Transitioning during residency - what could go wrong?

[rheumroom]

i know this isn't something commonly (ever?) talked about and so probably no 100% sure answers but would appreciate thoughts

current clerk who delayed transitioning prior to med school because was scared it would negatively impact my med school application, and am now delaying transitioning again for the same fears for carms - i like to think medicine is becoming less transphobic (and racist and sexist) but several bad experiences with preceptors made me think otherwise, and i don't want to risk jeopardizing letters with covid's impact

i've delayed this decision for years now but recently saw a transgender patient on a rotation who discussed how long they put off transitioning before finally taking the plunge and not looked back since, and it reinforced how i don't want to put this off any longer

basically my question is if i transition during residency (post-match, fingers crossed), what sorts of things could go wrong? i imagine the PD/senior residents will feel as though i misled them, or cause concerns around performance on if i need to take time off? would it be best to play safe and wait until i finish residency?

[ellorie]

I would guess it probably depends a fair bit on specialty and location.  I would potentially consider this when you do your ranking and try to stay in bigger, more diverse cities.  I would hope that everyone everywhere would be understanding and respectful, but I could also imagine a lot of confusion around names, and perhaps some horrifying comments here and there, depending on where you are located.

I know it's not much the same at all, but as a lesbian I know when I was training in London I experienced heterosexism at best from colleagues, especially in surgical specialties, and frank homophobia at times from the general public.  In Toronto there are tons of not-heterosexual people around and it's been much more comfortable.  Again, not the same, I know, but perhaps reflective of something.

I feel for you that you've had to give up something so important for fear of jeopardizing your career.  I can imagine it's a really personal decision as to what to do, with no real right answer, but I do think we are the best doctors when our needs are being met in our personal lives, and I hope you can find a way to do what you need to do.

I do hope that there are some people here who have experienced this first hand who can share with you, but if not, I also wonder if you have any mentors who are trans, or if there are people you could reach out to who are out in medicine?  The only person I can think of first hand is Carys Massarella - she is quite open about being trans and does a lot of advocacy - she gave a talk to us once and if I recall, she transitioned quite late, maybe not while in training, but I think while already in medicine.  She's emerg, I think.

I feel like when people are marginalized in some way, they often do reach out to each other, might be worth trying to find some offline contacts too if you can.

[ellorie]

The other thing to consider if you are planning to change your name as part of your transition, is that once you begin practicing under a particular name, it tends to follow you. For example, you start accumulating documents and certifications with your dead name on them (diploma, MCC, etc), and Colleges will sometimes ask about and display former names on your public profile (CPSO does display any former names you’ve had since you started practicing).  Hospitals and clinics may also ask for former names as do police record checks. So if your eventual hope is to be totally under the radar professionally, and not have your dead name easily findable or known by your colleagues and workplaces, and especially if your dead name is clearly gendered a particular way, an early name change (eg between finishing CaRMS and graduation/license application) may be something to consider. Just a thought that occurs to me. 

[LostLamb]

I believe there was someone a few years ago who underwent transition during medical school and felt extremely well supported. 
I know another staff who had practised for a while as their born gender and then took a year off and returned to practise as the other gender. 
 

only you know when is the right time. There is something to be said about doing the transition in med school and having your degree and licensing in your practising name—one less step to deal with in the big scheme of things. 
 

good luck! 

 

[Elgar]

Hey, thank you for sharing your story! I don't really have answers, but I can share a few thoughts that I had. So as you said, even if the world is more open to diversity than it was before, you'll (unfortunately) face stigma at some point, whether you transition before of after residency. I think the challenges you may encounter will possibly be quite similar in both cases, the major difference being that as a resident you are still in training and it's already a mental burden by itself. Though in terms of how it will be perceived by peers and collegues, I might be wrong, but I feel like it's probably gonna be the same.

Also, if you need to take some time off, I don't see why it would be any different from a parental leave. It may be inconvenient to the program, but this should be regarded as an important "life event" the same way as the birth of a baby (at least it's how it should be). Finally, I just truly hope that nobody will think that you'd mislead them, because your gender should have absolutely nothing to do with your medical competencies and quality of care <3 

 

[MSWschnoodle]

Full disclosure: I'm not transgender and don't have any particular expertise or wisdom. I just wanted to chime in and say Rheumroom I am sorry that amidst navigating an already complicated and stressful journey of matching during COVID that a fear of stigma in your chosen profession is complicating that even more. That is not fair to you and the fact that you have to worry about this at all is a statement of how far we still have to go in creating an inclusive environment in medicine. 

I would echo what Ellorie said about dead names etc. Starting with your medical school diploma you are going to start amassing papers and registration information that will follow you for the rest of your professional life. I don't know if you plan to change your name or not, but if having your chosen name as your only professional identity is something that's important to you then you could consider doing a legal name change right after matching for residency then just alert your new residency program that it was legally changed before they start issuing emails and logins. That will give you time to file your change in name/gender with your university before you graduate so your degree will be issued and printed with your chosen name. 

Ultimately your residency program (including the PD and senior residents) will have chosen you because they felt you would do well in the program and that's based on many factors beyond gender. I imagine that transitioning and living a life that is true to yourself will only serve to enhance all of the other great qualities you will bring to residency with you. Honestly if I was involved in CaRMS interviewing and advocated for someone I thought was awesome in interviews and that person showed up on the first day of residency having transitioned personally I wouldn't feel misled at all... I'd be thrilled that they felt comfortable enough to live their most authentic life in our residency program. Mileage will vary based on your chosen discipline and the program site you match at, but my sincere hope is that you will find yourself within a community of co-residents who celebrate and support each other. 

Having a resident transition either before or during residency may not be the most common thing but it's not unheard of. Regardless of how you choose to time your transition, once you match most faculties now have LGBTQIA2+ mentorship programs and supports available through the resident wellness office if you feel those would be helpful. They might be able to assist you in locating fellow residents or physicians who have transitioned during their careers and/or offer help navigating medical leave/logistical things (like how to get an ID badge with your chosen name if you transition part way through residency). 

All the best in your journey and in the match!