Conscientious Objection: Understanding When and Why Primary Care Physicians Object to Providing Health Care to Transgender and Gender-Diverse Patients in an Appalachian Medical Center

Authors

Mili S. Patel, University of Maryland, BaltimoreFollow
Kelley A. Jones, University of PittsburghFollow
Laura Davisson, West Virginia UniversityFollow
Elizabeth Miller, Division of Adolescent Medicine, Department of Pediatrics, University of Pittsburgh, Children's Hospital of Pittsburgh of UPMCFollow
Nicole Kahn, University of WashingtonFollow
Pamela J. Murray, Boston Children's HospitalFollow
Kacie M. Kidd, West Virginia University, MorgantownFollow

Corresponding Author

Kacie M. Kidd, MD, MS

Kacie.Kidd@hsc.wvu.edu

Author Affiliations

1. Mili S. Patel, MD: Resident Physician, Department of Pediatrics, The University of Maryland School of Medicine, Baltimore (Baltimore MD)
2. Kelley A. Jones, PhD, MPH: Postdoctoral Associate,Division of Adolescent and Young Adult Medicine, University of Pittsburgh School of Medicine (Pittsburgh PA)

3. Laura Davisson, MD, MPH, FACP: Professor and Associate Program Director for Internal Medicine, West Virginia University School of Medicine (Morgantown WV)

4. Elizabeth Miller, MD, PhD, FSAHM: Professor of Pediatrics, Public Health and Clinical and Translational Science, University of Pittsburgh School of Medicine

5. Nicole F. Kahn, PhD, MEd: Assistant Professor of Pediatrics, University of Washington School of Medicine (Seattle WA)

6. Pamela J. Murray, MD, MHP: Attending Physician, Division of Adolescent/Young Adult Medicine, Boston Children’s Hospital (Boston MA)

7. Kacie M. Kidd, MD, MS: Assistant Professor and Medical Director (Gender and Sexual Development Multidisciplinary Clinic), West Virginia University School of Medicine; E-mail: Kacie.Kidd@hsc.wvu.edu

Author Area of Expertise

Patel: Pediatrics, health inequity

Jones: Epidemiology, public health, statistics

Davisson: Appalachian health, health systems

Miller: Community-based participatory research, health equity research

Kahn: Epidemiology, public health, statistics

Murray: Adolescent and young adult health

Kidd: gender-diverse youth, gender-affirming care, transgender health

Abstract

Introduction: Transgender and gender-diverse (TGD) individuals face barriers to accessing primary and gender-affirming care, especially in rural regions where a national shortage of medical providers with skills in caring for TGD people is further magnified. This care may also be impacted by individual providers’ strongly held personal or faith beliefs and associated conscientious objection to care.

Purpose: This study assesses the prevalence of conscientious objection to providing care and gender-affirming hormone (GAH) therapy to TGD individuals among physicians in an Appalachian academic medical center.

Methods: An anonymous, online, cross-sectional survey of physicians was distributed to resident and faculty physicians in an Appalachian medical center. Survey domains included demographics, personal religious affiliations and practices, and assessments of willingness to provide specific types of care.

Results: Surveyed physicians (n = 115) had no objection to caring for TGD patients but notable objection to prescribing GAH therapy to adults (23.5%) and minors (33.0%). Self-identified “very religious” physicians were more likely to object.

Implications: Physician objection may present a barrier to care for TGD individuals in Appalachia. Provider and system-level interventions should be considered to ensure access to these necessary medical services.

DOI

https://doi.org/10.13023/jah.0601.05

Creative Commons License

This work is licensed under a Creative Commons Attribution 4.0 License.

Recommended Citation

Patel MS, Jones KA, Davisson L, Miller E, Kahn N, Murray PJ, et al. Conscientious objection: Understanding when and why primary care physicians object to providing health care to transgender and gender-diverse patients in an Appalachian medical center. J Appalach Health 2024;6(1/2):57–69. DOI: https://doi.org/10.13023/jah.0601.05