Melanie Cole, MS (Host): In recent years, efforts to enhance diversity in Ophthalmology have primarily centered on gender and racial representation. However, LGBTQ+ inclusion remains an area that requires attention. Today, our guest emphasizes the need for LGBTQ+ diversity, equity, and inclusion in Ophthalmology. And he proposes strategies to advocate for LGBTQ+ physicians and patients.

Welcome to Better Edge, a Northwestern Medicine podcast for physicians. I'm Melanie Cole. And joining me is Dr. David Ramirez. He's an Assistant Professor of Ophthalmology at Northwestern Medicine. Dr. Ramirez, it's a pleasure to have you join us today. I'd like you to start by speaking about why the LGBTQ+ representation is so important in Ophthalmology. How does this intersect with healthcare needs and concerns specific to this community?

Dr David Ramirez: Thank you so much for having me, Melanie. I'm happy to talk about this. It's been a passion and personal experience of mine for the last many years of my medical training. So really, all of this evolved, I would say, out of my own personal experience, which is a shared experience. Many LGBTQ+ ophthalmologists and physicians in general when I was in medical school, and even before that, I really had trouble finding a mentor from my community.

And this really kind of became an issue as I moved through medical school and through residency, not to say that I didn't have any fantastic mentors. I love my mentors who are not a part of the LGBTQ+ community and they have definitely strengthened, me, my work. But having someone to be able to bounce questions off of as I move through the process that are more specific to the community was something that I was really missing.

For example, when I was interviewing for residency, whether it would be even appropriate to be out while interviewing, whether that would disadvantage me in some way, what people's experiences with that had been like on the other side, whether it would be detrimental to discuss my partner, my relationship status, caring about where my partner would be and whether he could find a job at whatever place I was looking at.

Really trying to get to know the culture of Ophthalmology and the culture of the field was something that I was missing. And so when I was in residency, thankfully, I was in a very supportive program. I went to residency at the University of Iowa and was very frank about my interest in this space and my need for support, and they were fantastically supportive of me. And so, just through my faculty's connections, I was able to connect with another ophthalmologist at the University of Pennsylvania. Together, we approached our national organization, the AAO, the American Academy of Ophthalmology, really to ask for support in creating the space for trainees for the future, modeled after my experience and others' experiences of not having this mentorship.

So really, honestly, mentorship was at the center of what we were doing, and the Academy was unbelievably supportive of this. And I'm happy to talk more about that. But suffice it to say, we've grown substantially in our group over the last three to four years that we've been working on this, and the feedback from LGBTQ+ trainees has been overwhelmingly positive, and surprised that there was nothing like this, and honestly surprised that it existed. So, it really has been an incredible and positive experience so far.

Melanie Cole, MS: Thank you so much, Dr. Ramirez, for sharing your story with us because it really does highlight the whole inclusion discussion that we're having today and why this is so important. And I'd like to shift the focus for just a second to talk about patients and your experience. What are some of the specific healthcare needs and concerns that the LGBTQ+ patients may have, particularly in the context of Ophthalmology? We don't think of that quite as often. As you said, it was underrepresented and we think of it in terms of many other fields within the medical community, but not so much Ophthalmology. Speak a little bit about any unique considerations that you'd like to share.

Dr David Ramirez: I think you bring up a great question and it's honestly a question that a lot of us have. And the big problem at the core of that is data. To be able to answer these questions in an evidence-based way, you need data. And we are a community, a population, that historically has not had any data collected. We've been excluded from funding for studies looking at examining this population, particularly in Ophthalmology. In recent years, there's been a big push to kind of collect data on the LGBTQ population as a broader cohort. But in Ophthalmology specifically, there really isn't any information about whether there are specific needs. We know that LGBTQ patients are unlikely to be out to their healthcare provider. And we know that a lot of our inferences about the LGBTQ population come from similar studies on race ethnicity, kind of race or ethnic concordance, a.k.a. a patient being of the same race or ethnicity as their provider. You know, there's a greater sense of trust and, feeling like you're able to be taken care of by somebody who understands you. So, a lot of that research we've done inferred applies to the LGBTQ community, but we really don't know. And so, this is an area that I am actively looking into, that many others are actively looking into across the country and really trying to create a basis to have something to advocate for our patients because we really don't know.

The things that we do know are mostly about LGBTQ+ providers, feeling like you can't be out at work, feeling like you have higher rates of stress, anxiety compared to heterosexual peers, and that really extends into our ability to care for patients. But the question about what LGBTQ patients specifically within Ophthalmology want or need is a great one, and we really don't know.

Melanie Cole, MS: So as you're telling us about some of these unique challenges that LGBTQ+ physicians face during medical training and practice, and you've spoken about those and the underrepresentation, what role can physician allies play in advancing this diversity, equity, and inclusion in Ophthalmology? I'd like you to address some of the barriers to accessing eye care people in the LGBTQ+ individuals and community might encounter, such as discrimination, lack of awareness. Speak about how your colleagues can help to advance this awareness.

Dr David Ramirez: I'll just mention every year at the academy for the last three years, we've had a session on the LGBTQ community and ophthalmology and what that means and kind of introducing concepts about identity, and how to be a good ally, really. And we've had some really interesting discussions, actually, that have come out of those sessions. And a lot of people ask that same thing, how can I be better support the community. And one thing that I've heard is that it's hard really to bring it up. It's not something that a lot of people feel comfortable bringing up. And of course, you kind of risk saying something if you're nervous that maybe you don't mean, or using a word that you're not familiar with, or a pronoun. And people are generally good-intentioned and don't want to make that mistake.

One way that's really great to show your allyship is just to have a symbol of allyship. For example, a little rainbow sticker that you can put on your badge, or outside your office or something like that to let people know that you are an ally, that you're willing to discuss these things when brought up. I think it's totally reasonable to not initiate these conversations if you don't feel comfortable or feel like you don't want to be offensive or something like that. But honestly, those symbols are so strong. And for me, whenever I see that on my provider's badge, I feel much more comfortable talking about my partner or our family or our future plans, you know, even things as simple as building rapport can really help with. This also extends to making patients feel safe and comfortable in your office or your practice. So, having signage that is inclusive of LGBTQ+ individuals, whether that's having a picture of a same sex couple just hanging up on your wall, something as simple as that, having an LGBTQ+ magazine or something on the coffee table, having the rainbow signage or having signage that says something about inclusivity or all are welcome, I've really seen those popping up a lot, but these are kind of more passive but still really powerful ways to be able to express support for our community.

And then, just in the day to day outside of signage and symbols, being vocal support to your LGBTQ+ peers and colleagues, that really goes a long way in supporting the work that we want to do. For example, helping us recruit for these studies, being supportive of research ideas or research interests, that we have coming to some of our events at the Academy and bringing people to show support. these are all tangible actions that really go a long way to help move our community forward.

Melanie Cole, MS: And while we're talking about that, and I love your ideas of showing your support, and some of them are just so easy to do, and I thank you for that, now what about the ophthalmology organizations? What are some effective ways that they can help to raise awareness among healthcare professionals about these unique needs and challenges faced by both the patients and the patients physicians and people in the medical community in the LGBTQ+ community.

Dr David Ramirez: So, having a space just in itself is a powerful statement of support. And so, the American Academy of Ophthalmology has been incredibly supportive in our desire to create this space in a more professional setting. So, we've had several events over the last couple of years, which I've referenced a little bit, but really just focusing on having a space where people from our community, our allies can network. We've had a mentorship mixer this past year for the first time, which was really exciting with the support of the academy. And then, having this opportunity to present an instructional course about our community and our specific needs to educate people who want to be educated about this topic, I think, is really important. And so. Really having a seat at the table and being able to participate in decisions around our community, how the academy is going to engage with our community, and how we're going to help its membership really address this issue is super important. And again, thankfully, AAO has been really gracious about letting us have this space. And we've been growing and growing and growing every year, which is really exciting.

Melanie Cole, MS: I love that you set a seat at the table. I think that is so important to continue that discussion and conversation to raise awareness and come up with ideas and initiatives. Looking ahead, Dr. Ramirez, as we wrap up, what are some of your hopes and aspirations for the future of the LGBTQ+ diversity, equity, and inclusion initiative in the field of ophthalmology and really in healthcare as a whole.

Dr David Ramirez: I'll just say it is so meaningful to me to have a younger ophthalmologists, whether in training or in their first year of practice, come up to me at these events and say, "We never knew these things existed. I'm so happy I found this. I've always wanted a mentor who was a part of my community and someone who really understands me and my identity." And I've also had individuals who are near retirement or who are, you know, advanced in their career come up to me during these events and they become very emotional. One of my close friends has said, "This is the first time I've ever felt seen in my entire career as an ophthalmologist." And it makes me feel emotional to know that even just by having a space and representation and visibility really in a community that has traditionally been invisible, having that speaks volumes and having these conversations speaks volumes.

So, my hope for the future is to really cement and honestly operationalize a lot of our programs. We're building a mentorship program right now to connect more practicing ophthalmologists with medical students, residents to really try to get Ophthalmology to be at the forefront of helping people enter our field who are competitive applicants who may otherwise overlook it, because Ophthalmology may be seen as a traditionally less accepting specialty.

I mean, there was a study that came out recently in the survey of medical students, and it was almost 7% of medical students who identified as LGBTQ, only 3% went into Ophthalmology. And Ophthalmology was actually the second least popular specialty for LGBTQ+ students. And so, that's a clear indicator that we have work to do and that we need to continue to increase visibility. And that's why I'm so interested in creating these mentorship programs for students to be able to get the best talent into ophthalmology and not let something like their personal identity be a barrier to that. So, I really see that as the cornerstone of our movement moving forward.

Melanie Cole, MS: Your passion and compassion makes me emotional. Just hearing you discuss this, Dr. Ramirez. Thank you so much for joining us and sharing your expertise on this very important topic. To refer your patient or for more information, please visit our website at breakthroughsforphysicians.com.nm.org/ophthalmology to get connected with one of our providers.

That concludes this episode of Better Edge, a Northwestern Medicine podcast for physicians. Please always remember to subscribe, rate, and review Better Edge on Apple Podcasts, Spotify, iHeart, and Pandora. I'm Melanie Cole. Thanks so much for joining us today.