Advice on When and How Physicians Can Speak Out If Their Opinions Differ from Their Employer

Dr. Shah said that the Texas state legislature filed some 50 bills affecting LGBTQ people in 2019 and 2021 alone, with more than a dozen of those bills aimed at transgender youth. Then, in November 2021, the Dallas-based pediatric multidisciplinary transgender clinic GENECIS was closed without notice. “This decision was made by the leadership of the children’s hospital and academic institution against the wishes of the physicians and providers in this clinic,” said Dr. Shah. “The physician lead of this clinic built this program over seven years ago. Since its opening, it had seen more than 1,000 patients and had 600 active patients. The clinic had followed the recommendations of national and international societies such as the Endocrine Society, the American Academy of Pediatrics, and the World Professional Association for Transgender Health. “I saw a program within our hospital shut down literally overnight, with no information regarding this closure except what was published in the media,” Dr. Shah added. “The closure blocked access to care for an already marginalized group of children and families. As a physician colleague, I witnessed injustice at a professional level: how physicians may be blocked from practicing patient care that’s in accordance with updated clinical guidelines and evidence-based medicine, in contradiction to the Hippocratic oath that we took on the first day of medical school.”

In response to the clinic closure, Dr. Shah and others in her community circulated a petition that garnered more than 800 signatures. With permission from the university, they organized a peaceful protest, participated in educational activities such as a university-level grand rounds on health equity specific to LGBTQ people, and, within the otolaryngology department, conducted open discussion regarding the closure and what it means.

Physicians are human and layered with the effects of their life journey—how they were raised, their cultural heritage, their personal experiences. It’s simply a human right to express our unique, individual opinions and thoughts. —Julie Wei, MD

The experience of working with a group that shared her values and concerns was eye opening for Dr. Shah. “I met the most wonderful human beings for whom this cause was both professional and personal. I realized what it means to be an ally: You support those who are directly impacted by oppression, through acknowledgement, listening, empathizing, and, if it feels right, in speaking up, signing a petition, or coming out to march alongside them,” she said.