Spotlight: Rehabilitation specialists improve healthcare for transgender and gender nonbinary people
The significant health disparities and barriers faced by transgender and gender nonbinary individuals prompted the launch of the M Health Fairview Comprehensive Gender Care Program in 2018. The program offers a seamless, integrated approach to support patients, including those who are transitioning.
Our offerings range from counseling to surgery. This program is part of a robust legacy of gender care within M Health Fairview, providing patients access to coordinated care no matter where they are in their transition.
Two M Health Fairview rehabilitation specialists work as part of the program’s multidisciplinary team. Physical Therapist Betsy Walts, PT, OCS, WCS, Cert. MDT, supports patients facing pelvic health concerns during their transition. M Health Fairview Speech Language Pathologist Lisa Butcher, MM, MA, CCC-SLP, provides gender-affirming voice therapy for patients as they transition.
We caught up with Butcher and Walts to discuss their work and the future of transgender and gender nonbinary care through M Health Fairview.
What is your role within the Comprehensive Gender Care Program?
Walts: I specialize in pelvic and orthopedic issues. My role as a physical therapist involves evaluating and creating a treatment plan for possible side effects related to gender affirming surgeries such as urinary incontinence, pelvic pain, constipation, sexual dysfunction, or any other limitations that affect the patient.
Butcher: I provide gender- and identity-affirming voice care to help a patient’s voice match their gender. I was part of the Gender Care Program’s original planning committee in 2018 and continue as a primary member of the Lions Voice Clinic team along with my colleague, M Health Fairview Speech Language Pathologist Daniel Weinstein, MM, MA, CCC-SLP.
Tell us about your professional background. Why are you passionate about gender care?
Walts: I’ve been an orthopedic physical therapist for 22 years, and the last 10 years I’ve focused on pelvic health. Initially, I was asked to treat pelvic health conditions because of a system need. As my training and experience increased, I realized that it made me a much better orthopedic physical therapist and that the discrepancies in access to care for pelvic patients were considerable. As we started to recognize a need for gendered care, I decided to seek additional training along with my colleague, M Health Fairview Physical Therapist, Marian Delaney, PT, SCS, ATC.
Butcher: I hold master’s degrees in music and speech-language pathology. Although I continue to sing and perform around the Twin Cities, I was drawn to my work as a voice specialist because of the opportunity to help other professional voice users. As a person of color, I was interested in working with underrepresented populations, including transgender and gender diverse people. When the Comprehensive Gender Care Program was formed, my work in this area significantly increased.
How do you help others achieve their goals?
Walts: A big part of our first visit is discussing what goals the patient has and what they expect for treatment. I try to understand what is specifically important to them, then help by filling in the steps to get from our initial visit to discharge. It is not usually a straight line, so many times during our visits we are checking in with what is going well, what is not, then we work together to understand the barriers.
Butcher: Many of my clients have a functional voice, but it’s not their authentic voice. That can lead to significant vocal strain and dysphoria for many transgender and gender diverse people. I stress to all my clients the importance of finding a voice that is authentic to them, and I put their opinion of their voice ahead of mine. Each person has a unique set of goals, tailored to their needs.
How does the Comprehensive Gender Care Program address the challenges that transgender and gender nonbinary individuals face when seeking healthcare?
Walts: Access, safety, and community support are some of the biggest barriers for these patients in my experience. My goal is to provide a safe and accepting environment. We are working on providing inclusive options around gender on medical forms, and we’re also working to educate our colleagues who do not specifically work in gender care on the importance of and best practices for making our facilities welcoming to everyone.
Butcher: Some of the biggest challenges involve the frequent changes to insurance coverage for these services, which is why our program’s care coordinators are such an important resource for patients. They can help them navigate insurance. Our approach is to remain educated on the latest research and stay connected to our patients, having open conversations about their progress and experience. Bringing together a group of individuals that is fully committed to working with transgender and gender diverse patients is critical to maintaining trust in our health system.
