Higher education

University of Iowa clinic sees demand for transgender care

Some patients travel hours to LGBTQ clinic

(from left) Nicole Nisly MD, co-director of the LGBTQ Clinic  nurse Nancy Dole, and medical assistant Claudia Mckimat stand in a patient examination room at the University of Iowa Healthcare’s Iowa River Landing facility in Coralville on Thursday, July 23, 2015. (Adam Wesley/The Gazette)
(from left) Nicole Nisly MD, co-director of the LGBTQ Clinic nurse Nancy Dole, and medical assistant Claudia Mckimat stand in a patient examination room at the University of Iowa Healthcare’s Iowa River Landing facility in Coralville on Thursday, July 23, 2015. (Adam Wesley/The Gazette)

IOWA CITY — Providers with the relatively new Lesbian, Gay, Bisexual, Transgender, Queer and Questioning Clinic at the University of Iowa want to keep the waitlist for initial consults short.

But the growing interest makes that a challenge. The clinic already is scheduling first appointments two to three months out.

“We have plenty of patients,” said Katie Imborek, clinical assistant professor of family medicine and co-director of the clinic. “No one knew how many transgender patients there were in the state of Iowa or the level of need.”

UI Health Care in 2012 opened the state’s first LGBTQ clinic at its Iowa River Landing site. The clinic — which offers appointments on Tuesday evenings for a host of health needs like hormone therapy or post-surgical care — starting filling up immediately.

Since then, it has seen 175 new transgender patients, a central focus of the clinic. They make up 80 percent of its patient population, and Imborek said most come from outside Johnson County.

“Some travel hours to come see us,” she said.

The increase in interest could be partly related to more awareness of transgender issues nationwide, like Caitlyn Jenner’s recent transition from Bruce Jenner.

“It’s becoming more visible,” Imborek said. “And with that, patients who may have always been questioning and not had the term for it or name for it finally have these stories and think, ‘That is me. That really resonates with me.’ “

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The clinic represents a larger goal within the UI Hospitals and Clinics to be inclusive, welcoming and respectful regardless of race, ethnicity, orientation or religious background.

In addition to offering health care services specific to minority populations, the university has instituted ongoing and across-the-board employee training like its “Safe Zone Project,” which offers workshops informing participants about the LGBTQ experience and campus and community resources.

The efforts have made the hospital a Healthcare Equality Index leader, according to the Human Rights Campaign.

The university is looking beyond its hospital walls, offering diversity training to providers across the region and integrating it into the medical school curriculum.

Imborek said she hopes today’s efforts will mean tomorrow’s LGBTQ patients won’t have to go to a specialty clinic to receive services.

“Primary care doctors take care of way more complex issues,” she said. “This is empowering them that they have the knowledge and tons of resources, and I hope (patients) don’t have to keep driving from Marshalltown and Sioux City to come see us.”

One of the more simple things the UIHC has provided faculty and staff to foster a more inclusive environment is “terminology training,” said Nicole Nisly, director of the Department of Internal Medicine Diversity Recruitment Office and co-director of the LGBTQ Clinic.

That includes advice on how to discuss care options and how to use preferred pronouns and names. The organization has modified its electronic medical record system to allow patients to enter pertinent transgender information related to sexual orientation and gender identity.

“That training started before we created our clinic,” Nisly said.

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The impetus for the clinic, Nisly said, was awareness that the region’s transgender population was not getting adequate care. Since its opening, “The slots have been full every week.”

The majority of transgender patients who come to the clinic are interested in receiving some form of gender transition-related care. The meet with a team of providers, including a nurse, nursing assistant, pharmacist and physician. Nisly said the clinic also collaborates with other departments across campus for counseling, legal guidance and specialties like urology, plastic surgery, dermatology and psychiatry.

The need to cater to a diverse patient population will become increasingly important, said Sherree Wilson, associate dean for Cultural Affairs and Diversity Initiatives in the UI Carver College of Medicine.

According to UIHC data, 82.3 percent of the patients were white in the 2014 budget year. That was down 1 percent from the previous year, while nearly all minority groups accounted for a larger portion of the total patient population.

“I see this as a long-term goal and a long-term commitment,” Wilson said.

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