Family Physicians’ Attitudes and Scope of Practice Regarding Care for Transgender and Gender Diverse Patients in North Carolina: A Survey Study

BACKGROUND Transgender and gender diverse (TGD) persons face significant health disparities. We aimed to explore the scope of family physicians’ TGD care and physician factors related to the provision of TGD health care in North Carolina. METHODS Family physicians in North Carolina were invited to complete an observational survey from January 2024 to September 2024, exploring their training, beliefs, and practices related to care for TGD patients. Descriptive statistics characterized the responses, and bivariate analyses explored potential factors associated with whether physicians offered primary care or gender-affirming care (GAC) to TGD patients. Sub-analysis of data compared responses across regions of the state. RESULTS Of the 181 attending family physicians who completed the survey, 66.9% reported participating in some type of training in TGD patient care. Overall, 82.9% of respondents reported providing primary care to TGD patients, and 47.5% reported that they provided GAC to TGD patients. The most commonly reported barrier to providing any care to TGD patients was insufficient training. Bivariate analyses revealed additional physician, clinic, and training factors that may be associated with whether family physicians provide primary care or GAC to TGD patients. LIMITATIONS The present study is limited by a small sample size, with high likelihood of selection bias. CONCLUSIONS This study provides an initial snapshot into family medicine physician practices with regard to primary care and GAC for TGD patients. Our findings highlight the need for an increased focus on training, both mandatory and optional. We also identified key opportunities for targeted outreach, such as residency programs.