In my last blog entry, I reflected on employment nondiscrimination as one of four vital measures of equality in health care that also include patient nondiscrimination, visitation, and cultural competency training. A colleague responded about her personal experiences with discrimination on the basis of gender expression during her student years. Her comment served as a reminder about the lack of profession-wide protections for lesbian, gay, bisexual, and transgender (LGBT) PA students. While systemic change is in the hands of our colleagues at ARC-PA and PAEA, I'd like to touch on the topic.

Dohrenwend wrote in the journal of the Association of American Medical Colleges [AAMC], “there are times when politics and health are so intertwined that to forgo politics is to neglect health.” This has been the case for sexual and gender minority (SGM) students, faculty, and most importantly, patients. In this regard, the PA profession has yet to raise its voice. No credentialing provisions require PA programs and their affiliate clinical sites to include sexual orientation, gender identity, and gender expression in their nondiscrimination policies or to offer LGBT faculty and students equal benefits. Until recently, even the AAMC had been silent on institutional recognition of faculty and graduate professional obligations to LGBT students, faculty, and patients.

The LGBT civil rights movement informed a patchwork of protections for LGBT students at the intuitional level. Almost 300 US colleges and universities now have LGBT offices, and many belong to the Consortium of Higher Education LGBT Resource Professionals. However, not all institutions have established protections, often leaving SGM students without support when they experience discrimination. In April, the New York Times published on collegiate gay rights facing suppression. Of the four schools noted for discrimination on the basis of sexual orientation within the article, two have PA programs. The Times article cites a ‘zine published by SGM students from one of the schools that is “intended to bring attention to the lives and issues of [SGM minority]” students. These students express their frustration at, among other things, 2011 course syllabi that include the prevention and treatment of homosexuality and having to choose between the closet and therapy sessions intended to alter sexual orientation or risk expulsion. Students seeking protections for gender identity and expression often experience a similar set of challenges.

So, what does nondiscrimination for LGBT students look like? Issues of access and equity are organized by the California Postsecondary Education Commission (CPEC) into LGBT student data collection, institutional climate and policies, faculty and staff professional development, and student support services. In March 2007 the AAMC President distributed a memo to medical school deans in the US and Canada about the Executive Council's approval of recommendations on institutional programs and educational activities to address the needs of GLBT students and patients. The AAMC memo reflects the recommendations by the CPEC and then proceeds to make curricula recommendations, advising medical schools to “ensure that students master the knowledge, skills, and attitudes necessary to provide excellent comprehensive care for LGBT patients. Specifically, these curricula should include: training in communication skills with patients and colleagues regarding [LGBT] issues,” “faculty development programs … regarding LGBT issues,” and “comprehensive content addressing the specific health care needs of LGBT patients.”

Dohrenwend also wrote, “Medicine cannot fulfill its obligation to LGBT patients, students, and faculty without a considerable and determined commitment to change.” As long as PAs are informed by the findings of evidence-based medicine, I suspect it is just a matter of time before this change comes to the PA profession as well. Some PA faculty and institutions are leaders, adapting best practices in the areas of curriculum and professional development, policy, climate, and student support services, while amendments to the accreditation standards will be necessary for systemic implementation. Until the PA profession creates its own credentialing provisions based on institutional recognition of faculty and graduate professional obligations to LGBT students, faculty, and patients, individual programs have these benchmarks to guide them, and LGBT students can look to national assessment tools like the Campus Climate Index when considering where to apply.

Diane Bruessow practices in Middle Village, New York.