Compassionate, Competent, and Committed Care for the Transgender Community
Care Resource is a nonprofit, Federally Qualified Health Center (FQHC) with locations in Midtown Miami, Little Havana, Miami Beach, and Fort Lauderdale. Since its founding 35 years ago, Care Resource has shown dedication to LGBTQ health, in addition to the health of South Florida’s underserved communities. The health center is continuously recognized as a leader in LGBTQ Healthcare Equality Index (HEI). Care Resource’s best practices in LGBTQ care include but are not limited to: an Equal Employment Opportunity Policy to ensure non-discrimination in management practices and decisions, LGBTQ Patient Training for staff, and an LGBTQ-inclusive patient non-discrimination policy.
In this short interview, Ben Hersh, MD, Primary Care Physician, shares lessons and experiences gained from working with the transgender community. Since joining Care Resource in August 2019, he has positioned himself as a leader in providing respectful and accessible care for transgender patients.
OutClique: Tell us a little about your professional background.
Dr. Ben Hersh: I got my start in the medical field working as a medic at a local men’s free clinic. While I was there, I became empathetic to the experiences of trans men because although we intended to serve all men, we didn’t have the capacity to offer certain services for trans men. I later worked within a different clinic network where we were the first site in our affiliate to prescribe hormones to transgender individuals. These early experiences were especially formative in shaping my desire to serve transgender individuals.
When I began my formal medical training in Boston, I knew I wanted to focus my career on investing in the health of the whole person. I started with the intent to learn primary care and discovered Family Medicine. Family Medicine is unique in that it considers not just the individual, but their families, communities, systems of care, and the policies surrounding them. It assesses how these factors affect the individual and how they can be addressed to improve the individual’s health and the health of populations.
While in medical residency, I continued to gain skills in transgender health and received the opportunity to follow a panel of transgender patients at an affiliated gender clinic. I also helped create a training program for future primary care providers that taught learners how to conduct a respectful visit with a transgender person and the basic tenets of prescribing hormones.
OCQ: Tell us more about addressing the health of the whole person.
BH: For my first job in the South Florida area, I was looking for a mission-driven organization that embodied the principles of Family Medicine – excellent care of the individual while addressing the larger context they live in. One model of care that many clinics are adopting is the Patient-Centered Medical Home. It’s not just about accessing health care in a visit, but care coordination: accessing case managers, behavioral health, and lab and pharmacy services within a unified context. This model of a one-stop-shop has proven to be very effective for patients.
On top of that, I was trying to find a community health center that offered specific services that fulfill my professional passions: primary care, pediatric care, transgender care, general LGBTQ care, HIV care, and Medication Assisted Treatment (MAT) therapy for substance use disorder. I was worried I wouldn’t find an organization that would meet all of those different needs in South Florida—until I found Care Resource.
OCQ: What does it mean for a health center to provide quality transgender care?
BH: Transgender individuals shouldn’t have to go to a health center that’s specifically transgender-friendly in order to receive quality care—they should be able to go anywhere. It is important that health centers like Care Resource exist. Here, patients are assured that they are being cared for by knowledgeable providers. They know that they can access behavioral health services, case managers that are well versed in transgender issues, and receive safe referrals to ancillary services, including surgical support or speech therapy.
In addition to trans-specific needs, transgender individuals have the same health issues as everyone else. It’s important to me to know that I can send my patients to a cardiologist, nephrologist, or any specialist if needed, and know that they will receive respectful care.
OCQ: What are the specific issues trans individuals experience?
BH: It’s important to keep in mind that every transgender individual’s journey is unique. Their desires and needs in how they want to represent themselves and the transition they want to undergo are all different. The options range from a social transition with the adjustment of legal documents to the inclusion of medical services such as hormone therapy, speech therapy, and surgery. We have to acknowledge that everyone has their own journey, and we have to be able to support them in it.
Many transgender individuals, but by no means all, are very affected by social determinants of health: lack of housing and social support, substance use disorders, behavioral health issues, a disproportionate risk of suicide, and risk of HIV. They also experience trauma within the healthcare setting and harassment by providers—some have been told by providers that they shouldn’t be transgender or have had had inappropriate exams performed that had nothing to do with the reason they were coming in for care. These social determinants have a trickle-down effect on people’s health. Hopefully, as transgender individuals are more accepted into society, these determinants will become less of an issue, but right now, they’re present, and they need to be acknowledged and addressed.
OCQ:: How does Care Resource further address the various social issues that affect the health of transgender individuals?
BH: Generally, FQHCs have a better handle on addressing the social determinants of health than private practices that work in isolation. Care Resource does an excellent job with that. When you see a high ratio of case managers to health providers, you know that the health center is prioritizing understanding and addressing social determinants. Care Resource has taken the time to identify resources and put them together for patients, which means a lot in a less resource-rich state like Florida when it comes to health services for the underserved.
You can tell that Care Resource is a safe place where members of underserved communities can be themselves and don’t need to worry that they will be harassed or disrespected.
OCQ: What are some lessons you continue to apply in your medical practice?
BH: One of the most important things I’ve learned, and that has been told to me by trans patients, is that simply treating someone with basic respect, respecting who they are, is such an important part of the visit. Acknowledging their gender identity, using the correct personal gender pronouns (PGPs)—many patients have never experienced that in a health center. It’s such a low bar to provide that safe space for folks. We have to acknowledge that each of our patients has their own story and remember this in all of our interactions with them. Even within a community or group, each individual is different. Yes, a provider should understand issues that affect the trans community, but they should also see the unique person in front of them.
OCQ: What are the services Care Resource offers for the transgender community?
BH: In addition to primary care, the health center provides hormone therapy, surgical referrals, legal document assistance, letters of support, and behavioral services from trained and licensed professionals.
Given how much HIV and AIDS affect the LGBTQ community, we are encouraging people to come in for pre-exposure prophylaxis (PrEP), a once-daily pill that prevents HIV. The CDC is just recently starting to extrapolate data on the rates of HIV within the trans community. Men who have sex with men (MSM) are thought to have the highest rates of new infection in the U.S., but I believe the rates within the trans community, especially among trans women, could be higher. It’s important to get people at risk of acquiring HIV on PrEP—that will have a huge effect on our health outcomes.
We need people to know PrEP is available, and that the medications are incredibly effective and highly tolerable: patients are not experiencing adverse reactions. We have vouchers that allow uninsured patients to access an exam and basic labs at no cost to begin the PrEP regimen, including a follow-up visit for lab results. Depending on income and insurance, PrEP can be obtained for little to no cost.
OCQ: What is one word you would use to describe your commitment to transgender healthcare?
BH: Passionate: I’m passionate about providing quality care to individuals and improving care for all trans folks, within and beyond our health care center.
Learn more about Care Resource at www.CareResource.org.
About Care Resource:
Care Resource is a 501(c) (3) nonprofit organization and a Federally Qualified Health Center (FQHC) with four locations in Midtown Miami, Little Havana, Miami Beach, and Fort Lauderdale. The health center provides comprehensive health and support services to address the full health care needs of South Florida’s pediatric, adolescent and adult populations.