A.J. Stefani, DO, a hospitalist at UnityPoint Clinic Central Iowa Hospitalists in Des Moines, Iowa, says his favorite part of being an SHM member is that it’s “a place for all of us hospitalists to connect over our shared passion for outstanding hospital/acute care and to dive into the hard work of improving what often feels like a broken healthcare system. The people are friendly, supportive, bright, and enthusiastic. It’s a breath of fresh air to experience that level of passion and joy in medicine when so many folks have felt the burnout of the pandemic etc.
Lean into what makes you you and use that to your advantage to set you apart from others in your field. Being part of the LGBTQIA+ community can be something of a superpower.
Dr. Stefani
Q: How are you and your colleagues celebrating Pride Month?
A: Our organization has a rich tradition of supporting the LGBTQIA+ community. Staff get special branded Pride shirts, they can sign up to march in the Capital City Pride Parade, and they can display rainbow pins on their badges. Signs are displayed in clinics to make patients/families feel welcome, and our social media pages share You Matter moments with our LGBTQIA+ staff and their patients. In our specific office, my staff has adorned a mini-Christmas tree with Pride ornaments and tree skirt. Each of these may be a small thing, but the visibility and the unity of staff showing up and representing is actually very affirming as an out and proud physician and definitely puts our often-marginalized LGBTQIA+ patients at ease when they come here for care.
Q: Can you tell us a bit more about what inspired you to be a part of the SHM LGBTQIA+ Health Series and your experience working on this series?
A: I’m continually inspired by those who came before me and had the courage to be themselves and the audacity to live their truth in a world that often seeks to smite us for that very thing. There weren’t many visibly out physicians for me to look up to when I was going through school. I can think of one—who I met during undergrad—out of the hundreds the University [University of Iowa] hospital employed, and then there was my mentor during med school, Dr. Matt Roes.
He was a vibrant vocal voice for inclusion and reclaiming our perceived weakness as a strength in patient care. Sadly, he was taken from us far too soon due to cancer. I got to spend two months of rotations with him in his family medicine clinic and it was the most fun experience. He reminded me that whatever we do, wherever we practice, medicine should be fun and joyful. It doesn’t mean it won’t be difficult, sad, or overwhelming at times, but we should hold strong in the joy of scientific learning and the ability to impact people’s lives.
That foundation fueled me to seek out my residency mentor, Dr. John Carstensen, who helped me prepare the first-of-its-kind Grand Rounds on LGBT Healthcare & Disparities. It was through my research that I realized the current state of healthcare was perpetuating some of the disparities and stigma onto my LGBTQIA+ community and that the simple act of me living my truth in the face of the growing societal opposition to us as it pertained to same-sex marriage, trans healthcare, drag queen bans, trans bathroom bills, was actually a revolutionary step of activism. It has also allowed me to feel more completely whole as a person and healthcare provider so that I don’t have to hide and live some sort of code-switching double life at work and home.
I am grateful for the chance I may have to impact other LGBTQIA+ providers I meet. Being involved on a broader scale with the SHM LGBTQIA+ Health Series helps me perhaps reach people beyond my local network and once again, let folks know that you can be a fulfilled successful out, and proud queer physician in Iowa or anywhere in the country.
Q: Looking to the future of hospital medicine and healthcare, what are your hopes for equity in the field? What can we be doing today to continue these efforts?
A: To create equity in the field, we first have to survey regularly the current state of our physicians, advanced practice providers, nurses, therapists, etc. If we don’t know what percentage of us are out there in all healthcare fields, how can we see the disparity of underrepresentation that exists?
While I have seen a small but significant growth in gay, lesbian, and bisexual providers in Des Moines where I practice, there are virtually no out trans or gender non-conforming providers that I’m aware of. We have to examine why that is on a local scale but also in relation to the national tide of oppression and hate the trans community is experiencing. I would love for organizations to leverage their DEI [diversity, equity, and inclusion] teams (of which I’m proudly a part at my organization) to create subcommittees or special interest groups to reach out to the trans community and trans youth to talk about the impact of healthcare in their lives, career opportunities for trans people in healthcare, and what can be done to be more inclusive. I continue to believe that if enough of us are a beacon of hope and light for our LGBTQIA+ families, more people will eventually gravitate towards careers in healthcare because they know they can, they know it’s safe, and they know that healthcare truly is changing for the better.
Q: What advice would you share with young leaders and aspiring LGBTQIA+ hospitalists or healthcare professionals?
A: Lean into what makes you you and use that to your advantage to set you apart from others in your field. Being part of the LGBTQIA+ community can be something of a superpower. If we live authentically and treat patients with the empathy we often wish was given to us in our earliest healthcare experiences, then we truly will change people’s lives and their perceptions and outcomes will be better. Healthcare needs more LGBTQIA+ practitioners to survive and evolve to best care for patients in the future.
Q: Our focus this year is equitable care for transgender patients and hospitalists. What has been your experience working with transgender patients?
A: As a trans ally, and someone who has cared for several trans patients over the years, my experience has been that our trans patients just want to be seen, heard, and cared for with respect and dignity. Something so small as basic human respect and kindness is often not extended to many of our trans family and that injustice and disparity is a deep wound that can’t be healed in one encounter with an affirming clinician, but it is a start. I do my best to not rush them along and to give them the space to share not just their acute health issue but also their long-term lived experience with healthcare; I try to validate their emotions around what many describe as past trauma. I can’t take it all away for them, but I can let them know that I hear them, and I will do everything in my power to build trust and support into my relationship with the patient. I can work with my staff to provide inclusive care, and to use correct pronouns and correct preferred names. I can help to signal leaders at my institution where gaps exist in the training of our staff on caring for trans patients and work with our lab staff to change what triggers “abnormal” hormone levels for a trans patient on hormone therapy.
The other experience I have had is recognizing a lack of state resources for our aging trans community. Unfortunately, our higher-level long-term care facilities often don’t know how best to care for trans patients, and many will just choose not to accept them because it would be “too hard” for their staff to learn or “disrupt” the other members at that care center. The reality is our trans patients will need care in long-term care facilities and we need to find ways to best make it a safe and comforting experience.
Dr. Stefani earned his medical degree from Des Moines University and completed his residency at the University of Iowa- Des Moines internal medicine program. For the past 10 years, he’s been a hospitalist for UnityPoint Clinic Central Iowa and has spent the last six of those years as hospitalist medical director. He currently is an associate clinical professor for the University of Iowa Carver College of Medicine, vice chief of staff for the medical executive committee, physician representative on the health system DEI committee, and physician representative on the board of UnityPoint Eyerly Ball Community Mental Health Services. He has a passion for educating future physicians on LGBTQIA+ healthcare and the disparities that marginalized communities face in modern American society. He is also a proud husband to Michael Volenec, and dog dad to three miniature Schnauzers (Ruthie, Nellie, and Rex). You can find Dr. Stefani on X—@DrAJStefani; Instagram—dsmhawk01; Facebook—AJ Stefani; and LinkedIn—Andrew Stefani, D.O.