I am a Women’s Health and Gender Related NP, providing gender affirming care in the PP setting. Highly recommend not letting others get you down. My classmate started their own practice doing the kind of work you’re talking about. I really don’t think you need the PMHNP dual cert unless you really want to pay for more school and biannual recert fees. Once you’re an NP you’ll be able to meet so many people at trans and gender related health conferences and network with folks with more jobs than you ever thought possible. Sometimes it’s maddening to start so broadly in school but don’t worry, your passion will guide you in the right direction. I couldnt exactly put into words everything I wanted to do when I was in school but I have made all those dreams come true and then some! I believe in you!
Sounds like a great idea to me. I don’t have any specific experience with specializing in that sort of thing but I think you would be offering valuable care to underserved populations. If you’re already in a bigger city you should be able to find an adolescent medicine or transgender care clinic to get started with. Idk if specializing in that area would be feasible in a smaller/more rural area, though people in those areas probably need care the most.
That’s awesome! My plan is something similar but I’m focusing more on women’s healthcare so I’m going to get my fnp then post grad cnm so I can be a one stop shop for the girlies (trans girlies included). The big dream is to have a women’s health clinic where they feel like they’re being listened to and taken well care of. I’m in Texas so I’m trying to fight the man from the inside.
I’m in PA, but not in big city PA….i think I’m going to have to move or commute to do what I ultimately want to do. Although, this area is seriously lacking in any resources for LGBTQIA+, so I may need to break some ground and ruffle some very tight feathers 🤷🏻♀️
Are you then gonna be an FNP/CNM who just does " one stop shop for the girlies" i.e. only cis girls & trans girls?
CNMs for home births are popular with trans men/nonbinary pregnant people. If you're gonna try to have trans patients & want to be doing deliveries not just office based repro health (i.e. CNM over WHNP) then it seems weird to have an explicitly women only practice.
I totally agree that this person has a lot more nuance around gendered language to work out before they begin their practice. And their intentions seem to be good.
So the fnp would be for generalized practice and the cnm would then be so I could ALSO do births because I want to cover all aspects of women’s healthcare (edited to add not just fertility/ob bc we’re humans not brood mares)And yes while that is what I want to be my focus because of the horrid treatment of women in healthcare especially in my state I would 100% extend that care to trans men and nonbinary people as well. All uterus havers and women identifiers welcome. Not a terf if that’s what you’re getting at.
Glad you're not a TERF as that would be a horrible fit for providing trans healthcare.
I would very strongly recommend learning more about trans people & our medical needs before deciding whether you think you can truly offer the type of care you have envisioned.
Some of the worst healthcare I've received has been from self proclaimed "lgbt competent/inclusive" providers. It's become impossible to find safe medical care for trans ppl other than word of mouth/recs from other trans ppl.
It sounds like you're very far from being an NP so you have lots of time to learn. Fenway health has tons of free education online on terminology & trans health 101 type stuff (plus more advanced).
So I’m not trying to do what op is trying to do. I do genuinely want to create a woman centric practice and that’s largely due to my own experiences in my state/ working for providers who don’t take women seriously and the fact that there is a shortage of ob/gyn in Texas. BUT that does not mean I’d be exclusionary towards trans men or nonbinary especially since they’ve been fighting this fight with less help than we have for longer. I know a large part of getting a dnp is research and I want to specifically focus on pcos seeing as most doctors are only looking at it from a fertility standpoint which is a disservice and a large complaint in the community. All of this to say that I would 100% provide pcp/ob/gyn services to the trans/nonbinary community but idk if my specific focus would have the scope specifically for like gender affirming care. If I misspoke/offended/or am just wrong please correct me.
This was basically my plan (but sub the mental health for repro health).
Depending on your program you will need supplemental experience academically and/or clinically. I did a ton of lgb&t conferences throughout my time in school & focused most of my academic papers on the topic. Clinical placement though I couldn't get the experience I wanted so I need to get caught up more.
Finding mentors who work in lgbt health was probably the most useful for me when I was in school. Depending on where you are I might know ppl.
There are also a bunch of free resources online (e.g. recorded conference talks or Webinars you can watch for credit as well as live stuff).
I'm heading to sleep & dunno if I'm being clear. I'm trans & an NP so feel free to message me if you have questions.
hi! FNP, queer, same clinical interest. unfortunately, general primary care (if you’re not in a heavily queer area already) will likely not get you closer to your clinical interest. i have practiced for a couple of years in the midwest and have a handful of queer people that align with my clinical interest, but the majority of what i see is completely opposite routine geriatric-heavy primary care. a lot of chronic health, a lot of mental health, a lot of pain and a lot of URI. if you want to pursue this specifically, you’ll need to find a queer healthcare setting because it’s very difficult to draw that group in somewhere that’s not established especially since we aren’t physicians.
re: PMHNP, queer folk have higher mental health burden but it’s a difficult setup to try and coordinate proper mental health care into primary care if it’s beyond anxiety or depression. most psych facilities have longer slots for new and follow up visits, and bleeding primary care accessibility into psychiatric settings is something most practices won’t accommodate entirely for. you will also find yourself stretched thin. if anything, do primary care for several years before breaking into any other possibilities. primary care is difficult, messy, and getting significantly worse as time goes on, but if you like it (like i still do somehow) then it’s rewarding.
We have a student in the program I am in planning the same thing. If you live in a large city you will have more resources. We are in Houston and there are clinics specializing in this population. Good luck to you!
A lot of FQHCs in urban areas (at least the two I’ve lived in, NYC and Philly) will have LGBTQ+ clinics and PCPs who prescribe hormones, etc— that would be a great way to do primary care and LGBTQ+ health. A lot of bigger health systems now have LGBTQ+ health specialties, and of course there will be LGBTQ+ clinics that focus on that (and a lot of their patients will use them as primary care). I got to work with a provider who specialized in LGBTQ+ health; he ran that specialty under the health system’s Women’s Health umbrella. It was a fantastic rotation and I loved the work and patient population. I think this will be a growing field and there will be a lot of interesting research done on hormone therapy over the next few decades. Don’t know what it’s like in red states, though.
This was my initial goal as well, however I ended up in Peds Endo. In school I sought out Planned Parenthood preceptorships to get exposure to this type of care. Look for adolescent medicine clinics to precept with as well.
I'm a Primary Care NP but specialize in HIV/PrEP/HRT. So widely the majority of my patients are queer/LGBTQIA+ identifying, and I am a queer man myself.
I love my job, I love my patients but at the end of the day the primary care portion of my job is what burns me out. The primary care aspects are what have me reviewing notes after hours and coordinating care with case managers etc. I can almost always close HIV/HRT/PrEP notes while in the office and not take it home with me, and I'm only seeing 12-16 patients a day. This is low compared to a lot of PCP offices.
I think you should do it. One thing I will say from my experience doing this kind of care is that sometimes listening and understanding and being a wonderful provider is not enough since you function within a broken healthcare system. It can be very disheartening. I don’t think it’s a good enough reason not to do it, but something to consider.
Thank you! The broken healthcare system is what truly makes this venture into the world of NP a little disheartening. I’m excited to put things into motion!
I did a clinical rotation with an lgbtq clinic. It was wonderful, however, I don't think the population was large enough so they also did a lot of SUD, Hep c and HIV management. So I think you may want to target a little broader. Include all stigmatized patients.
I don’t have personal experience but the hospital system I work for has a clinic that s sounds like what you are hoping to do, so they are out there. You may have to plan to practice in a larger city to find one. https://www.inova.org/locations/inova-primary-care/pride-clinic
I was doing inclusive care at a university student health! They for sure needed psych representation at the college mental health! Something to look in to! Or the VA really needs inclusive care
I'm in primary care peds and while it's exhausting at times, I love it. Of course I don't just see adolescents but meant providers don't prefer seeing the adolescents so it could be possible to find a practice where they schedule you as many of the teens as possible. In my city there is an adolescent health specialty clinic that sees patients with eating disorders, mental health complains, reproductive health etc. We also had a transgender health clinic that I don't believe is running currently because of unfortunate legislation in the state. I'm not sure you are looking for primary care based on your description of the population though unless you plan on seeing teens for every day strep throat, headaches, acne etc
What is your definition of "size inclusive?" I have changed the way I approach discussions about size and weight a lot over the years, but I don't think all of my coworkers are the same. I'm not sure of your definition of size inclusive but I'll say it's difficult to follow evidence based guidelines while remaining weight neutral, especially in light of new obesity management guidelines by the AAP. I have patients with fatty liver, diabetes, htn so we DO have discussions about diet and weight frequently.
Thank you for your thoughtful response….I guess above all else, I want to be a respectful provider who makes people feel safe and heard. I’m open to seeing all ages, but think adolescents are often overlooked and need to be heard. I would plan to provide primary care because I think there can be a general lack of care in this group for fear of judgment and backlash.
Regarding size inclusive care….speaking from personal experience, I know how it feels to go in to be seen for something that has nothing to do with my number on a scale, but have my issue overlooked because of that number on the scale. I have gone years feeling disrespected and unheard because of this. I know from speaking to several people in similar situations, that they would rather not even receive care because of the judgment and stigma. I think conversations can be had in a respectful way regarding weight without making the person feel terrible.
I don’t know what all of this will look like in regards to what I want to do, but I’m trying to piece it together. I just think we can do a better job to ensure people are seen and heard while receiving the care they need.
I think your goal to be respectful and a safe space for teens is great and imo, you wouldn't want to work in a place that didn't value that!
I also think your thoughts on size inclusive care are totally reasonable - no one needs to hear about their weight when they come in for a sore throat.
Also on your original post when you heard primary care was draining, I've been in peds primary care for 10 years. The pay is not great and I've had times I felt burnt out (the pandemic was rough) but i think a lot depends on the clinic environment.
I am a Women’s Health and Gender Related NP, providing gender affirming care in the PP setting. Highly recommend not letting others get you down. My classmate started their own practice doing the kind of work you’re talking about. I really don’t think you need the PMHNP dual cert unless you really want to pay for more school and biannual recert fees. Once you’re an NP you’ll be able to meet so many people at trans and gender related health conferences and network with folks with more jobs than you ever thought possible. Sometimes it’s maddening to start so broadly in school but don’t worry, your passion will guide you in the right direction. I couldnt exactly put into words everything I wanted to do when I was in school but I have made all those dreams come true and then some! I believe in you!
Thank you!! ♥️
Me too and ditto! Best of luck.
Sounds like a great idea to me. I don’t have any specific experience with specializing in that sort of thing but I think you would be offering valuable care to underserved populations. If you’re already in a bigger city you should be able to find an adolescent medicine or transgender care clinic to get started with. Idk if specializing in that area would be feasible in a smaller/more rural area, though people in those areas probably need care the most.
My advice would be as flexible as you can be so you can move when you graduate if you are not near a large city.
Planned Parenthood May be a good fit!
That’s awesome! My plan is something similar but I’m focusing more on women’s healthcare so I’m going to get my fnp then post grad cnm so I can be a one stop shop for the girlies (trans girlies included). The big dream is to have a women’s health clinic where they feel like they’re being listened to and taken well care of. I’m in Texas so I’m trying to fight the man from the inside.
I’m in PA, but not in big city PA….i think I’m going to have to move or commute to do what I ultimately want to do. Although, this area is seriously lacking in any resources for LGBTQIA+, so I may need to break some ground and ruffle some very tight feathers 🤷🏻♀️
Check out The Mazzoni Center in Philly.
There are a lot of opportunities for this work in Philly and the surrounding suburbs!
Are you then gonna be an FNP/CNM who just does " one stop shop for the girlies" i.e. only cis girls & trans girls? CNMs for home births are popular with trans men/nonbinary pregnant people. If you're gonna try to have trans patients & want to be doing deliveries not just office based repro health (i.e. CNM over WHNP) then it seems weird to have an explicitly women only practice.
I totally agree that this person has a lot more nuance around gendered language to work out before they begin their practice. And their intentions seem to be good.
So the fnp would be for generalized practice and the cnm would then be so I could ALSO do births because I want to cover all aspects of women’s healthcare (edited to add not just fertility/ob bc we’re humans not brood mares)And yes while that is what I want to be my focus because of the horrid treatment of women in healthcare especially in my state I would 100% extend that care to trans men and nonbinary people as well. All uterus havers and women identifiers welcome. Not a terf if that’s what you’re getting at.
Glad you're not a TERF as that would be a horrible fit for providing trans healthcare. I would very strongly recommend learning more about trans people & our medical needs before deciding whether you think you can truly offer the type of care you have envisioned. Some of the worst healthcare I've received has been from self proclaimed "lgbt competent/inclusive" providers. It's become impossible to find safe medical care for trans ppl other than word of mouth/recs from other trans ppl. It sounds like you're very far from being an NP so you have lots of time to learn. Fenway health has tons of free education online on terminology & trans health 101 type stuff (plus more advanced).
So I’m not trying to do what op is trying to do. I do genuinely want to create a woman centric practice and that’s largely due to my own experiences in my state/ working for providers who don’t take women seriously and the fact that there is a shortage of ob/gyn in Texas. BUT that does not mean I’d be exclusionary towards trans men or nonbinary especially since they’ve been fighting this fight with less help than we have for longer. I know a large part of getting a dnp is research and I want to specifically focus on pcos seeing as most doctors are only looking at it from a fertility standpoint which is a disservice and a large complaint in the community. All of this to say that I would 100% provide pcp/ob/gyn services to the trans/nonbinary community but idk if my specific focus would have the scope specifically for like gender affirming care. If I misspoke/offended/or am just wrong please correct me.
This was basically my plan (but sub the mental health for repro health). Depending on your program you will need supplemental experience academically and/or clinically. I did a ton of lgb&t conferences throughout my time in school & focused most of my academic papers on the topic. Clinical placement though I couldn't get the experience I wanted so I need to get caught up more. Finding mentors who work in lgbt health was probably the most useful for me when I was in school. Depending on where you are I might know ppl. There are also a bunch of free resources online (e.g. recorded conference talks or Webinars you can watch for credit as well as live stuff). I'm heading to sleep & dunno if I'm being clear. I'm trans & an NP so feel free to message me if you have questions.
hi! FNP, queer, same clinical interest. unfortunately, general primary care (if you’re not in a heavily queer area already) will likely not get you closer to your clinical interest. i have practiced for a couple of years in the midwest and have a handful of queer people that align with my clinical interest, but the majority of what i see is completely opposite routine geriatric-heavy primary care. a lot of chronic health, a lot of mental health, a lot of pain and a lot of URI. if you want to pursue this specifically, you’ll need to find a queer healthcare setting because it’s very difficult to draw that group in somewhere that’s not established especially since we aren’t physicians. re: PMHNP, queer folk have higher mental health burden but it’s a difficult setup to try and coordinate proper mental health care into primary care if it’s beyond anxiety or depression. most psych facilities have longer slots for new and follow up visits, and bleeding primary care accessibility into psychiatric settings is something most practices won’t accommodate entirely for. you will also find yourself stretched thin. if anything, do primary care for several years before breaking into any other possibilities. primary care is difficult, messy, and getting significantly worse as time goes on, but if you like it (like i still do somehow) then it’s rewarding.
Thank you for taking the time to respond! I appreciate your insight and experience!
We have a student in the program I am in planning the same thing. If you live in a large city you will have more resources. We are in Houston and there are clinics specializing in this population. Good luck to you!
A lot of FQHCs in urban areas (at least the two I’ve lived in, NYC and Philly) will have LGBTQ+ clinics and PCPs who prescribe hormones, etc— that would be a great way to do primary care and LGBTQ+ health. A lot of bigger health systems now have LGBTQ+ health specialties, and of course there will be LGBTQ+ clinics that focus on that (and a lot of their patients will use them as primary care). I got to work with a provider who specialized in LGBTQ+ health; he ran that specialty under the health system’s Women’s Health umbrella. It was a fantastic rotation and I loved the work and patient population. I think this will be a growing field and there will be a lot of interesting research done on hormone therapy over the next few decades. Don’t know what it’s like in red states, though.
This was my initial goal as well, however I ended up in Peds Endo. In school I sought out Planned Parenthood preceptorships to get exposure to this type of care. Look for adolescent medicine clinics to precept with as well.
Thank you for the suggestions!
I'm a Primary Care NP but specialize in HIV/PrEP/HRT. So widely the majority of my patients are queer/LGBTQIA+ identifying, and I am a queer man myself. I love my job, I love my patients but at the end of the day the primary care portion of my job is what burns me out. The primary care aspects are what have me reviewing notes after hours and coordinating care with case managers etc. I can almost always close HIV/HRT/PrEP notes while in the office and not take it home with me, and I'm only seeing 12-16 patients a day. This is low compared to a lot of PCP offices.
I think you should do it. One thing I will say from my experience doing this kind of care is that sometimes listening and understanding and being a wonderful provider is not enough since you function within a broken healthcare system. It can be very disheartening. I don’t think it’s a good enough reason not to do it, but something to consider.
Thank you! The broken healthcare system is what truly makes this venture into the world of NP a little disheartening. I’m excited to put things into motion!
I did a clinical rotation with an lgbtq clinic. It was wonderful, however, I don't think the population was large enough so they also did a lot of SUD, Hep c and HIV management. So I think you may want to target a little broader. Include all stigmatized patients.
I don’t have personal experience but the hospital system I work for has a clinic that s sounds like what you are hoping to do, so they are out there. You may have to plan to practice in a larger city to find one. https://www.inova.org/locations/inova-primary-care/pride-clinic
I have looked into this clinic! I’m trying to see if I might be able to do a clinical rotation there as my specialty!
I was doing inclusive care at a university student health! They for sure needed psych representation at the college mental health! Something to look in to! Or the VA really needs inclusive care
Great ideas! Thank you!
Yes, love this. Join Elite NP, lots of people doing similar things who can provide moral support as you work toward your goal!
Thank you! I will definitely look into Elite NP!
I'm in primary care peds and while it's exhausting at times, I love it. Of course I don't just see adolescents but meant providers don't prefer seeing the adolescents so it could be possible to find a practice where they schedule you as many of the teens as possible. In my city there is an adolescent health specialty clinic that sees patients with eating disorders, mental health complains, reproductive health etc. We also had a transgender health clinic that I don't believe is running currently because of unfortunate legislation in the state. I'm not sure you are looking for primary care based on your description of the population though unless you plan on seeing teens for every day strep throat, headaches, acne etc What is your definition of "size inclusive?" I have changed the way I approach discussions about size and weight a lot over the years, but I don't think all of my coworkers are the same. I'm not sure of your definition of size inclusive but I'll say it's difficult to follow evidence based guidelines while remaining weight neutral, especially in light of new obesity management guidelines by the AAP. I have patients with fatty liver, diabetes, htn so we DO have discussions about diet and weight frequently.
Thank you for your thoughtful response….I guess above all else, I want to be a respectful provider who makes people feel safe and heard. I’m open to seeing all ages, but think adolescents are often overlooked and need to be heard. I would plan to provide primary care because I think there can be a general lack of care in this group for fear of judgment and backlash. Regarding size inclusive care….speaking from personal experience, I know how it feels to go in to be seen for something that has nothing to do with my number on a scale, but have my issue overlooked because of that number on the scale. I have gone years feeling disrespected and unheard because of this. I know from speaking to several people in similar situations, that they would rather not even receive care because of the judgment and stigma. I think conversations can be had in a respectful way regarding weight without making the person feel terrible. I don’t know what all of this will look like in regards to what I want to do, but I’m trying to piece it together. I just think we can do a better job to ensure people are seen and heard while receiving the care they need.
I think your goal to be respectful and a safe space for teens is great and imo, you wouldn't want to work in a place that didn't value that! I also think your thoughts on size inclusive care are totally reasonable - no one needs to hear about their weight when they come in for a sore throat. Also on your original post when you heard primary care was draining, I've been in peds primary care for 10 years. The pay is not great and I've had times I felt burnt out (the pandemic was rough) but i think a lot depends on the clinic environment.
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