Let's try something new!
An experiment for you to beta-test, if you please
This isn’t the post I was planning for today, but I hope it will prove to be a happy accident.
I’d planned to publish a podcast interview that was recorded and then put on hold for a few weeks because my guest was anxious about having her voice ‘out there’ where someone might identify her. She would be anonymous, and we were careful to avoid any descriptive details. Though my audience is boutique-size (quality over quantity!) and friendly, it was still conceivable that she’d be recognized and outed at some point, and I understand and support her decision not to publish the episode. The downside, however remote, would probably be the end of her career.
Two other potential interviewees were similarly situated. Both craved the therapeutic benefit of speaking out — one had reached out to me about it — but in the end felt they needed to stay quiet for now.
Meanwhile, I was having a written back-and-forth with someone who had made interesting comments on my posts and on other Substacks we both read. She’s a primary-care pediatrician who is affiliated with a children’s hospital in the U.S., and she, too, was reluctant to record an interview, but gave me permission to publish our online chat. It deals with her relationship to the American Academy of Pediatrics (AAP), and to her introduction to the concept of ‘trans kids’ around the same time as my own discovery of the concept via my trailblazing daughter, around 2016.
The best part is that she agreed to answer questions in the comments! This is also an invitation for other healthcare providers among you to be heard but not outed, especially if you work in a ‘gender-affirming’ milieu, which my guest does not. I just have two rules:
Obviously, don’t ask anything that would tend to identify the doctor if she answered truthfully.
Please stay on topic and resist the urge to wander off toward a vaccine debate, for instance.
With that, here’s our conversation, in which I call my guest Dr. P, for Pediatrician:
ME: To get us started, can you describe your relationship to the AAP?
DR P: I joined as soon as I finished my residency and would attend occasional national or state meetings to gain knowledge on general topics and also to get continuing Ed credits. Later I got very active in a certain Section and was Section chair for a few years and am still on the exec committee for that section. I was active in writing policy and clinical reports for that section and revising a quality improvement course related to that section. None of my engagement with the AAP had anything to do with trans issues.
ME: Without necessarily disclosing your section, could you name some examples of what a section is? How many sections are there?
DR P: There are about 50 Sections and there are also Committees and councils. I don’t actually know the difference. Sections can be topic focussed like ‘allergy and immunology’ or kind of people focussed like ‘pediatric trainees’. There is a wide variety. The AAP both represents pediatricians and also serves as a repository of practical knowledge in the field. It is not a pediatric research organization. It is focused on practice.
ME: This is interesting! There were about 65,000 AAP members last time I checked. If you think back to when you decided to join, can you remember what persuaded you? I learned from Dr. Julia Mason that an AAP ‘fellow’ has voting privileges, and that kind of membership costs $700 per year. Are you a fellow? Are there other membership levels?
DR P: So I joined because of potential continuing med education credits. Then I started my academic career and my hospital paid my dues. There is a much reduced rate for trainees and early career physicians and somewhat reduced for retired. I can look up all those fees. I find the internal structure very arcane and they are always reorganizing.
They have a lot of staff people and do a lot of lobbying. I think that’s where they can get into trouble on trans issues. Although they can’t take a political stand it’s obvious the org is on the left. It was nuts when Trump won.
ME: Can you expand on that last point?
DR P: I was at the National mtg that fall I guess 2017 after he took office. I remember the plenary session which is honestly kind of political, so much about the border and kids in cages — the president of the AAP went to the border —and there was just a kind of uproar. So I kind of think that the trans ideology is identified as Democratic or left and being opposed to it is seen as Trumpian, which is a terrible look in this org.
I think during the Trump years the org got very polarized on the left even if not directly about the trans issue.
ME: Are you familiar with the story of Dr. Jason Rafferty and his single-author statement on affirmative care that became official AAP policy? I worry that this question is patronizing given that you’re the MD/AAP member and I’m not even a journalist; but I know you don’t work with ‘trans’ kids, and maybe the AAP wasn’t very forthcoming with this info at the time, except with gender specialists, because even they had a feeling it was sketchy?
DR P: I heard of this much after it happened. I didn’t know much about it til later. A single author is very rare: maybe the only time this happened. The board of AAP is supposed to approve of these statements.
ME: Right, so the sketchier aspects of the policy weren’t advertised to every AAP members. But in general, when AAP endorses a new policy — e.g., didn’t it just approve semaglutides for obese kids? — does their standard process involve notifying all members of the opinion so doctors are always up to date?
DR P: There are some publicity pieces, but no way can I keep up with everything and it’s hard to know if these publicity pieces are mandated or just happen. So the answer is not sure.
I didn’t see Rafferty’s policy statement when it came out and it is highly unusual to have one author. I haven’t heard of that in other cases.
ME: If the AAP is not the main source of practice guidance, who is that source? Peds is such a generalized, wide-scope field that I would think there’d have to be a formal system for disseminating new findings, and maybe even strict rules/protocols that must be followed. Am I off base?
DR P: AAP practice guidelines carry a big weight particularly in less academic settings like private practice. There is actually no formal system for disseminating knowledge! We need a certain amount of continuing Ed credits and also to keep up with boards but there is no one way of doing this! The AAP has been very wrong before: on preventing pediatric allergies. This guideline involved delaying introduction of potential allergens and was based on consensus opinion and caused allergies!
ME: This is fascinating. Can you be more specific about continuing ed and board certification? Does every doc have to complete a certain number of hours per year (if so, how many?) and is there a wide range of organizations providing that continuing ed? I’m very curious about WPATH’s role in this area.
DR P: I’ll check into all the regulations. The American board of pediatrics is not the same as the AAP and it is the certifying body for pediatrics in terms of the initial exam and staying up to date. The states require a certain amount of continuing ed for maintaining your state license. It’s 25 hours a year in my state. You can randomly be asked to provide evidence of attendance or on line completion of educational sessions. Going to an AAP meeting would be a good way to get these credits.
I don’t think that you could get these credits from WPATH. Don’t know.
ME: I just read an article about UCLA’s med school violating California state laws against race-based admissions, and how it’s affected student performance to the point that faculty members blew the whistle to a reporter (Aaron Silbarium in the Washington Free Beacon). I don’t know if you were involved in training or teaching, but do you have anything to say about this problem? Based on my podcast conversation with Dr. Lewis, I know it isn’t confined to UCLA.
DR P: I saw that too! It must be terrible for whistleblowers to speak out. I was on the residency training side and evaluation. Not the med school. I know that my hospital’s residency program tried to get more minority applicants. They did this more through encouraging them by meeting other minorities when they interviewed. I never saw incapable residents who were minorities! Some were better than others but all met a threshold of like B plus. Everyone was serious.
ME: That’s reassuring! The article says this:
Within three years of [admissions and DEI director] Lucero's hiring in 2020, UCLA dropped from 6th to 18th place in U.S. News & World Report's rankings for medical research. And in some of the cohorts she admitted, more than 50 percent of students failed standardized tests on emergency medicine, family medicine, internal medicine, and pediatrics.
…which supports an argument made in another episode of the pod by ML, a professor of data science who has grave concerns about the state of research in academia.
DR P: It seems like UCLA’s head of admissions is really far out ideologically. When students aren’t prepared and have trouble with the curriculum they will fail boards.
So ultimately what’s the point of doing this? It’s horrible for the student to be such a failure. And it’s predictable. With a low grade point average and test scores this is all obvious. It’s literally setting up the student for failure.
ME: Right, and if it’s the case that DEI and Admissions staff aren’t evaluated by the outcomes they set in place — if they’re rewarded only for diversifying the class without regard to graduation rates or the achievement of careers in medicine — then it’s a cynical sham. And it makes victims out of better-qualified candidates based on their immutable identity characteristics, which is illegal in California.
Is there anything else you want to discuss?
DR P: One other thing. My first encounter with trans issues. I knew nothing about it. I was at an AAP meeting and had nothing to do so I walked in to a trans session already begun.
From what I could gather the issue was gatekeeping. Could or should you treat trans kids outside of a big center for kids. This was like 2016. There was some idea that if any doc could give insulin for a kid with diabetes you don’t need to be in a special center to give cross sex hormones. There was some debate about this. I remember being shocked.
Activists were already running the show even back then.
ME: Did you talk to any colleagues about it, either at that meeting or back home?
DR P: No, actually not. But I never forgot. It seemed so weird. Now the guy running the session didn’t advocate this. He was more like you need a lot of expertise. But there were people talking about gatekeeping and barriers etc.
Something felt very wrong to me.
How could any physician compare this to diabetes?
ME:I wonder if your spidey sense told you it would be risky to say anything. A lot of us had that feeling, whether or not we were working in healthcare.
DR P: Yes. I had walked in in the middle just kind of observing and sat in the back. More of a listener.
ME: After that incident, did the topic of treating ‘trans kids’ recede from your real life, or did it slowly insert itself? If not in your practice then in your peripheral vision, so to speak.
DR P: It slowly inserted itself into my peripheral vision. Not really from my work but from the general culture. Sometime around then (2017) I remember the clinical social worker where I worked showing me the gender bread man thing.
Sorry I don’t remember why she showed it to me. Anyway I thought it was ridiculous. Like who made that up and what evidence backs it up. And again I was shocked that this social worker bought the whole concept. No questions.
ME: Was she expecting you to take it on board?
DR P: Yes. For sure it’s like this is wonderful. And I just kind of listened and thought omg where did this crap come from.
I’m very evidence based.
ME: Did you ask her about the evidence for it?
DR P: I don’t remember. Probably just kind of assessed the situation and didn’t. Sorry I don’t remember details just that I I’m getting this feeling that there is a lot of garbage going on.
I hope this isn’t too vague.
ME: Fair enough, and you’re fine! Was the social worker young and/or recently graduated?
DR P: She was young. Like late 20s! White. Married. Hetero. Had a baby that year.
ME: Apart from that informal exchange, did the hospital ever require any training in anything related to ‘gender-affirming care’?
DR P: Yes I remember one training about 5 years ago. It was before Covid. On LGBTQ. Pronouns were specifically discussed. A lot of residents started wearing pronoun pins then.
We also had yearly on line diversity training which was pretty harmless.
ME: Was the first one just for the peds dept?
DR P: I am at a children’s hospital so by definition just us. But don’t know if peds surgery did it too.
ME: Did it cover diagnosis and treatment of ‘trans’ patients?
DR P: No. It was more like how to be nice to people who may be different from you. Very generic.
ME: So what do you think was the hospital’s expectation if you were to have a child walk in and say something about gender identity?
DR P: To refer to their gender clinic. And not ask too many questions!
ME: Yeah, that tracks with everything we’ve been learning along the way. Anything else you want to add?
DR P: I guess that’s enough for now.
Healthcare providers: your training and education matter to all of us, but I’m starting to think your commitment to critical thinking matters just as much, if not more. Do you have anything to add to this conversation? Let’s hear from you in the comments.
 | A guest post by
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Hi Jenny, thank you for this article and I think you have a curious mind and a vested interest (your own daughter, as I do as well—two girls, in my case), so I do think you’re in your own way a journalist. Also, I dearly hope your two other people that are uncertain about their voices being heard do find a way to cautiously/carefully let us all hear their voices. I’m deeply curious and at the crux of it all, I want to know whether there are more folks out there like me/us.
Thank you so much to Dr. P. I think it has been extraordinarily rare for any pediatrician or pediatric nurse practitioner to speak out. Thank you, thank you, thank you.
My background is that I got a degree in nutrition by hook or by crook (took a long time, didn’t have a ton of family support, waitressed my way through college, etc.), did a Peace Corps stint in Maternal and Child Health, and then worked for WIC for five years in a rural community and finally went back to school for an associates degree in nursing and took the licensing exam and became an RN. I call myself a Renaissance Woman because though my credentials aren’t high and mighty and I took a few stumbles with my grades, I have arrived at where I am now and have a rich background that I summon up daily (hourly?) in my work now as a pediatric nurse in a doctor’s office in a very busy suburban area of a large metropolitan city on the East Coast. I’ve only been in pediatrics since 2020, fyi. I worked as a nurse in other specialties previously.
I have had two experiences with the trans stuff. One, was when I first began in the private doctor’s office and I encountered my first trans kid, this would have been 2021. I was so excited. The girl wanted to be called a boy’s name and had headphones on throughout all of my interaction with her, wouldn’t acknowledge or talk to me, there was only communication via her mother (who was on her phone a lot), and the patient had a very long list of MH diagnoses. I carried out the provider’s orders for the patient and they went on their way and I was very excited for having cared for my first ‘trans’ kid who was about 15 years old at the time.
We started getting more of the kids who were saying they felt “gender confused” and it seemed to be gaining in popularity as a social contagion but I hadn’t thought much of it.
Then in summer of 2021 my older daughter turned 14 and had been in a summer camp with about six other kids (this was still pandemic-y times) at a sailing camp. And also my daughter had a smartphone for the first time. Out of the six kids at that summer camp, three said they were trans and one said she was nonbinary and that “she wakes up in the morning and decides how she feels-male vs female”. (I only found out about the “decisions” this group of kids had made later).
In the fall of 2021, our previously girly girl began dressing like a male, got a very short haircut, and somehow acquired a binder. (Our other younger daughter had had to be hospitalized with anorexia after she had gained a lot of weight during the pandemic and when she returned to school, got teased about it and subsequently began restricting her food intake and I hadn’t realized she was having trouble. So I was quite distracted).
Our older daughter left me a two-page, scripted letter replete with footnotes with references for parent-support via GLAAD and HRC.org saying that at age 14 she had decided she wanted a double mastectomy and wanted to be called a boy’s name, blah blah blah
We were shocked to our core as parents. The school supported this nonsense as did a different summer camp we found out called her by this boy’s name, and everyone said she was so “brave”.
After a nearly six month close working relationship with my younger daughter’s (she was 10) brand-new, young pediatrician for the younger daughter’s anorexia, with weekly check-in’s at first and then continued monitoring, I decided to bring in my then nearly 15 yo daughter to the same pediatrician.
I had called ahead and said I wanted to discuss her “gender issues”. I think that, given that the more experienced pediatricians at the practice were also saying that my younger daughter’s voyage through dealing with anorexia was *helping* the new, young pediatrician learn, that the young pediatrician also may have first consulted with the older pediatricians about how to handle a “gender issue” case prior to our walking in to that appointment.
They separated me and my daughter. Consulted alone with my daughter for a while. Then separately spoke to me and informed me my daughter was trans. And that she’d felt this way for a long time. And that they were going to be going forward calling her by a boy’s name and would change her name in her medical chart. The pediatrician got super close to my face and said “this is happening, this is best practice” and intimated that it was “life-saving” care though my daughter was not depressed in the slightest. And though this pediatrician had first met her the year prior when she was a bouncy, sweet, girly 13yo. And though I told the pediatrician that four out of the six kids at her summer camp the previous summer had all “come out”. The pediatrician said this is what the American Academy of Pediatrics advises.
When I told my younger daughter’s psychologist that we were now having a situation with the older daughter she squealed in delight “this so wonderful!” (that our daughter was saying she was trans) and that it is so “rare” and she was so brave. She “strongly encouraged” us to seek out a “gender specialist” and sent me a list. One of them were as “kink-friendly”. I told the psychologist about the four out of six in the summer camp but she brushed it off. I told her I’m not sending my 14 year-old daughter to a “kink-friendly” therapist.
We continued to see that psychologist for the younger daughter and then, fairly predictably, my younger daughter began to imitate her older sister and the “transgender trend” I guess she was seeing lots of places (school, social media, her own sister, camps, etc.) and her psychologist (who I later fired) “celebrated” my younger daughter’s “discovering” her own trans identity.
These two providers gaslighted me, did not rely upon evidence-based practices, and shamed and threatened us as parents for not following in lockstep what they were saying to do (and what the AAP says to do and what Jack Turban has written articles about in Contemporary Pediatrics journal) though I HAD followed in lockstep what was absolutely life-saving care and was evidence-based for my younger daughter’s eating disorder.
My experience in working in my own pediatric’s office is that the providers often don’t want to rock the boat regarding certain ideologies and they are busy so they often rely upon an “Academy”’s summation of how to take care of certain issues. This has been exploited via bad actors within the American Academy of Pediatrics which can carry great heft and influence.
I was shocked to my core and, after soul searching, realized they’d lost my trust in them as an institution.
The older daughter is (slowly) coming out of her ideology at age 16 and the younger daughter at age 13 has recovered (mostly) from the eating disorder but still is dressing like a boy.
I wonder if it is because society is reaching “peak” with all of this. I hope so.
This is an excellent way in to the conversation that needs to be had. Perhaps starting up a US Pediatric Research organization might be a way of marginalizing the AAP which sounds more like an affinity group. The AAP has influenced pediatric policy of so many other countries. I hope you are able to find other peds to interview.