The Mount Sinai Health System in 2020 launched a pioneering one-year medical fellowship program specializing in LGBTQ+ health. Its mission was to create a new primary care specialty that combined expertise in disciplines such as preventive medicine, infectious diseases, gynecology, endocrinology, psychiatry, and research, and provided holistic care to this minority population.
The American Medical Association (AMA) Foundation was so supportive of the idea that it provided Mount Sinai with funding to cover the fellowship for a second year—which begins in July—and develop a model program for future LGBTQ+ fellowships around the country. Recently, the AMA announced plans to fund 10 new fellowships in 2022, many in the South and other areas of the country where LGBTQ+ patients have more limited access to high-quality health care.
Michael M. Gaisa, MD, PhD,
“There are particular needs, both psychosocial and medical, that arise from being members of this community, and I think, until now, that has not been appreciated to the extent that it deserves to be,” says Michael M. Gaisa, MD, PhD, Director of Mount Sinai’s LGBTQ+ Health Care Fellowship, and Professor of Medicine (Infectious Diseases), at the Icahn School of Medicine at Mount Sinai.
One of the fellowships’ goals, Dr. Gaisa says, is to “educate more knowledgeable, competent, and sensitive providers on a national scale.” Mount Sinai’s new fellowship is a “blend of subspecialties that have traditionally been siloed.” Typically, he adds, doctors do not “complete their conventional residencies or fellowships with the breadth of experience bundled into our LGBTQ+ fellowship curriculum, so that’s what we’re trying to accomplish.”
In July, Roy Zucker, MD, will be the first physician to have completed Mount Sinai’s fellowship. An internal medicine and infectious disease doctor who practices in Tel Aviv, Dr. Zucker started the fellowship in New York City during the COVID-19 pandemic last summer. Admittedly, the timing “wasn’t perfect,” he says. But as New York began to open up he was able to transition from providing telehealth to in-person care. He also spent the year conducting research, and working with Mount Sinai Innovation Partners to create an app that would make it easier for gay men to access PrEP, medication that prevents the spread of HIV, through Mount Sinai’s MyChart patient portal.
Dr. Zucker is active on social media and uses his platform to promote the need for health screenings, vaccinations, and harm reduction from recreational drug use among LGBTQ+ people. In June, he held community-wide discussions about harm reduction in drug use in advance of the New York City Pride Parade.
In general, Dr. Zucker says, lesbian women tend not to seek out preventive care. As a result, they do not receive the routine mammograms and Pap tests that would enable them to be diagnosed at earlier stages of breast or cervical cancer when they can be treated more successfully. “In this population there’s many more cancers just because of a lack of screening,” he says.
Roy Zucker, MD
Doctors also need to be educated about LGBTQ+ health, he adds. Some physicians mistakenly assume that lesbians do not have to be screened for cervical cancer because they are not having sex with men. In addition, doctors do not always test gay men accurately for chlamydia and gonorrhea. They perform a standalone urine test instead of swabbing other exposed anatomic sites, such as the rectum and throat, and miss the majority of positive cases.
One mission of the new fellowship is to “export expertise and awareness to other departments within Mount Sinai and on a broader scale,” says Dr. Gaisa. “Hopefully, we can change some existing paradigms and shape awareness and standard clinical practice in a more meaningful way.”
Fellows will work closely with the Mount Sinai Center for Transgender Medicine and Surgery, the Mount Sinai Adolescent Health Center, and departments that are as seemingly far afield as geriatrics. “One day I work on transgender medicine, another day it’s LGBTQ+ psychiatry,” Dr. Zucker says. “I work with addiction medicine, and three days a week I work in HIV and sexually transmitted diseases clinics. For many years, we had physicians who always took care of the LGBTQ+ community—they were called ‘LGBTQ-friendly doctors.’ There was never proper training for that.”
Dr. Zucker’s connection with Mount Sinai began in early 2019, when he arrived from Tel Aviv to begin a one-month observership in HIV training with Antonio Urbina, MD, Professor of Medicine (Infectious Diseases) at Icahn Mount Sinai. When Dr. Zucker inquired why Mount Sinai did not have a fellowship specializing in LGBTQ+ health, Dr. Urbina put him in touch with David C. Thomas, MD, Interim Chair of the Department of Medicine at Icahn Mount Sinai; and David L. Reich, MD, President of The Mount Sinai Hospital and Mount Sinai Queens. That is when the wheels started turning. In 2020, Dr. Zucker returned to Mount Sinai as the inaugural fellow.
He and Dr. Gaisa are aware of only one other LGBTQ+ medical fellowship in the world, a program at the University of California, Los Angeles, which started a year before Mount Sinai’s.
“You say to yourself, ‘I’m sure this program already exists,’ and you start looking and say, ‘Wow, where is it?’” Dr. Zucker says. “This is pioneering. We’re creating the next ambassadors for this specialty called LGBTQ+ medicine and we’re bringing it to the world. One or two people doing this each year is not enough. It’s about passing it forward.”