Finding the right fit as an LGBTQIA OD
Sometimes it takes several tries before settling into an inclusive practice that’s right for you.
Image credit: AdobeStock/BeaunittaVanWyk/peopleimages.com
I always planned on keeping my private life just that—private—and not being out at work or throughout my professional career. I was worried how I would be viewed by my professors, colleagues, and employers.
Findings from studies have shown that many people falsely equate queerness with incompetence and unprofessionalism in the medical field.1 However, I knew I was competent and professional and didn’t want to jeopardize others’ perception of me. Because of this, I stayed closeted in optometry school, and I was very competitive with my examination scores and social capital. I burned myself out joining clubs and committees and studying to have the highest mark.
During my residency, I came out and found that I was very well accepted and that not many people cared that I was queer. It helped being in an academic institution and a large city where a culture of acceptance and inclusion fosters a safer environment for queer employees. One notable exception occurred when one of my superiors made a comment about how I dressed, stating I looked more “casual” than my female peers. This was surprising to me, as I usually wore sweaters and nice pants, nice shoes, and my white coat; however, all my female colleagues wore skirts, dresses, and heels more often. I see this microaggression as a one-off and overall felt very comfortable being out during my residency.
After I left the academic bubble, things changed, and I found I was changing jobs more often than I anticipated. In hindsight, I have realized that I left these environments largely because of how I was treated as a member of the LGBTQIA community.
My first job was with an ophthalmology group, and I left after being there for only 3 months. I was appreciative of the mentorship that was provided to me as a new physician, but I wasn’t credentialed, couldn’t sign off on any medical record, and had very little autonomy. I did not feel like a respected or valued member of the care team. The final straw was when the ophthalmologist didn’t listen to my recommendations for what I saw as a textbook giant cell arteritis case. I recommended urgent hospitalization with intravenous steroids, blood work, and temporal artery biopsy. He deleted my plan from the patient’s chart and discharged her home. The patient ended up losing sight in both of her eyes, and only then did he start her on a course of steroids. I’m not sure whether my perspective was dismissed because I was an optometrist, a woman, a lesbian, or perhaps all the above.
My next job, back in my hometown of Colorado Springs, Colorado, seemed like a better fit clinically, but I didn’t feel comfortable or safe being out at work. My employer and the office manager were members of a historically conservative church. There wasn’t a rainbow flag anywhere in the office, and I was the only queer employee I knew of. One day, my office manager sat me down and stated that she “knew I was gay” and that I “wouldn’t be fired over it.” At this point, it was still legal in 28 states for an employer to terminate or not hire someone because they were LGBTQIA.2 What had been a spotlight on my identity in residency became an unrelenting floodlight at this new job that made me deeply uncomfortable. I was with the office until the COVID-19 pandemic hit, and then my hours were reduced to the point where I wasn’t making a livable wage to cover my mortgage and student loans but was making too much to qualify for unemployment. One in 5 working adults had their hours reduced during COVID-19, but 1 in 3 LGBTQIA working adults had their hours reduced during COVID-19 (and this number is likely underreported, with many people in the closet).3 The other physicians, who happened to be straight, were working overtime. So it was time to find a new gig.
I joined a group practice that worked in conjunction with dentistry and orthodontics, primarily serving children from low-income backgrounds. I felt good about the mission, and in my contract, it explicitly stated I wouldn’t be discriminated against based on gender identity or sexual orientation. My contract also held me to the same standard, stating I wouldn’t discriminate against other employees or patients based on their gender identity and sexual orientation. I also wasn’t the only queer health care professional working at the office and felt much more comfortable to be out and proud at work. Diversity, equity, and inclusion (DEI) training was mandated along with Health Insurance Portability and Accountability Act and Occupational Safety and Health Administration compliance. The company sent out Pride Month newsletters, and in June, I made rainbow ribbons for the technicians and physicians to wear if they wanted one—and everyone wanted one! I even had to make more to include the dentistry and orthodontics side!
As my primary population was children, I wore a rainbow flag pin year-round. So many patients complimented this pin, underscoring how visibility was so important for our community, especially our LGBTQIA youth. The office put forth an effort to respect pronouns and preferred/chosen names, and it was a great place to work. That is, it was until we underwent new leadership and the office did away with DEI learning modules, Pride Month newsletters, and rainbow lapel pins. The office culture was now much less inclusive and much colder. I found myself becoming less happy at work.
So I switched jobs. Again.
This time, I decided to work for a large corporation and give telehealth a try, which is where I am now. I absolutely love it. I feel much safer at work, and I can serve patients in states and communities that I otherwise wouldn’t feel comfortable working in. Once again, I have a DEI module to click through, and the company has done an excellent job of intentionally hiring a diverse set of employees.
However, no system or corporation is perfect, and there are still some hurdles to overcome. For example, my spouse and I are looking to start a family, and when I went to put in a parental leave inquiry, my options were “maternity leave” or “paternity leave.” My spouse will be carrying our child, so I don’t fit into either of these categories. When I submitted by inquiry, the HR representative responded, “Are you adopting?” This assumption stung. There are so many ways LGBTQIA couples can start their family, and this assumption flippantly discounts the time, energy, and financial resources that couples spend family planning through other means such as intrauterine insemination, in vitro fertilization, and surrogacy.
If there is one thing I’ve learned in my frequent job hopping, it is the difference between lip service and improving a workplace culture. Changing verbiage to be more inclusive is an easy fix, but changing culture and how your providers feel in the office? Not so much.
My advice to any LGBTQIA optometrist (or straight ally) out there is that it’s OK to move on from an employer that isn’t healthy for you in one way or another. You shouldn’t tough it out because you’re worried about how job hopping or employment gaps may look on your resume. Lastly, you do not have to be out at work—you don’t owe your patients or employers anything but quality care—but if you decide to be out at work, you deserve to be valued, safe, and included.
References:
Williams ND, Winer B, Aparicio EM, Smith-Bynum MA, Boekeloo BO, Fish JN. Professional expectations of provider LGBTQ competence: where we are and where we need to go. J Gay Lesbian Ment Health. 2022;80(8):10.1080/19359705.2022.2146825. doi:10.1080/19359705.2022.2146825
Gruberg S, Madowitz M. Same-sex couples experience higher unemployment rates throughout an economic recovery. Center for American Progress. May 5, 2020. Accessed October 17, 2024. https://www.americanprogress.org/article/sex-couples-experience-higher-unemployment-rates-throughout-economic-recovery/
Gil RM, Freeman TL, Mathew T, et al. Lesbian, gay, bisexual, transgender, and queer (LGBTQ+) communities and the coronavirus disease 2019 pandemic: a call to break the cycle of structural barriers. J Infect Dis. 2021;224(11):1810-1820. doi:10.1093/infdis/jiab392
