Breaking Barriers: LGBTQ+ Healthcare with Dr. James Kostek

Season 3, Episode 4

Dr. James Kostek, Medical Director of the Babs Siperstein PROUD Center, joins us to talk about inequities LGBTQ+ individuals face in seeking medical care. Listen to learn about progress as well as the persistent challenges in LGBTQ+ health, and hear his advice for aspiring medical professionals interested in this field.

Transcript

Eric Sutton [00:00:08] Hi everyone. This is Eric, and you’re listening to Financing Ambition, a Laurel Road podcast.

In honor of Pride Month, today’s episode will be focused on a crucial and evolving area of medicine: LGBTQ+ healthcare. While this field has seen significant progress, there are still many challenges and disparities that need to be addressed. According to recent studies, LGBTQ+ individuals face numerous health disparities compared to their heterosexual and cisgender counterparts.

For example, the CDC reports that LGBTQ+ youth are more likely to experience depression than their peers. And the National Institutes of Health highlight that transgender individuals often encounter barriers to healthcare access and report higher rates of discrimination in medical settings.

Joining us today to shed light on these issues is Dr. James Kostek, a dedicated specialist in LGBTQ+ healthcare. Dr. Kostek is also a key figure at the Babs Siperstein PROUD Center, a beacon for LGBTQ+ medical care and advocacy. Dr. Kostek, welcome to the podcast. Thanks so much for joining us today.

Dr. Kostek [00:01:28] Thank you. I appreciate the invitation and the pleasure is all mine.

Eric Sutton [00:01:32] Okay. Let’s jump right in with a quick introduction for our listeners. Could you tell us where you’re based and maybe a bit about your career and background?

Dr. Kostek [00:01:41] Yeah, absolutely. So, I’m based currently in Somerville, New Jersey, which is where the Babs Siperstein Proud Center is. But a little bit about my background – I’m a board-certified family physician by my training, and I’m originally from Buffalo, New York. I went to medical school at Touro College of Osteopathic Medicine in Harlem, New York. And then from there, I completed my residency in family medicine at Overlook Medical Center, where I served as chief resident during my time there. Prior to joining the Babs Siperstein PROUD Center and my current role, I was the managing physician of a small practice in South Orange, New Jersey, and I became involved in LGBTQ+ health care specifically because I identify as a member of the community myself. And I found that there was a huge gap in LGBTQ+ specific care needs within health systems as a whole, and really wanted to become a leader in that field for other individuals who had a desire either for care for themselves or other people who wanted to learn more about LGBTQ+ health specifically.

Earlier this year is when I joined the Babs Siperstein PROUD Center – a part of Robert Wood Johnson Saint Barnabas Health System – I started in January, where I have served as the medical director for about the last five months.

Eric Sutton [00:02:51] I’d love to hear a bit more about the history of the Babs Siperstein PROUD Center. How long has that been open?

Dr. Kostek [00:03:02] Yeah, so the Babs Siperstein PROUD Center was founded in 2017, and we celebrate our fifth-year anniversary in 2022. We were actually the first center of this kind in New Jersey to focus specifically on LGBTQ+ health care specifically. And we started with around 40 patients when we first opened, and today we have over 2,300 individuals under our care. What really makes us a special place are the services that we offer to the community, in addition to primary care, which is what I offer as a family physician from my training.

But we also provide gender affirming hormone care to adults and comprehensive sexual health care. We offer additional services to the community as well. We have a patient navigator on staff, who we use to help connect patients to affirming medical specialists. We have a nurse on staff who also works by training individuals on how to administer their injectable hormones, should they be started on that route of treatment, to make sure that they’re doing it in a safe way and doing it in an accurate way. We have a mental health practitioner on staff as well, who offers counseling specifically to LGBTQ+ individuals. But we will work to connect somebody to any mental health therapist or practitioner of their choosing. We also work really closely with surgeon to offer gender affirming surgery to individuals. And by doing that, we were able to have really successful patient outcomes. Our staff in our office works to obtain grants that allow us to also provide services to patients who need them. We are able to move our patients actually to the office should they have, transportation, insecurities, or limitations and, at times, also, we give things like grocery gift cards to people who are experiencing food scarcity. So not only are we able to take care of, you know, “general health 101,” but we also kind of spread out into a lot of other spaces, which I love.

Eric Sutton [00:04:46] That sounds like a really valuable resource for the queer community. And, and also you mentioned it’s a relatively new facility. I’m curious about other similar centers in other states, is there a trend, do you think, in more specialized healthcare facilities opening up for LGBTQ+ patients?

Dr. Kostek [00:05:08] Yeah, absolutely. There are other centers that exist throughout the country. That being said, there certainly are not enough. Despite living in New Jersey where we are, this is considered a sanctuary state for transgender individuals. And I still, where I’m located, have patients travel over an hour just to come see me for an appointment to receive their care. There’s definitely been an increase in these type of facilities over time. Specifically, as health systems have recognized and really striven towards delivering equitable healthcare to individuals and and making that a top priority, and recognizing that in that journey that there are specific needs that are best served to this community by creating a specific health center.

Eric Sutton [00:05:50] It’s good to hear that specialized healthcare is becoming more accessible to the LGBTQ+ patient community. And, although it does sound like a lot of progress is being made, research showers there are still significant gaps.

A 2020 survey by the Center of American Progress, for example, found that LGBTQ+ people face disturbing rates of healthcare discrimination – from harassment and humiliation by providers to actually being turned away by hospitals, pharmacists, and even doctors. And in terms of just getting access to healthcare in general, the study showed that LGBTQ+ folks who were turned away by a healthcare provider face significant difficulty finding an alternative provider.

In fact, almost 20% of LGBTQ+ respondents said it would be very difficult or not possible to find the same type of service at a different community health center or clinic. And those living outside of metro area reported an even tougher time, with 41% of non-metro LGBTQ+ people saying it would be very difficult or not possible to find the same type of service.

So, with this in mind, I love to talk more in depth about the history of healthcare for the LGBTQ+ community – then versus now. So, to start, can you tell us what it has been like for this community historically?

Dr. Kostek [00:07:17] Yeah, absolutely. You know, something that is really important to understand is that not so long ago, things were drastically different. LGBTQ+ individuals have and still do continue to face discrimination. For example, the disease we know of as HIV was initially called GRID  back in 1981 when it was first identified that stood for Gay-Related Immune Deficiency), and it was also called “gay plague” or “gay syndrome,” as initially it only seemed to affect homosexual men, and that certainly put a large target in focus on gay men specifically, further fostering the fear and discrimination of gay men, whether they were or were not affected by HIV. And that is only back as far as 1981, which is wild, you know.

On a more granular scale, in today’s day and age, I’ve had transgender individuals be turned away from other providers for being transgender because they “wouldn’t know how to treat them” at that point. So, that’s really alarming to see. And in 2023, today’s day and age, another aspect of care is that individuals, especially practitioners and patients as well, don’t feel completely comfortable discussing sexual health, which can play a huge part in someone’s overall health, such as disclosing having same-sex partners, fearing that that may elicit judgment from somebody who may be serving as your healthcare practitioner. If you fear judgment, people are less likely to be forthcoming. So, patients have reported things like when asking for Pre-exposure prophylaxis (or PrEP) – something that patients can take to reduce the rate or chance of transmitting or catching HIV – that they’ve been met with responses like, why would you need that? Almost like questioning them or feeling like an interrogation or, or the provider not even having knowledge of that treatment. And patients are ultimately being done a disservice in these instances and are discouraged of being forthcoming about their own personal needs and health issues.

Eric Sutton [00:09:13] You know, it’s difficult to be reminded of some of these darker parts of queer history, particularly as a member of the LGBTQ+ community myself. So, tell me, what are things like now, Dr. Kostek? Have things changed for the better, do you think?

Dr. Kostek [00:09:29] I do think things are changing. You know, change in healthcare has been really gradual. It has been consistent over the years, certainly with the increase in political rights of LGBTQ+ individuals. However, that is still being challenged today, and at this very moment, in some states. And cultural acceptance overall has really empowered people to live their lives, I think, more visibly. Things have improved in a way substantially for certain groups of us.

You know, speaking very plainly, I think as a gay man, quality of life has improved for our sector of the LGBTQ+ group. But really, we should not become complacent with the progress we’ve made. We still don’t have extensive studies within our population, such as, cardiovascular risk and heart risk of transgender men, breast cancer studies in trans women, rectal cancer studies in individuals who have receptive anal intercourse, despite all groups having potential risk for these things. You know, despite having, for example, similar rates of HPV between transgender men and cisgendered women, they are much less likely to undergo things like cervical cancer screening. In addition, they are also less likely to have breast cancer screenings or even a primary care doctor because of the fear of judgment or even access to care. Individuals do not routinely seek care because of the aforementioned issue.

You know, another aspect to consider that the healthcare system at large is not educated to the needs of these individuals. Recent data shows that in New Jersey, we had the highest amount of new HIV cases in 2021 since 2016. That’s five years – all of a sudden, that jump to the high and a record high, which was decreasing before that. To me, that jump is concerning and shows that we have a need for providers to continue to educate people on HIV prevention moving forward and educate providers on how to best support their patients who may benefit from taking something like PrEP. You know, the new current recommendations, for example, for HIV prevention, is that anyone who has multiple sexual partners, regardless of your gender or sexual orientation, would benefit from actually HIV prevention. And a lot of people are likely not having these types of discussions with their health providers.

We’re also seeing, on top of that, an increase in rates of certain sexually transmitted infections such as syphilis. And there’s new cutting-edge treatments out there, such as something called DoxyPEP or doxycycline, which is the antibiotic we routinely use to treat infections all the time. And it’s the concept of taking this medication after a potential exposure to reduce rates of certain sexually transmitted infections. That concept is really important, and it’s still not widely discussed or really being implemented to people who would really benefit from using it.

Eric Sutton [00:12:05] So, like we talked about at the top of our conversation, while there has definitely been some progress on this front, there are still significant opportunities for improvement. For example, let’s talk a little more about the trans community specifically, because I know they’re a particularly vulnerable population. How would you describe the current state of trans healthcare?

Dr. Kostek [00:12:29] You know the state of care is really poor. I will be honest. It’s very tumultuous in today’s climate. In 2024 alone, there have been 38 anti-transgender bills passed in the United States. And another 339 that are still active or being explored.

What’s really special and we’re so thankful for is in April of 2023, Governor Murphy signed Executive Order 326. And that grants protection to anybody providing or receiving gender affirming care. It actually prohibits health insurers from denying or limiting coverage for services, including gender affirming care, due to somebody’s gender identity and expression. A lot of people who live in different states do not have this privilege. And so, with the passing of this executive order, I’ve actually seen a large number of transgender individuals move to our state – or even move multiple states – before coming to New Jersey and becoming my patient due to the increase in anti-transgender legislation and transgender discrimination that they’re experiencing.

You know, studies show that, transgender individuals, they were surveyed, and 29% – a little less than a third – said their healthcare provider refused to see them because of their gender identity, and 21% had experiences with the provider using harsh or abusive language. And again, 29% said they had unwanted physical contact from a healthcare provider. So, to answer your question – yes – there has been some progress, with development of these centers, but certainly not enough progress and actually even regression in some instances. I would say it really all needs improvement.

Eric Sutton [00:14:04] So, then, what are you seeing as the most dire healthcare issues that trans patients are facing?

Dr. Kostek [00:14:23] I would say fear of the medical system and the ability to access competent and safe care are some of the biggest issues. You know, being a patient in any healthcare setting can be very anxiety-inducing, regardless of being part of the LGBTQ+ community or not. And, and so the fear that can be based on either prior negative experiences in the healthcare field, fear of judgment based on someone’s perceived gender or sexuality, or even concern for care being withheld.

You know, outside of the baseline apprehensions surrounding the healthcare system, transgender individuals are more likely to experience things like poor mental health, financial instability, housing instability, and substance use disorders. When someone can’t even access care, or is afraid to access care, they’re more likely to miss important screenings for preventable diseases like certain cancers, breast cancer, cervical cancer, prostate cancer, colon cancer, etc. I could list them all. And then other medical illnesses that you’re routinely screened for at a doctor’s visit, such as diabetes, high blood pressure, high cholesterol, and so on and so forth. If these problems are not adequately addressed, if we’re not able to provide those services, we’re ultimately going to have poor health outcomes in the long term. So, to me, that probably is the most dire issue that they’re experiencing, right from a health standpoint.

Eric Sutton [00:15:43] All are really critical points you’re bringing to light here for us, Dr. Kostek, thank you for sharing that. So, for future doctors who are listening, who are interested in specializing in LGBTQ+ healthcare and specifically trans care, what would you say they should be most aware of?

Dr. Kostek [00:15:59] Yeah. You know, I think first and foremost, they should be aware that they really need to get involved. That is that the first thing. They have to be motivated and passionate about it.

And they should seek out education regarding LGBTQ+ health issues. You know, for the most part, clinicians, we receive little to no LGBTQ+ health education during our training, whether that be in school or residency. And so, it’s important to connect with other individuals who are involved in the field and find a mentor or find a support system.

A great starting point for education in trans care and what they should be aware of is they should join the WPATH – the World Professional Association for Transgender Health. It’s an organization that helps set the best practices for taking care of transgender individuals worldwide, getting involved in the trans community and getting to know your patients. You know, really being willing to listen to someone in a very open-minded space where they can express themselves freely is so important. Word of mouth is really everything to the LGBTQ+ community. If someone has a great experience or feels comfortable being their authentic self with you, that will spread, and people will seek you out. It’s important to note that you can’t know everything, and it’s okay to not know everything. It takes time to learn that all, but you really need to have a willingness to learn and to seek information to support your patients. And that will really go a long way with each individual.

Eric Sutton [00:17:21] That’s really helpful information for medical students looking for the best training in this field and wanting to make the most of it, thank you. So, Dr. Kostek, beyond training, what would you say is the most challenging thing about a career focused on the LGBTQ+ population? And on the flip side of that, what is the most rewarding thing?

Dr. Kostek [00:17:48] I think the most challenging thing that I experience is probably balancing the different bio-psycho-social dynamics that come into play with treating patients. Helping someone with their physical health is one part. But if a person cannot get to medical appointments or does not have insurance coverage to afford their medications, or even a stable living situation, it really adds a lot of complexity to their care and makes little things that should be small obstacles – that I think the general person may be able to overcome really quickly – can make it a lot more cumbersome for that person. So, you know, that to me is the biggest challenge. And really playing in the factor of how to best address all those things simultaneously with limited resources outside of what you can perform for them in your office.

I think it’s really rewarding, though, to have a patient come to you and trust you with their well-being and to really see the positive impact you’ve made on their health and see them change over time as an individual, because you’ve been able to be there and support them through things, even if you cannot solve every problem all the time for them.

Eric Sutton [00:18:57] So, Dr. Kostek, let’s talk about the dream state a bit. Looking into your own crystal ball, what is your vision for the future of healthcare for the LGBTQ+ patient community? What would you most want to see happen?

Dr. Kostek [00:19:17] I really would love to see a further investment in LGBTQ-specific care and competency across all health care systems, not just the ones that are placing emphasis on it, like where I’m currently located. You know, it should be something that should be the standard across every organization, around the country. The goal of equitable care is for any person, regardless of your gender, race, sexual orientation, etc. to receive the same high-quality level of care.

I would love to also see insurance companies offer greater access for gender affirming treatments to patients, to really reduce barriers to care and increase collaboration along all healthcare providers to improve healthcare outcomes amongst LGBTQ+ patients specifically.

Eric Sutton [00:20:00] That sounds like a really great path forward, and I’d like to think we can get there, and we need to. According to a recent Gallup poll, the percentage of US adults who consider themselves something other than heterosexual has more than doubled since Gallup first asked about sexual orientation and transgender identity back in 2012.

About 1 in 10 millennials today and 1 in 5 Gen Z adults identify as LGBTQ+. And if these trends continue, it’s likely that the percentage of the population who identify as LGBTQ+ will exceed 10% of US adults at some point within the next three decades.

And that bodes well for our future, I think, because with more out queer people in the population, we will likely see more folks entering medical fields who identify themselves as LGBTQ+. According to a recent survey from the Association of American Medical Colleges, 14% of all graduates identified as LGBTQ+.

Dr. Kostek, do you think that these fairly significant generational changes and trends pointing to higher rates of LGBTQ+ identification, will naturally help drive change in this field and continue to improve patient outcomes?

Dr. Kostek [00:21:20] Absolutely. I really do think it will. You know, when you have a stake in what is at hand, you’re more likely to take a vested interest and push towards greater progress towards that issue if it affects you directly. It’s not necessarily that we have more LGBTQ+ individuals being born, but to me it speaks to that people feel more comfortable disclosing and being open about their identities. And to me, that is a sign of true progress.

Eric Sutton [00:21:45] 100%, I could not agree more. So, Dr. Kostek, we’ve covered a lot of ground today on the state of LGBTQ+ healthcare and where it’s heading. Before we say goodbye, I’d love to close out this episode with some more advice for our listeners, many of whom are future medical professionals themselves. What would you say are the top three things future doctors who are interested in specializing in LGBTQ+ healthcare should know?

Dr. Kostek [00:22:15] Number one is the work is not easy. It takes time, dedication and you have to be passionate about it. Get comfortable being uncomfortable and not knowing everything off the bat and challenge yourself.

I’d also say you should really understand that the person you’re working with is unique, and they have a special set of life circumstances that have brought them to you that day. Your interaction in that moment will help shape their future relationship with their health and their body. And during that time, you really should be empathetic and well intentioned with everything you say.

And then lastly, you know, this is a pioneering field. Get ready to constantly push yourself to review not just guidelines, but the newest research that’s being conducted. This is certainly an opportunity to become a leader in the medical field.

Eric Sutton [00:23:04] Dr. Kostek, thank you so much for sharing your knowledge and your time with us today. You’ve shared so many great insights, and we’re really grateful that you could be here to help us get a better understanding of where LGBTQ+ healthcare is at right now, and the direction it’s heading in. So, thank you so much for joining us again, and happy Pride Month.

Dr. Kostek [00:23:27] Thank you.

Eric Sutton [00:23:28] And as always, thanks to our listeners for joining us. For more information about Laurel Road, visit laurelroad.com and follow us on Facebook, Instagram and LinkedIn. And stay tuned for the next episode of Financing Ambition.

Episode References

https://www.rwjbh.org/rwj-university-hospital-somerset/treatment-care/babs-siperstein-proud-center/https://www.wpath.org/

https://www.wpath.org/

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This podcast is produced for information purposes only and is not an offer or solicitation of any product. Any views, opinions, findings and conclusions expressed in this podcast are solely those of the participants and do not necessarily reflect the views of Laurel Road or its affiliates. Laurel Road, KeyBank and its affiliates are not providing any financial, economic, legal, accounting or tax advice or recommendations in this podcast. The information contained in this recording may not be current, and Laurel Road has no obligation to provide any updates or changes. Neither Laurel Road nor any of its affiliates makes any representation or warranty, of any kind, as to the accuracy or completeness of the information in this podcast and expressly disclaims any and all liabilities around such.

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