The landscape of pediatrics is deteriorating rapidly in the Southeast United States as political attacks on gender-diverse youth persist. I write as a witness who has experienced how healthcare organizations are willing to cater to extremists trying to eradicate gender-affirming care.
The night the first tweet went out from the American Accountability Foundation, a known extremist group working to “expose” gender care providers, I knew it would be trouble. They were fixated on one point: the age of the youngest patient at their first visit. They falsely conflated this fact with hormone use, incorrectly suggesting that 4-year-old children were receiving hormones. From there, Elon Musk detonated the situation with an inflammatory tweet that misrepresented the abstract. Ignoring the social capital he possesses, he amplified the disinformation.
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With that tweet, a social media hellstorm broke loose. Not even a full day later, administrators demanded I turn over files as state legislators pressured them. It was left to me, a student, to tell them I would not turn over data as they placed their careers above data security and my federally protected educational materials.
Nancy Mace, the sitting congresswoman for the SC-01 district, sought to weaponize the social media frenzy to take shots at her opponent, a local pediatrician with no involvement in gender care. The self-proclaimed “voice of reason” for the Republican party continued to throw aside science to advance her own career. This attention not only promoted a false narrative about gender care practices, but it continued to place all of us who were involved at risk. We met with security, local police, and personal legal counsel to try and keep us out of harm’s way.
While the political backlash was distressing, it did not come unexpectedly. The lack of institutional support students, staff, and patients received during the process was disheartening. It was unnerving to see a state-wide medical institution entirely cast aside children whose families sought evidence-based care for political gain. At this point, I knew it was time for me to leave my home state.
The recent politicization of certain healthcare services has become a salient deciding factor for medical students and residents when relocating. As physicians-in-training, we aim for diverse educational experiences that readily prepare us to help care for our patients. Medical students and resident physicians have struggled in conservative states to experience family planning and LGBTQIA+ care. In many states post-Dobbs, trainees interested in gynecology must contemplate disregarding otherwise well-fitting programs because of the politicization of their field.
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Should they choose to remain in a conservative state, often they must train in other states to receive adequate education. Care for gender-diverse youth now faces similar scrutiny with implications for pediatric medical education. Conservative lawmakers have reduced this life-saving care to a political uproar based on disinformation with no regard for the children they are bullying.
In some instances, the lack of medical instruction is of little concern compared to the mental health and physical safety concerns experienced by these clinicians. There is a palpable amount of distress experienced by healthcare professionals who are legally restricted from providing necessary care for a patient right before them. Additionally, bomb threats, online and in-person harassment, and death threats have sadly become routine for learners and providers who offer these life-saving medical services.
Restricting services like gender care, menstrual management, and family planning will create a “brain drain” effect, where highly qualified trainees and practicing clinicians will leave their homes and relocate to areas where they can learn and practice medicine based on science.
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As a future physician, I was still deciding where to pursue my training. South Carolina was my home—I grew up there, my family is still there, and I truly developed a sense of community there. Sadly, this past year, politicians and institutional leadership at my medical school made it clear I was unwanted there.
I had always wanted to stay in South Carolina and practice, but for my mental health and personal safety that was no longer an option.
I hope that legislators and the politicization of medicine will not only impact patient care in the short term but also result in a consequential exodus of physicians.
Dr. Thomas Agostini (he/they) is a resident physician specializing in pediatrics on the West Coast. He is interested in adolescent medicine, including gender care and substance use medicine.
Courtesy Dr. Thomas Agostini
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