Dr. Rita Lee is a professor of Medicine at the University of Colorado School of Medicine. She also serves as the director of Health Systems Science and Health Equity for the School of Medicine and as the director of the Health Equity in Action Lab (HEAL) at the Office of Diversity, Equity, Inclusion, and Community Engagement on the Anschutz Medical Campus. She is a past program chair for the SGIM 2021 Meeting and chaired the LGBTQ Health Interest Group for 10 years. She was interviewed for this SGIM Forum Theme Issue given her significant knowledge in clinical care, expertise in educational programming, and long-standing SGIM advocacy for sexual and gender minorities.
Tell us something about you that most SGIM readers wouldn’t know.
RL: I never actually set out to have a career in advocacy—it was actually something I stumbled into as somebody who identifies as a lesbian. I saw a clear gap in LGBTQ healthcare and education, and that’s how I started doing this work. I am an avid gardener and enjoy rock climbing. My wife and I have 2 boys.
What career accomplishment would you say is most important to you?
RL: I will actually reference two things. First is being a founding member of the UCHealth Integrated Transgender Program. Because of the known health disparities among gender diverse patients, it is critically important that we act to address these. We were not only able to create the clinic to provide direct care to patients and also have had downstream impact on the UCHealth System—implementation of SOGI (sexual orientation and gender identity) data collection in our electronic health record and training staff on being culturally responsive.
The other accomplishment, still in progress, is building the new Health Systems Science curriculum, with a dedicated health equity lens to it. Traditionally, LGBTQ content has been siloed into specific sessions. We are also intentionally integrating LGBTQ content into other domains—we have multiple cases integrating a diverse spectrum of LGBTQ identities across content areas. We don’t just exist in an LGBTQ box, and this new curriculum will help trainees see that.
How did you get involved with LGBTQ Health? What were the steps that lead there?
RL: I came out when I was in medical school. I had a negative interaction at a healthcare visit, which made me feel shame. I wondered what it might be like for patients who were not in healthcare. I looked at our curriculum and noticed that there was no content on LGBTQ health so I decided to do something. I recommended that we include content and offered to help build it. They said yes—and that is where this ball started rolling!
Has medicine ever made you feel like you needed to hide yourself and your identity? How did you overcome that?
RL: Unfortunately, yes. When I was a medical student in the late 1990s, I remember overhearing residents making homophobic jokes about a patient with pneumocystis pneumonia. The way they implied that all patients with HIV must be gay or deserved their illness did not feel safe or nurturing to the patient or to myself.
I was not out during the residency application process—I feared I would not get a residency spot. When I arrived there, I knew it was important to come out to my colleagues. When I applied for a job after my chief year, I was intentional in my applications about what I wanted to do and who I was as a lesbian. I wanted to work at a place that would accept me for who I am. If they didn’t want to interview me because of who I was, I didn’t want to work there.
How do you think LGBTQ and allied providers can best increase representation in Medicine?
RL: Some of it relates to a new focus on holistic admissions into medical schools and residency programs, but also pipeline programs. LGBTQ individuals are still relatively invisible as a demographic. We don’t yet have a place to identify SOGI data in the application process, so it becomes difficult to be intentional about recruitment and representation. It’s hard to feel like you count if they don’t count you.
Being able to count and be counted is a critical first step. From there, we can actually be intentional about including it as a dimension of diversity that adds value to Medicine and to health care in general.
How has SGIM helped you get to where you are today?
RL: Early in my career, someone handed off the LGBTQ Health Interest Group to me, one of my earlier leadership roles. It was a great way to get early leadership experience and network with individuals with similar interests. From there, we developed LGBTQ content for SGIM—I have learned a great deal from these folks. Many of us in the interest group have grown up together in our careers. It’s especially helpful for those of us who may live in less LGBTQ-dense regions where our home networks are smaller. It is nice to have a space where you feel welcome.
How does it feel to have medical schools all over the country using your LGBTQIA+ curriculum?
RL: It is awesome that our MedEdPORTAL curriculum1 was in the top 10 for 2021! It really feels good to know that this work is getting disseminated, and we are allowing schools lacking faculty expertise to teach this. To take what we built and to use it across the country feels amazing. The downstream impact will be huge—the number of students at each program, times the number of schools who use it, times the number of patients they will see—I’m in awe of the potential wide-ranging impact.
What keeps you going with so much to do—what keeps you from running out of steam?
RL: I do run out of steam every once in a while, but not very often. For me, it’s intentional integration and overlap in the work (with clinical work, Health Systems Science, and HEAL) and doing work that is incredibly meaningful. I connect it to the impact that it can have in so many people’s lives—it inspires me to continue moving forward. I also try to pace myself—I will continue to move forward, but don’t have to solve it all at once. Racism has been around for hundreds of years, it’s not going away overnight. It’s the same for LGBTQ oppression. I enjoy teaming with people who have aligned interests and different skill set—it also allows the work to move forward and multiplies the impact. I also set boundaries so I can be present at work, present with my family at home. I practice gratitude every day.
What advice do you have for young physicians interested in medical education and mentoring, particularly in the LGBTQ+ spectrum?
RL: For students who identify as a SOGI minority, bring your authentic self to the work that you do if you can do so safely. It can be intimidating, it may be safer in some places than others, and it’s liberating.
In being one of the first out faculty on my campus, people got to know me as an individual and that alone can change people’s hearts and minds. It’s also easier, emotionally, and cognitively, to focus on being a good student, physician, educator—rather than always worrying about what other people are thinking or saying.
For those interested in medical education or mentorship, don’t be afraid to ask for what you need and take advantage of the opportunities that are out there. If there isn’t a mentor who “does what you want to do,” don’t let it stop you. You can be the content expert and simultaneously leverage the skillset of someone else with a medical education background. I used “collateral mentors” to help with survey design, curricular design, and evaluation since no one was doing LGBTQ education at my institution at the time. Believe in yourself. I believe in you.