Fellows of the LGBTQ+ Medicine Fellowship from left to right, Jean Carlo Rodriguez-Agramonte, MD; Alexander Boulos, MD; Roy Zucker, MD.
Throughout the day, the flow of patients at Mount Sinai Health System’s Institute for Advanced Medicine clinics is nonstop, says Jean Carlo Rodriguez-Agramonte, MD. “But I couldn’t be happier, seeing these patients and knowing I’m helping them,” he adds.
Caring for LGBTQ+ people forms the bulk of Dr. Rodriguez-Agramonte’s training as part of the LGBTQ+ Medicine Fellowship at the Icahn School of Medicine at Mount Sinai. The third fellow since the program’s inception, he rotates through various specialties—internal medicine, adolescent medicine, and endocrinology, to name a few—through a year of training to learn skills needed to provide competent care for LGBTQ+ populations.
“The kind of care we’re trying to impart is one that is focused on addressing the patient’s identity,” says Erick Eiting, MD, Medical Director for Quality of the Center for Transgender Medicine and Surgery, and program director of the LGBTQ+ Medicine Fellowship. The fellowship is now gearing up to recruit its fourth fellow in the upcoming academic year.
When Mount Sinai created the fellowship in 2020, it was one of the first two such programs in the country—the other was at the University of California, Los Angeles. “There’s a dire need for fellowships such as ours,” Dr. Eiting says. “That there were none prior was shocking given the legacy of health crises with the LGBTQ+ population in this country.”
Erick Eiting, MD
Only about a third of medical students have had any sort of LGBTQ+ training, and even that might be in the form of lectures that span one day, notes Dr. Eiting. “We need to step up and shape the future of LGBTQ+ medicine,” he says.
At the core of that effort is addressing disparity. Studies have shown that rates of depression, suicidal ideation, substance use, and HIV are significantly higher in LGTBQ+ populations, and yet access to health services to address those issues continue to be difficult for these communities, says Alexander Boulos, MD, MPH, who was the second program fellow. “Having a physician who’s well-trained to be sensitive to the patient’s gender identity and sexual orientation can help ensure proper testing, or asking the right questions,” he says.
The LGTBQ+ Medicine Fellowship has evolved over each iteration, and continues to challenge itself to grow. “Just as we train each fellow, we try to have each fellow help us expand the offerings we have,” Dr. Eiting says.
With a goal of diversity, the program is aiming for greater representation in gender, racial, and socioeconomic background from future fellows.
“Having people with rich and diverse backgrounds will bring about the ‘rising tide phenomenon,’ where a rising tide lifts all boats,” says Dr. Eiting. Just as a fellow receives instruction from the institution, so too does the fellow teach and be able to share experiences with staff who work alongside them, he adds.
Additionally, the fellowship seeks to ensure relevance amid rapidly changing technology in the health field. For example, Mount Sinai recently launched a telehealth program for pre-exposure prophylaxis (PrEP) for HIV, and Dr. Eiting hopes future fellows might be able to think creatively about technological innovations. “Telemedicine has great potential for LGBTQ+ medicine. How can we take it further?” Dr. Eiting asks. “That’s a goal: to always be thinking about how we can increase access more.”
Read more about the experiences of current and past LGBTQ+ Medicine Fellows
Jean Carlo Rodriguez-Agramonte, MD; 2022-2023 LGBTQ+ Medicine Fellow
What drew you to the fellowship?
When I was applying, there were only two such programs of its kind: one at Mount Sinai and one at UCLA. But what was a particular draw for Mount Sinai was that there was a large Latino population, especially Puerto Rican, in New York. There’s a saying that Puerto Rico almost feels like a borough of New York City. But coming from there, I was interested in continuing to treat and understand that population.
What were some of your takeaways from the fellowship?
The amount of patients I’ve seen here and the availability of resources is incredible and humbling. As a physician, you don’t get sidetracked from your goal of treating patients simply because of the lack of resources.
For example, when a patient comes in here, they get to have their labs done immediately, instead of having to wait weeks. Then, I get the results first, and I’m able to explain the results to them. It feels more personal and leads to better communication. Sometimes, when patients get their results first without any guidance, it leaves them with a lot of questions and causes unnecessary stress.
Being surrounded by so many experts here at Mount Sinai, it doesn’t feel like you’re constantly running into walls. Patients sometimes expect you to know everything, but we don’t know everything. At least here, I know where to tell my patients to go to, even if I don’t have all the answers.
What were some challenges or highlights faced during the program?
I got dropped into a population I wasn’t used to seeing a lot of, such as the transgender population. I had a lot of learning to do on how to properly care for them. Not just medically, but also on things such as using the proper pronouns, and centering their identity as part of the care.
A highlight for me was being able to treat Latino patients at a deeper level. In general, it’s very difficult to provide preventive care without understanding the person’s underlying culture, since so many nuances are unsaid. But I’ve had so many Spanish speakers say to me, “I’m so glad I can speak to you on my own terms. Because you get it.” That connection feels special to me each time I hear it.
What do you hope to achieve after the fellowship?
I hope to implement the things I’ve learned here in Puerto Rico, particularly regarding providing better transgender care. I also hope to be part of the conversation there for improving medical education on LGBTQ+ populations. Just as it is here, medical school systems there lack inclusive care instruction.
Part of why I wanted to go into family/internal medicine and pediatrics is that I like the “figuring out the puzzle” part of medicine. Unlike in surgery, where all the complicated part of diagnosis is done and you’re fixing the problem, in family medicine, you’re talking and listening to patients and figuring out what is wrong. Similarly, I want to figure out where the missing parts are in research and education, and find the answers.
Alexander Boulos, MD, MPH; 2021-2022 LGBTQ+ Medicine Fellow
What drew you to this fellowship?
Ever since medical school, I’ve been involved in increasing awareness of LGBTQ+ health issues, giving training and competency lectures to faculty, staff and residents about the LGBTQ+ patient, and even starting a PrEP clinic at the Veterans Affairs in the Bronx to help increase access to medication that can be used to prevent HIV for at-risk patients living in underserved communities.
I realized that I’ve been working in LGBTQ+ medicine all this time and not even knowing it. When I discovered the existence of this program while completing my preventive medicine residency program here at Mount Sinai, I knew it was the perfect opportunity to help set the tone for the rest of my career.
What were some of your takeaways from the fellowship?
I remember vividly, after my first day of this fellowship, calling my family and friends and saying, “I’ve never seen so many gay patients in my life!” And I was absolutely loving it. How was it that I was already a resident and hadn’t had much exposure to LGBTQ+ patients?
In the program, I was able to rotate and learn from experts in almost every field, including infectious disease, endocrinology, plastic surgery, urology, OB/GYN, psychiatry, adolescent medicine, and addiction medicine. The scope of experiences I had was nothing short of amazing. I got to scrub in for gender-affirming surgeries, including vaginoplasty, chest masculinization, and facial feminization. I’ve worked with experts in HIV/AIDS treatment, provided gender-affirming hormone therapy to transgender and gender-diverse patients, and even cared for intersex pediatric patients.
Why do you think LGBTQ+ fellowships are important?
Especially today, there are many places in the United States where health care access for LGBTQ+ communities continues to be a challenge. We’ve seen a recent wave of anti-transgender bills passed throughout the country that serve to block and/or limit access to gender-affirming care.
Programs such as this one are important for changing the future of medicine, as it serves as a bold statement about the need for more training and resources to serve a community that has all too often been left out on their own. We need more doctors to be advocates for LGBTQ+ patients and to be aware of their specific health needs, just as we are trained to do so for every other patient.
Unfortunately, that training isn’t quite the norm yet, and I’m here to help change that. I’ve found my purpose in this field and I want to help make a difference for my community.
How do you intend to make that difference, after your residency?
As I gear up for graduation and make my way out in the real world, I plan to continue serving the LGBTQ+ community clinically as a primary care physician, focusing on HIV/AIDS treatment, PrEP management, anal cancer screening, and gender-affirming care.
In addition, I hope to play a part in medical education reform where we can incorporate important LGBTQ+ competency trainings in medical school curriculums. Doctors and medical students need to be more comfortable treating LGBTQ+ patients, and they’ve shown that they are open to learning.
I also hope to increase my community outreach engagement to the LGBTQ+ population directly and find new and innovative ways to teach and inform the community about important health issues, such as ones they might find too uncomfortable bringing up to their provider. I’m excited to see what the world has in store for me, but one thing I do know is that it all started here.
Roy Zucker, MD; 2020-2021 LGBTQ+ Medicine Fellow
How did you get involved with the first fellowship?
I had been working in LGBTQ+ medicine in Tel Aviv for about seven years, and was in the infectious disease program at the Tel Aviv Sourasky Medical Center (Ichilov). Mount Sinai has a collaboration with my hospital, and Mount Sinai’s dean of education came to Ichilov to discuss setting up a one-month observership program at its Institute for Advanced Medicine.
I participated in that program and realized physicians seemed to only be looking at their own disciplines, and no one was looking at LGBT care holistically. For example, a transgender patient will get the best care with a transgender medicine practitioner, but if HIV is involved, another provider would need to be involved.
I thought, “Why not a training program where providers are taught to look at the broader picture of LGBTQ+ care—including the spectrum from transgender medicine to psychiatry to HIV care?” I wrote an email to David Reich, MD, President of The Mount Sinai Hospital, not expecting a response. In five minutes, I got an email back, and soon we started discussing starting up the program. A year and a half later, I became the first fellow.
What were some of your takeaways from the fellowship?
Unlike in Israel, the patients at Mount Sinai are much more diverse. The exposure to the patient diversity really challenged me as a physician in how I get to treat and address patients. There were initial cultural and language differences, but patients were patient with me. On the professional side, because I had already been treating patients and involved in LGBTQ+ medicine for many years, I felt I had a lot to offer to people working alongside me. While Mount Sinai was giving me expanded knowledge, I also felt people could learn from my experience in Israel too.
While the term “leadership” might be overused in America, I felt it was really on display at the Health System level, and also at the Icahn School of Medicine. Their commitment to health care delivery and excellence has led to great name recognition in Israel, where being affiliated with Mount Sinai is an impressive achievement.
What are you working on today?
Since August of 2021, I have been the Director for LGBTQ Health Services with Clalit, the biggest health service organization in Israel overseeing 5 million patients. We created LGBTQ+ clinics in Tel Aviv, Jerusalem, and Haifa.
I am also Director for LGBTQ Health Services with Ichilov in Tel Aviv, and in partnership with city hall, we’re about to open an LGBTQ community health center that integrates medicine and community initiatives. A focus of this center involved “clinical champions”—people within Ichilov who are specialized in a specific branch of LGBTQ medicine such as geriatrics or adolescent medicine, who will focus on research and education.
These are some current steps, but I am hoping to guide what the future of medicine might look like for LGBTQ+ people.
What might that future look like?
Even in 2023, LGBTQ+ patients are still hesitant to access health care services because they’re afraid of exposing themselves and are not comfortable discussing their sexuality with providers. Patients are going to hospitals when their conditions become an emergency, not before, when things can still be prevented. We need to provide accessibility on the patients’ terms—if they’re only comfortable in an LGBT-defined space, it should be there.
But in the long term, I hope that LGBTQ+ care goes beyond just about providing accessibility and addressing discrepancies, but more into “community-oriented” care. This means thinking about LGBTQ+ populations across all ages—how they’re exposed to LGBTQ+ topics, how they age and their mental health, etc. For example, if you’re talking about sexual health and gender identities at a younger age, having that acceptance early on affects mental health outcomes later in life. When you put it there from the beginning for young people, they don’t feel as on the fringe.
As someone who has an entrepreneurial soul, I found Mount Sinai embraced that spirit. I came to New York and people here at the program helped take an idea from my head and made it real. The biggest motivational word of mine is “no”—when someone says “no,” all the more I want to make it happen. Mount Sinai certainly helped with the obstacles to make my dream happen.