I: Welcome everyone to the APAMSA NHAAPI Health Issues Interview series, where we’ll be interviewing researchers, policymakers, community-based organizations, and other experts on health-related topics that affect the NHAAPI community. My name is Grant Wen and I’m the health advocacy director at APAMSA National. 

For this interview, I have the pleasure of introducing Dr. Lin Fan Wang. Dr. Wang is a family medicine doctor and the Chief Medical Officer at FOLX Health, a queer and trans telemedicine company. In addition to her clinical work, Dr. Wang is a cofounder of Centering Equity, Race, and Cultural Literacy in Family Planning (CERCL-FP), whose mission is to use critical race theory and reproductive justice frameworks to dismantle structural racism within reproductive health care. She created and moderates the Gender Affirming Health Care Listserv, is on the board of Medical Students for Choice (MSFC), and is a fellow at Physicians for Reproductive Health (PRH).

Sure, absolutely. In academics, we often start off with where we went to for education, but I’m going to start off with my immigration story, because I feel like that’s so relevant to NHAAPI communities. So I was born in Taiwan, and then I moved to the US when I was around four or five years old. I grew up in the white suburbs of Michigan and I was really rebelling against medicine–I didn’t want to do it. I think just because in NHAAPI communities, it’s like you have three options for jobs—-you go into medicine, you become a lawyer, or you go into engineering. So I was like, I’m gonna rebel against that. But then I was doing some work in research, clinical research, and I found that it was just really interesting to me. Not so much the research part, but the clinical and the medical parts. And so that’s kind of how I got into medicine, and I ended up going to medical school at the Albert Einstein College of Medicine in the Bronx, New York. 

And at that time, I was thinking maybe pediatrics because I liked kids, maybe psychiatry, because I was interested in people’s minds and how they make decisions. And as I was going through my clinical rotations, I realized that I liked all of them, with the exception of surgery. I felt like in surgery, my hands were always in the wrong places. Even though I held them where the surgeons told me to hold them, they were still the wrong places. So I thought that surgery was not for me, I can’t, I don’t even know where to put my hands. 

But because I liked doing everything, I decided to go into family medicine. And as part of my family medicine work, you know, I just loved it. It really drew me in because one, I was able to see people of all ages. But I think the other was just the culture of Family Medicine is around taking care of entire families, and also really thinking about how the community piece affects individual health. And then as I was getting into family medicine, it was also about full spectrum care. It was about prenatal care, seeing kids, and the elderly. And as part of that, I realized, you know, as a person is coming to me, I should be able to take care of whatever issues they’re having. So that includes like mental health and includes pregnancy and abortion care. And it should include LGBT care as well. 

And so after I finished finishing residency, I was really thinking about, what do I do now? Right? And I did end up deciding to do a fellowship because I felt like you know, I wanted a little bit more time to explore what parts of medicine I actually like. I wanted some more training specifically around how to train other people and provide health care. So I did end up doing a family planning fellowship. But of course, for all of you students out there, you don’t have to do a fellowship, it’s perfectly fine for you to finish your residency and then just go directly into practice.

But I did do a fellowship and then afterwards, I was kind of also trying to decide what I wanted to do. And I found that advocacy was just immensely important for physicians to be a part of. Advocacy is really scary, right? I think especially for NHAAPI folks, because we’re kind of taught to be quiet, to not make a lot of waves, to kind of just focus on your job. But advocacy is hugely important. Legislators really listen to physicians when they speak out, and especially when they’re passionate, and they’re speaking out on behalf of their patients. So I did end up doing an advocacy fellowship. And then after that, I was like, “Oh, so I can’t keep going, I can’t keep training, I actually need a job now.” But I was thinking, “Well, what do I actually want to do?” And that’s how I came into really focusing on care for the LGBT community, I was looking for a job that was outside of New York. So I came to Philly, and I worked at Mazzoni Center for a while. And it was just really a wonderful match in terms of my interests, my own background. I think for me, I really enjoyed working with my community, the queer community, and in particular, the clinic had Title V funding, and we also had Ryan White funding to be able to do HIV care. As a part of that we’re also providing a lot of care for marginalized communities, including NHAAPI folks.

I’m happy to share more about how I came into FOLX health and why I decided to do telemedicine, but I also work with CERCL FP (Centuring Equity, Race and Cultural Literacy in Family Planning). As part of that work, we are a group of former family planning fellows who are all either people of color or co-conspirators, who are creating a training curriculum for clinicians and family planning, who are wanting to incorporate reproductive justice and critical race theory into their work. I am also working with another group of family physicians of color in abortion care, and we are working on a separate project thinking about how we can best support physicians of color who are interested in providing reproductive health.

In terms of FOLX health, I think it was a combination of things when I was working at Mazzoni Center. If you’re not familiar with Mazzoni Center, it is a clinic specifically for LGBTQIA populations, and during my work there, we realized that patients were traveling for hours to get to us. Care for LGBTQ communities should be part of all the work that we do, right? So no matter what specialty you’re in, you should be able to take care of a patient who identifies as queer or trans, but I was finding that patients were traveling specifically to come to our clinic and so I thought well, maybe I should move into the primary care world and think about how do I train other family physicians or their primary care physicians in incorporating this type of care into their practice. 

I was doing that for a while when I was working at Einstein hospital, and then COVID hit and we had to provide telemedicine, and I found that it was a completely different experience for my trans patients. Because that meant that they could do our visits in the comfort of their own home. It meant that they didn’t have to worry about being out in public and possibly being misgendered. They didn’t have to worry about “what do I wear when I walk into the hospital?” or “How do I present myself?” “Is someone going to make comments about how I look?”.  All of that went away and I was able to see them in a place where they felt safe and comfortable. Part of that was just really improved access right? My no show rates really went down. And they were able to actually come and be present during their visits. They were much more relaxed. And so I thought, if I’m really thinking about access, I should really be thinking about telemedicine. And then I found FOLX health. They were a new startup looking for clinicians to work for them. And I was like, this is a perfect match of all my interests and joined.

So I think one example of critical race theory ties into healthcare is about counter narratives. We work within these dominant narratives, where it’s really about a world where everyone is white, straight, cisgender. Christian, and if you’re not part of that dominant group, then there are stories being told about you and your community, and you have no part in that. So these are stories like, “all trans people have hard and difficult lives,” or “queer NHAAPI people don’t exist.” A lot of it is thinking about who gets to tell the stories and how the stories are told. And from the counter narratives and thinking about dominant narratives, the way that I started to think about stories with my patients, is “how do I create a space in which they tell the story of themselves however they want to?”. So it might mean that they don’t even tell their story, right? If they’re like, I don’t trust you enough, or this space doesn’t feel safe enough for me to share my story. And then for me to be okay with that. Or for them to say, “you have to know all of my life in order for you to even take care of me.”.  So then we spend 15-30 minutes just talking about their life story. But it’s really about creating the space in which they own and have the power in deciding what is told. I think the other piece is just really being intentional about, when I ask questions, how I ask them. Do I think about autonomous decision making in everything that I ask? And I think particularly for NHAAPI and queer communities, there’s a lot of questions that can be very invasive, or feel very invasive. Things like sexual health history or decisions about end of life, cancer diagnoses. So it’s a lot about letting me understand where you are and letting me tell you why I’m asking you all these questions, and then you can decide how you want to engage in that. And they might say, “No, I don’t want to talk about my sexual health,” and for me to be okay with that.

I find that FOLX health allows me the opportunity to really tailor things. And so part of our process is because we know how damaging the healthcare system can be and that many queer and transgender (particularly transgender) patients have experienced harm, either verbal or physical in the health care setting. We know that they bring all those things with them to the visit. So part of the process is to allow patients to decide, do they even want to interact with the clinician at all. So they could elect to just not even have a visit with us, but they would fill out a questionnaire and they could answer questions that we think are clinically relevant. So we give them power to not have a visit with us. But when they do decide to have a visit with us, I usually end up starting out being very open ended, just being like, this is your time. We have 15 minutes, 30 minutes, however long it is. And would I say that “you decide what happens during this visit. I want to make sure that we answer all your questions, and you can share as much or as little as you want.” And then that kind of sets the tone for that for that visit.

A lot of it is all around thinking about culturally relevant care, especially being able to provide care that is not just culturally relevant, but specific to that individual person. Because the queer and trans community, the NHAAPI community, we’re all extremely diverse. And we all have our individual specific needs. But I think it’s like, in particular for the queer and trans community, is thinking about how do we make the environment gender neutral, and not make assumptions about people. And that’s true for the NHAAPI community as well. Let’s not make assumptions about what someone thinks or what their values are just because they are NHAAPI, right? Because you have NHAAPI folks who grew up in the US or who have had several generations in the US, right? And that person’s gonna be different from someone who just came to the US as an adult. Or if they came to the US and have gone to graduate school versus someone who has a second grade education, right? Those are two very different people with very different needs. It’s all about one, trying to make the environment gender neutral and affirming as possible, but the other is really not making assumptions about people, but asking them questions. 

I think another big issue for the NHAAPI community is translation services. I think that in terms of the NHAAPI community, you’ll find that communities immigrate either regionally or by country, so they kind of tried to gravitate towards each other. And so part of it is making sure that whatever service you’re offering is relevant to the communities that you’re serving.

I think it’s scary and hard because, as a physician and someone who works in trans health, I know that access to trans health care for children and for young adults is extremely important for their success. You had brought up health disparities before among the LGBTQ community, and part of what causes health disparities is not having support. And support can look many different ways. I think when people think of trans health, they think things like medication, hormones, and surgery. 

But that’s not the case for many trans people, and especially not for trans and gender diverse youth and children. It’s really about—- are they or their families getting the right information? Are they being supported and whatever their gender journey is? We know that when kids are supported in their gender, they thrive, they do well, when children are not, that’s when it causes all these horrible health disparities. The other thing to know is that there is a lot of evidence based research around what helps keep these children safe. And these legislations are all the complete opposite of that. They are really about transphobia, hatred, whereas it should really be about the families and children making the decisions that are right for them with their health care provider. 

In terms of what we can do, it is mobilizing your state. If you have the opportunity to speak out against legislation, call your legislator. I know, it’s really scary, so if you can, do it with your friends, get a group together, or just make a script. They really just want to hear from you. And you just speaking out can make such a huge difference.

I: Thank you so much for sharing. That’s something that we’re definitely trying to do at APAMSA, giving students the resources to know how to advocate for their communities. And that’s definitely something that we are interested in continuing to do in the future as well. Thank you so much, Dr. Wang, again, for taking time out of your schedule to do this interview.