A Critical Assessment of the Transgender Health Care Workforce in the United States and the Capacity to Deliver Gender-Affirming Bottom Surgery

Abstract

Background: Gender-affirming surgery is a critical component of transgender health care, but access information is limited. The study aim was to assess workforce capacity to perform gender affirming bottom surgeries (GABSs) in the United States. Methods: A questionnaire was administered via email, phone call, or fax from February to May 2020 to 86 practices identified as performing GABS by searching 10 Web-based databases with standardized keywords. Questions assessed training capacity, surgical capacity, and surgeon experience. Results: Thirty-two of 86 practices responded, 20 met the inclusion criteria. Practices were identified in 15 states, with an average 2.4 (SD, 1.3) surgeons performing GABS per year. States with the greatest number of total providers offering GABS were Illinois (n = 21), Texas (n = 10), and Massachusetts (n = 13). No significant correlation between number of GABS types offered and geographic population density (r = −0.40, P = 0.08), or between number of providers and geographic population density (r = 0.19, P = 0.44). Vaginoplasty was most frequently performed, with the longest waitlists and highest number of waitlist additions per month. Phalloplasty was the second most common procedure, and waitlist additions per month exceeded provider capacity to perform the procedure. Most surgeons performing GABS were plastic surgeons and urologists, whereas obstetricians/gynecologists performed the majority of hysterectomies. Conclusions: This study demonstrated a shortage of providers with requisite training and experience to provide GABS. Although more robust studies are needed to better characterize the relationship between the number of patients seeking GABS and available providers, these findings indicate a need for improved training.

Comparing scrotoplasty complication rates in transgender and cisgender men: An ACS NSQIP study

“…This is consistent with rising rates of gender affirming surgery from the 2000s onwards, particularly after Medicaid expansions under the Affordable Care Act of 2012 and subsequent state-specific expansions in 2015. 7 , 9 However the relative growth of masculinizing genitoplasty has lagged in comparison to other procedures, likely due to the limited numbers of qualified, culturally-competent providers available in the professional workforce, 10 and as evidenced by the relatively few patients identified in our analysis.…”

Unreasonable Expectations: A Call for Training and Educational Transparency in Gender-affirming Surgery

“…1–4 As the stigma associated with such procedures has started to recede, the field began a rapid growth with the current workforce insufficient to meet demand. 5–7…”

“…[1][2][3][4] As the stigma associated with such procedures has started to recede, the field began a rapid growth with the current workforce insufficient to meet demand. [5][6][7] With this growth, a paradigm shift will be critical to preserving the quality of care. This is in part brought on by the rising popularity of procedures far more rarely attempted in previous decades.…”

Geographic Variability of Genital Gender-Affirming Surgery Centers and Costs of Hospitalization

“…The main barriers to GAS described in the literature include limitations in insurance access, high out-of-pocket costs, presurgical requirements, and physician density 3,4 . Geographical location, which may affect all of the above barriers, has also been raised as a possible unifying factor 5–7 .…”

“…2 The main barriers to GAS described in the literature include limitations in insurance access, high out-of-pocket costs, presurgical requirements, and physician density. 3,4 Geographical location, which may affect all of the above barriers, has also been raised as a possible unifying factor. [5][6][7] In fact, the significant variability of cultural and political viewpoints about GAS across US regions suggests that geography may be one of the most significant obstacles to care.…”