 1969, in New York City, is well known, there were other confrontations. Trans activism started in San Francisco as early as 1966, three years before Stonewall. Gene Compton’s Cafeteria was an all-night restaurant where members of the LGBTQ+ community would gather to eat and socialize. However, this period of civil rights (which encompassed sexual and gender marginalized groups) was met with opposition and resulted in police harassment of mostly trans women. 

Stonewall was the result of a police raid on the gay club, which sparked an uprising between patrons, neighborhood residents, and the police. The raid lead to six days of protest and often-violent clashes with the NYC police force. Marsha P. Johnson, a “self-made” drag queen, is noted as a leader in the uprising and hailed as an important figure in gay liberation in America. Stonewall shifted the activism of the LGBTQ+ community to the forefront. A year after the riots, activists organized a march to Central Park with a theme of “Gay Pride.” By the 1970s, Pride celebrations had spread across the United States and are now celebrated worldwide.

During this Pride Month, it is essential to acknowledge the health and well-being of of LGBTQ+ communities. In medicine, we must continue to strive for equity and inclusion for this community. For example, a 2016 report stated that 39% of bisexual men, 33% of bisexual women, 13% of gay men, and 10% of lesbians do not report their sexual orientation to medical providers for fear of not being properly treated. As we lean into our vision of Health for All and the values of well-being, equity, and inclusion, recognizing Pride Month and eliminating barriers causing the health inequities within the LGBTQ+ community is critical.

Kara: I am excited to have PA educator, Diane Bruessow, MPAS, PA-C, and recent PA graduate, Mariah Leroux, MHSc, PA-C, join me in celebration of Pride Month! Would you share a little about yourselves?

Diane: I am a clinically practicing PA educator and the Director of Justice, Equity, Diversity and Inclusion for the Yale PA Online program. In addition to typical academic responsibilities, I serve on the management team of the Yale School of Medicine Dean’s Advisory Council on LGBTQI+ Affairs and chair the LGBT health policy working group. I also serve as a clinical ambassador for the CDC’s campaign to Stop the HIV Epidemic Together. In this role, I am an influencer, directing clinicians to the CDC’s one-stop–shop, HIV Nexus, which provides the most current information on HIV prevention, screening, and treatment. My clinical and research areas of interest are sexual and gender minority (SGM) health. 

Mariah:  I have been practicing in women’s health in the Bronx, NY, for eight months now. I have served in various leadership roles within AAPA including Student Academy President-Elect, Student Academy President, External Affairs Committee member, and Student Director on the AAPA Board of Directors for the past 2 years.

Kara: Why is Pride Month important to you? In addition, why should it be important to all of us as PAs and PA educators?

Mariah: Pride Month is deeply significant to me as a member of the LGBTQ+ community. I came out to my family and friends relatively recently — about 3 years ago — and before that point, that part of my identity was a source of fear, shame, and confusion. Since then, Pride celebrations have been a time for me to celebrate and express the joy that comes from living as my authentic self. It is also a time to connect and celebrate with other members of the community, many of whom have similar stories to my own, and to remember those who have gone before us and fought for our right to love openly. 

This time should be important to PAs and PA educators as well, because there are members of the LGBTQ+ community everywhere we are — they are the PA students sitting in our classrooms, they are the patients we see every day, and they are PAs themselves. Even if your students do not identify as LGBTQ+, they are learning from you, and they deserve the opportunity to learn to care for this community from a place of respect and understanding of the unique challenges they face. 

Diane: The greatest indicator of success is support. Pride is an opportunity for sexual and gender minority (SGM) people to be seen and supported. When someone is not out, productivity suffers (over 30%) compared to those who are able to be out — simply because of the wasted mental energy. Wishing a LGBT PA educator colleague a “Happy Pride” says that you see them as whole individuals; it is a show of support for them. 

When a PA educator is out and supported, it creates opportunity for SGM PA students to see themselves in the profession. For programs without LGBT faculty representation, I encourage programs to make newly matriculated students aware of the Lesbian, Bisexual, Gay, and Transgender (LBGT) PA Caucus, an affinity group for LGBT PAs and PA students founded in 1979. 

Kara: The U.S. Department of Health and Human Service (HHS) specifically set goals for LGBT populations in the Healthy People 2020 campaign. Thankfully, that has continued in the Healthy People 2030 campaign with the overall goal to “improve the health, safety, and well-being of lesbian, gay, bisexual, and transgender people.” How can PA programs meet this goal? What are ways PA programs can enhance their curriculum to do so?

Diane: SGM health is a relatively new area of medicine. The evidence supporting LGBT health disparities has been around since the 1980s, with the first national lesbian health survey, and then the first national survey on men who have sex with men (MSM) in the 1990s. Prior to that, in the 1970s (when social scientists offered irrefutable evidence that same-sex sexual attraction and behavior was common, existing across all cultures, and not inherently pathological or negative, and homosexuality was removed from the DSM), it was assumed that sexual minority people had the same health experiences as straight people.  

The greatest challenge for PA educators in supporting the goals of HP2030 is to avoid an oversimplified approach of presenting a laundry list of areas where SGM people experience health disparities. It is important to have students think through the important root causes of these disparities, which include the influence of social determinants of health, bias, stigma, and discrimination on sexual and gender minority people’s health outcomes. Today, there are many medical textbooks with SGM health content that are valuable resources for programs, from clinical medicine to pharmacology.

Mariah: PA programs can achieve this goal by including a robust education regarding LGBTQ+ health, including mental health. There are challenges and disparities that are unique to this population, and programs should dedicate the time and attention needed to ensure that students graduate fully equipped to address these issues. They can do this by creating a new block of material dedicated to LGBTQ+ health, or they may include it throughout the curriculum. It is also important that programs create inclusive environments through actions such as normalizing the use of pronouns, so that students feel comfortable doing the same for their future patients once they graduate. 

Kara: Over the last several years, there has been more visibility for members of our community who are transgender. While this was a population that was briefly mentioned during my PA training, it was not until a few clinical experiences as an emergency medicine PA that I started the work to learn and understand their specific healthcare needs. In what ways can PA programs prepare students to care for transgender patients?  

Mariah: Address the unique challenges that transgender patients face head-on and, more importantly, teach students to identify and combat any biases that they may have regarding transgender people. Teach students that transgender patients are valid and deserving of the same whole-person care we are taught to give every patient. Train them to ask about pronouns and what words their patients prefer to use when speaking about their bodies. Perhaps even create opportunities for students to hear directly from trans patients and the challenges they face when they seek medical care, so that students learn to be the solution to these issues. 

Diane: My PA education experience was similar. In the early 2000s, someone near and dear to me transitioned. I witnessed how they were treated when attempting to access medical care. As a PA, that was my professional sandbox and I was appalled. I also recognized that my otherwise stellar PA education failed to prepare me for transgender patients. Therefore, I did what any PA does when we want to learn more about a topic in the spirit of lifelong learning: I set up an automated PubMed search. I have been following the literature on trans health for the last 20+ years. This commitment to lifelong learning and wanting to share knowledge with other PAs led to my contributions to four medical textbooks, specifically discussing trans health.

Outside of textbooks, the LBGT PA Caucus offers educational webinars and has a speakers bureau established for those programs seeking PAs well versed on this topic. The University of California San Francisco (UCSF) has a Gender Affirming Health Program in the Department of Family and Community Medicine, which has great resources on primary care best practices.

Kara: PAEA’s updated strategic plan consists of the 10 core values, including learning, inclusion, equity, and well-being. How can PA programs become more inclusive and equitable to allow for optimal learning and well-being for LGBTQ+ staff, faculty, and students?

Mariah: PA programs should create inclusive environments and actively seek out members of the LGBTQ+ community whenever possible. While programs are prohibited from explicitly asking about sexual orientation or gender identity, there are other ways to work towards greater LGBTQ+ representation. Programs can use the professional networks of their current employees to reach out to those in the LGBTQ+ community and encourage them to apply for open positions. They can also actively recruit students at LGBTQ+ undergrad student events or in online groups. Visibility is also key, so including a diverse group of people in marketing campaigns can also be beneficial. Programs can connect current LGBTQ+ students to resources such as campus affinity groups, which can provide further support during their time as students. 

Kara: Why does LGBTQ+ representation in our profession matter?

Mariah: Whenever I encountered an openly LGBTQ+ lecturer or PA during my training, I instantly felt both excited and at ease because I knew that they would see and understand me on a level that many people do not. I knew that they would not judge me for who I am, and I felt I could be more open with them because of that. It created an environment where I could be seen, heard, and understood. In turn, that empowered me to put my best self forward. We need LGBTQ+ PAs and PA educators for the same reason we need racially and ethnically diverse PAs and PA educators. Representation ensures that historically underrepresented groups such as the LGBTQ+ community have a voice and that they receive culturally competent care. It also ensures that perspectives that are more diverse are in places of leadership to drive innovation and growth within our profession. Finally, it empowers the next generation of PAs to step out boldly to promote true equity and inclusion for all. 

The PA profession holds patient-centered care as a central value, and the best way to continue this is to create inclusive environments and equip students to provide comprehensive, culturally relevant, evidence-based care for LGBTQ+ patients. 

Diane: Simply put and following our desire to practice evidence-based medicine, the data is consistent that patients do best when their health care team includes providers who are like them.

Kara: Thank you both for your time.  I know that your insight will help our PA programs consider ways to develop educational environments that are inclusive for faculty, staff, and students. I am hopeful that this discussion will continue to spur us all to be intentional in the development of our curriculums to serve the LGBTQ+ population in our community.

Resources Mentioned:

Bruessow D, Rolls J. Pharmacotherapy related to transgender care. In V. McCoy Hass, G. Kayingo & B.Q. Luu (Eds.), Advanced Pharmacology for Prescribers (pp 453-472) New York: Springer Publishing Company; 2021.

Bruessow D, Baker J, McLaughlin K. Care of the LGBTQ+ patient. In J. Van Rhee & S. Neary (Eds.), Clinical Medicine for Physician Assistants. New York: Springer Publishing; 2022.

Bruessow D: LGBT special populations. In K. Kemle, N. Demetrov (Eds.), Palliative Care Medicine for Physician Assistants: Fostering Resilience and Managing Seriously Ill Patients. Oxford University Press; 2021.

Centers for Disease Control and Prevention. HIV Nexus www.cdc.gov/hivnexus

Jackson A, Bruessow D, Duran-Staton A, Kemm M. Role of the physician assistant in managing gender incongruence. In A. Duran-Stanton & A. Jackson (Eds.), US Army Physician Assistant Handbook, 2nd ed. Fort Sam Houston, TX: The Borden Institute; 2021.

Lesbian, Bisexual, Gay, and Transgender PA Caucus. www.lgbtpa.wildapricot.org

Schneider J, Silenzio V, Erickson-Schroth L. The GLMA Handbook on LGBT Health. Santa Barbara, CA: Praeger; 2019.

Deutsch MB, ed. UCSF Gender Affirming Health Program, Department of Family and Community Medicine, University of California San Francisco. Guidelines for the Primary and Gender-Affirming Care of Transgender and Gender Nonbinary People, 2nd ed. Deutsch MB, ed. June 2016. https://transcare.ucsf.edu/guidelines