These four directories represent the most widely accessed and available means of identifying LGBTQ-competent healthcare providers in the United States. The analysis of these directories reveals several areas for improvement in the optimization of the existing directories as well as the creation of future directories. Specifically, focus was given to populations served, total number of providers, provider-specific feedback, and searchable criteria, i.e., provider name, location, specialty, population identity, service type, payment types, gender identity, and languages spoken.
Of the directories, two (i.e., the GLMA Provider Directory and OutCare Health OutList) provided valuable information for the LGBTQ population as a whole and two (i.e., the RAD and WPATH Member Directory) were specific for the transgender population. There were a considerable number of providers listed on each directory. Of note, on all directories, providers self-registered and self-asserted that they met the cultural competency standards set forth by each directory. None of these directories except the OutCare Health OutList showcased organizational-specific cultural competency certifications; for example, providers on the OutCare Health OutList have the opportunity to participate in training and become certified by the organization OutCare Health. This lack of organizational evaluation of cultural competency among the other three directories may generate apprehension for some LGBTQ people, especially if self-registered providers only have competency in one specific subpopulation of the LGBTQ community. For instance, the transgender population has unique healthcare needs, such as high rates of certain health conditions and less health insurance coverage [3] and specific preventive services and treatments (such as gender-affirming hormones and surgeries) [23]. On both the GLMA Provider Directory and OutCare Health OutList, which serve the general LGBTQ population, providers may list their particular subspecialties, e.g., having the ability to specify transgender expertise. Given that past research has shown that providers’ funds of knowledge differ between general LGBTQ education and population-specific proficiency (e.g., the transgender population) [12], it is paramount that provider directories specify LGBTQ education, training, and certifications. In addition, for current and future directories, partnering with one or more of the seven national LGBTQ health centers [15]—the Callen Lorde Community Health Center (New York, NY), Fenway Health (Boston, MA), Howard Brown Health Center (Chicago, IL), LA LGBT Center (Los Angeles, CA), Lyon Martin Health Services (San Francisco, CA), Mazzoni Center (Philadelphia, PA), and Whitman Walker Health (Washington, DC)—would likely yield avenues for organizational-specific cultural competency certification of providers.
Provider-specific feedback is very important for the LGBTQ population, yet only the OutCare Health OutList and RAD allowed this feature. More than half of LGBTQ people endure interpersonal discrimination including slurs, microaggressions, sexual harassment, and violence. Likewise, as many as one in five suffer from discrimination in healthcare environments [2]. The public’s ability to review specific providers not only illustrates firsthand patient perspectives on provider care but may also foster reassurance to LGBTQ people and increase their willingness to seek care. Implementation of this feature across existing and future directories may promote increased utilization of these directories by the LGBTQ community. Furthermore, future research should consider the impact that provider review has on LGBTQ people’s avoidance of care.
Similarly, searchable criteria are essential for the LGBTQ population to ensure cultural competency. The GLMA Provider Directory, OutCare Health OutList, and RAD provided various fundamental searchable fields, while the WPATH Member Directory only provided three criteria. Notably, transgender people of color often experience more challenging healthcare experiences because of both transphobia and racism, and many prefer providers of color and/or LGBTQ-competent providers in order to avoid discrimination [24]. In addition, much of the LGBTQ population confronts significant financial barriers to healthcare [25, 26]. As such, these visible attributes allow providers to build trust with the LGBTQ population by showcasing their quality care, attitudinal awareness, and cultural competence concerning the intersections of sexual orientation, gender identity, race, ethnicity, and socioeconomic status. For current and future directories, offering these features would be very valuable to reach and provide care to diverse, non-English speaking subpopulations of the general LGBTQ population.