The Health Curve

Denied and Dismissed: The LGBTQ Community’s Fight for Equitable Healthcare - with Justin Ayars, CEO of Equality MD

• Dr. Jason Arora • Season 1 • Episode 3

Share episode

The LGBTQ community faces worse health outcomes, barriers to care, and systemic discrimination in healthcare—yet their struggles remain largely overlooked. 

Despite being officially recognized as a health disparity population by the National Institutes of Health (NIH), inequities persist. LGBTQ patients often experience discrimination in a clinical setting, leading many to avoid seeking care altogether. 1 in 6 are denied care and 1 in 5 experience discrimination from health insurers. Meanwhile, LGBTQ youth are 4-5 times more likely to attempt suicide than their straight peers.

In this episode, we sit down with Justin Ayars, CEO of EqualityMD, to discuss the healthcare challenges LGBTQ patients encounter, where these stem from, and how we can build a more inclusive and equitable healthcare system.

Dr. Jason Arora:

Hello and welcome to The Health Curve. I'm your host, Jason Arora, and today we're going to be talking about healthcare for the LGBTQ community. Why does this matter? Well, the LGBTQ community faces significantly worse health outcomes than others, with higher rates of chronic illness, mental health struggles, and barriers to accessing care. The reason we're talking about it is we want to help folks understand the issue, we want members of the LGBTQ community to feel reassured that they're not alone, and we want everyone to be aware of some of the solutions out there. Now, the numbers are pretty staggering. One in six LGBTQ adults have experienced discrimination in a healthcare setting. Nearly half of transgender individuals have faced denial of care or mistreatment by medical professionals. A fifth of LGBTQ adults and a third of transgender adults have delayed or avoided seeking medical care for fear of discrimination. And finally, LGBTQ individuals are less likely to have health insurance than others. So in some way, the medical community and healthcare system is still failing the LGBTQ community, as well as other communities, which we'll talk about in future episodes. But for today, we want to understand why this is happening for the LGBTQ community and what we can do about it. So to help us unpack this, I'm joined by Justin Ayers, who is a former healthcare trial attorney turned serial entrepreneur, and now the founder and CEO of EqualityMD, which is a company that is dedicated to making healthcare more inclusive and accessible for LGBTQ patients. Really good to have you here, Justin. Thank you for joining. Thanks for having me, Jason. It's a pleasure. So I was researching this topic beforehand and looking at some of the statistics out there around discrimination in a healthcare setting, mistreatment or denial of care, healthcare coverage through insurance, these sorts of things. And as we were discussing before the podcast, a lot of the published research out there, whilst being true, we see a lot of understatement of the issue. So rather than me throwing down some statistics that I found through sort of the common literature and research. I thought, let's ask our expert. What is the state of play? Like, what are some of the statistics out there that reflect some of the issues around healthcare for the LGBTQ community?

Justin Ayars:

That's a great place to start is where are we right now? And it's not in a good place. The one thing the pandemic did was put a big spotlight on all kinds of glaring healthcare inequities that different underserved communities have endured for generations. So for our community, the LGBTQ community of which I identify, one in three experience discrimination in a clinical setting. And that causes one in four to avoid care altogether, either because they've experienced that discrimination or they're fearful of experiencing that discrimination in a doctor's office. One in six are denied care So they show up and the doctor finds out that they're LGBTQ status and decides not to give care. And one in eight live in states where doctors can legally deny care. One in five experience discrimination from insurance companies. And 17% of our community are uninsured, which is twice the national average. And 43% are underinsured, which is one and a half times the national average. And we were able to get this information by doing a massive five-month customer discovery project in partnership with Cedars-Sinai, UC Berkeley, and the National Research Institute with their healthcare division. And we found that because our team at EqualityMD, we're all members of the LGBTQ plus community and therefore there's an inherent level of trust. We're also leaders within our respective domains that we bring to the table to the company. And because we've lived the problem we're solving, there's more trust in us asking the question rather than a big university asking the question or a research entity asking the question. And that's why we were able to get some of these staggering statistics that are not part of the sort of general research you might find doing a Google search.

Dr. Jason Arora:

Astonishing. I mean, the numbers are truly staggering and we know that there are Sure.

Justin Ayars:

So I graduated law school in 2007 and had a clerkship and then the great recession hit and I was lucky to get a job. And the job I took out of necessity was defending insurance companies in healthcare litigation cases. So don't hold that against me. Easy

Dr. Jason Arora:

job.

Justin Ayars:

Yeah, right. Right. So I was working for the dark side, if you will. But after about a year and a half of doing that, the Great Recession dragged on and on and on. And young attorneys like myself in the last one and first one out. So I lost my job, like almost 65 percent of my graduating class. And I swore never to go back to health care again because then I saw from the inside how inequitable our system was. And lawyers, as I jokingly say, are really counselors at life, not just counselors at law. We get asked questions that span the gamut of the human condition. And traveling across the country in various capacities as a serial entrepreneur for the past 15 years, I've engaged with everyone from Fortune 500 executives to nonprofit volunteers. And the most common question I've received from people, no matter what their geography or walks of life has been, where can I find a doctor who makes me feel safe? And this really resonated with me because because I'm whiter than paper. And so I go check out with a dermatologist every year or two, just to make sure I'm being preventative in skin treatment, cancer treatment. And I had a new doctor in DC, which is the highest gay population per capita. And I made a self-deprecating joke about my sexual orientation because I was sitting there naked in a hospital gown and already feeling kind of vulnerable and awkward. And when I made the joke that I was gay, The doctor was putting on the gloves and he said, I can't complete this physical examination because I don't feel comfortable touching your skin. He took his gloves off and walked out of the room and leaving me feeling less than human. But that's when I realized my experience is really not uncommon. And all those stories about people asking me that question, where can I find a doctor makes me feel safe, came top of mind. And it stayed top of mind during the pandemic when everyone was talking about health care. And that's the one good thing the pandemic did. It showed how drastically different certain communities perceive and receive care compared to others. And LGBTQ, as you mentioned, is as much needed to talk about because it represents every other demographic out there, from racial minorities to military veterans.

Dr. Jason Arora:

What are some of the most shocking or frustrating stories that you've heard from others in the community? Can you give us a couple of examples?

Justin Ayars:

Sure. So, A large number came from the lesbian and bisexual female community, largely when they had children. And they brought their children in with either their spouse, their female spouse or their female partner, or however they wanted to identify the other adult they brought with them. And doctors continuously asked them, who's the father? Where's the dad? Where is he? And they said, there is no father. to the point where sometimes the doctors would ignore the other woman in the room as the mother or the partner. Similarly, a lot of lesbian and bisexual women, primarily lesbians who only sleep with women, have been asked for pregnancy tests and insisted that they receive pregnancy tests. When they say, I don't sleep with men, I'm a lesbian, and the doctors would say basically they're checking a box and they have to do it. When doing some interviews as part of this 32,000-plus patient survey and then 350-plus in-person interviews, we also spoke with clinicians. One doctor, and I have this quote because I think it sort of hits the nail on the head. I'm a healthcare provider, and I know just how uninformed my peers can be when treating LGBTQ patients. I'm painfully aware that I did not receive any LGBTQ cultural competency training in medical school, and this has impacted my practice. And I think that really gets to the heart of it, is that there's a lack of training in medical school so that when doctors are presented with patients who present differently, be it the sexual orientation, gender identity, it's not that they don't necessarily have a malicious intent towards these patients. It's they don't have the skill sets to be able to create that safe space in which the patient that they're seeing feels comfortable to be their authentic and vulnerable self in front of them.

Dr. Jason Arora:

And this is something we're going to come back to as a member of the medical community myself. Obviously, it makes me sort of very angry to hear that my peers are behaving in this way. But then there are issues around training and knowledge and skills. And this is an issue that needs to be taken to the right sort of institutions to train up our future doctors, our future nurses, to be able to serve all patients better. So we've talked about some statistics about health outcomes, access to care, etc., What other kind of unique issues in healthcare does the LGBTQ community face that they're underserved in by the current healthcare system?

Justin Ayars:

So in 2016, the National Institutes of Health declared the LGBTQ community what's called the health disparity population. And that by definition means that they have historic lack of access to care and unique healthcare concerns. A lot of people think, oh, HIV, AIDS, and STDs, but it's much more than that. Lesbian women, for example, have higher rates of intimate partner violence, have higher rates of mental health issues, obesity, and substance abuse. And all of these things can lead to physical, mental trauma, depression, anxiety, cardiovascular issues, type 2 diabetes, cancer, and heart disease. So these types of issues, if not addressed, then they're not treated. And I always say doctors can't treat what they can't measure, but they also don't know what questions to ask. And if they're not asking the questions, they're not getting the information to be able to treat the patient and ask the questions that might be able to get them the kind of care that they really need.

Dr. Jason Arora:

There's another stat I came across that, and this is probably another understatement, so if you can help us correct this, please do, that youth in the youth in the LGBTQ community are four or five times more likely to attempt suicide than their straight peers. Is that accurate? Sadly, yes. Yeah. And so we kind of understand now just how big the disparities are, how big the issues are. And this is a diverse group in itself, of course, as well. You know, we've grouped together a few different categories, you know, if you will, in this sort of macro group. I mean, how did the disparities... And the issues, the unique needs vary across the LGBTQ plus community itself.

Justin Ayars:

Sure. I'm a big Star Trek geek, so I like to use some of the phrases they have there. And one is infinite diversity and infinite possibilities. And that's pretty much what the LGBTQ community is, is infinite diversity. But there are also infinite possibilities of challenges when it comes to health care issues. If you're a racial minority, say you're African-American, male or and a military veteran. You might be living with issues that relate to your race, issues that relate to your service, perhaps PTSD, and issues that relate to your sexual orientation, being gay. All of them converge when you go to the doctor for anything, and you can't discount those identities when factoring in what types of questions could be asked and what type of treatment options are available. You also have to consider the ability of the individual patient to be able to pay for whatever services that are available. As I mentioned, 60% of our community are either uninsured or underinsured. And so patients are already trying to navigate a very complicated health system, managed care system with insurance companies, health systems, and pharmaceutical companies. So just because you have an insurance card from your employer doesn't mean that you're fully covered. So it's hard to be able to figure out where you fall in the covered spectrum when it comes to your different identities when receiving care. How much of this is cultural, political, or religious do you feel? I don't think you can discount those elements. One of our investors invested as a straight ally because when he was doing the rounds as his residency in Los Angeles at a hospital. There was a man that came in on a stretcher at the wee hours of the morning from a car accident, bleeding profusely. His gay lover was with him. And the doctor he was shadowing said he wasn't going to treat the guy on the stretcher because he was bleeding and didn't want to get AIDS. This was not long ago. And there are still people who, just because they have medical degrees or law degrees or any type of advanced degrees, doesn't mean they're good people. They're always bad apples. Now, the vast majority are not. I don't think people go into medicine to not treat people. But there are sometimes issues. I said one in eight LGBTQ folks live in states where doctors can legally deny care. And those reasons are for religious or other types of personal convictions where they can say, I don't need to treat this patient because of the strongly held beliefs I have. And I think that's a big problem.

Dr. Jason Arora:

Yeah, and that gets us onto the medical community and training of doctors and nurses and our ethical obligations. When I was trained, I was trained in the UK, as you know, and this is true universally, you're trained to treat all patients equally irrespective of their background or beliefs. So there is the ethical aspect of this, but then there is the practical training aspect of this in that Many medical schools don't provide any or enough formal education on LGBTQ health specifically. Now, this is also true for other quote unquote minority groups, but doctors and nurses, when surveyed, a lot of them don't feel entirely comfortable treating LGBTQ patients because of a lack of training, lack of understanding of the unique health needs. They don't want to ask about sexual orientation because they don't want to make patients uncomfortable, even though they'll ask them to fill a form out asking the same thing, which is kind of strange. And then, of course, implicit bias, which goes back to some of the cultural, political, religious things. So as someone who has worked with physicians and nurses and other healthcare professionals, what's your perspective on what's missing here How much of it is down to training? How much of it is that these medical professionals are not abiding by their ethical obligations? And beyond those things, what are the other things that you see as being issues with the medical community that they need to overcome to sort of meet the moment on this? In the end

Justin Ayars:

of the day, it comes down to a lack of data about how our community, which is about 20 to 30 million strong in the U.S., No one's really sure because not everyone's going to raise their hand and say, please count me when counting LGBTQ people in America. It's an invisible population in that sense, isn't it? Exactly. Because even when patients in our community go seek care, they can choose not to come out. And if they don't, they're not being asked questions they might, that they probably should be asked, that can help them with preventative issues and keep them out of the emergency department. But You see, in terms of the lack of data, it really exacerbates existing health disparities, creating a cycle of decreased patient engagement and worse patient outcomes. And to combat this, there has been some, not so much formal training in medical schools in the U.S. per se, but there are certainly some wonderful organizations out there that do LGBTQ cultural competency training. Some provide continuing medical education credits for it, and that's wonderful. But There's a lot of burnout amongst providers, as we saw. And we went fortunate to go through the Cedars-Sinai Accelerator in Los Angeles towards the end of 2023 and got to know a lot of clinicians. And there are some clinicians out there that are just so burnt out. They thought that sexual... assault and sexual harassment training was the exact same thing as LGBTQ cultural competency training. And I don't fault them for just not understanding because their brains are fried. They're overworked and overburdened. But then you have different extremes of examples. Say that there's a gay man who's broken his ankle and needs an x-ray. He goes in for an x-ray and the chart somehow says that he's gay or bisexual. And so suddenly the doctor is taking the image and asking about When was the last time you had an HIV screening or STD test? And the guys who's getting x-rays saying, can we just talk about my ankle? And then other times they aren't asked these questions at all when it's going to a primary care physician. And it's just a question of how do you ask these questions in a manner that makes the patient feel that they can be comfortable answering them? And this sort of checkered patchwork that exists across different health systems, different electronic healthcare records. There's the lack of interoperability, so there's a technology issue there involved. The heart of it is a lack of data, and that's something that we at EqualityMD are trying to tackle in addition to providing inclusive healthcare through our telehealth platform.

Dr. Jason Arora:

The interesting thing about this aspect to me is that as a medical professional, when you're trained to assess, understand healthcare, a patient before you treat them, you have to develop a picture of the human being that you're treating, you know, both from a biological perspective and a non-biological perspective. And this is like the basic level of personalized healthcare, right? In that when you take a history, you're asking relevant questions so that you can provide them with the appropriate plan and treatment. Again, not just biologically in terms of, you know, drugs they may take or whatever but also in terms of lifestyle changes and you know contextual factors things they can or cannot do in their day-to-day lives you take a social history typically you want to understand do they smoke do they drink are they married do they live alone you know these sorts of things and so to me when you are having that consultation being able to ask these questions in the right way and i think first understanding why they're important and and why they need to be in that pro forma of taking a history for a patient And back when I trained in medical school, I cannot confidently say that we were trained to ask about sexual orientation. We were trained to ask about a lot of other things. But starting with the fact that this is a variable that impacts health outcomes and will impact access to care if you're seeing a patient and what they're going to do when they leave your office or they leave the ER or whatever. And so this has to be built into the rubric of how you assess a patient, I think, from the medical perspective. And This needs to start in medical school, really, in the way we train our healthcare workers.

Justin Ayars:

Absolutely. And I don't know how that can be implemented in a consistent way. And that's the key thing is there's very different ways in which these types of issues can be addressed through training, but not all training is created equal. And I think that there are some best practices out there. One of the organizations that we work with is the National LGBTQIA Health Education Center out of the Fenway Institute in Boston. It's sort of a gold standard for cultural competency training. And there are other wonderful organizations out there, some private companies like Violet, some nonprofit organizations, and there are more and more of them. And this goes for other underserved communities too. I don't think there's a single answer. It's just that there's a need for the provider to be willing to undergo this type of training, whether they get CME credits or not, because they're going to be presented more and more with patients who might not look like they do. And what's interesting is just because a doctor identifies as LGBTQ, for example, doesn't mean they're going to be able to deliver culturally competent care because they could still be an asshole.

Dr. Jason Arora:

Absolutely. I kind of want to get into health insurance and regulation and some of the issues around that. Maybe it makes sense for us to start with the Affordable Care Act, you know, as sort of a recent piece of legislation in the U.S. that included protections for the LGBTQ community.

Justin Ayars:

Sure. The ACA certainly helped a lot of Americans gain access to health care in ways that they didn't in that past pandemic. after I stopped practicing law defending insurance companies in healthcare. So things did get better in terms of access and understanding. When the NIH declared our community health disparity population, they opened up a national office of health minority and gender studies, which went dark this week. And that was a wonderful resource that was just collecting information and providing best practices and talking about some of the reasons for the discrimination in healthcare that led them to classify our community as a health disparity population. Our team is monitoring it because it's impacting a lot. A lot of people are very concerned by changes that have taken place or might take place under the current administration. So we need to really come together as a community and figure out what resources are available, what information is genuinely legitimate, particularly as people doom scroll through social media. It's fear mongering. It's governing by fear. But there are opportunities for us to find out where are the best sources of information, and we're hoping to be able to provide some of that for our community.

Dr. Jason Arora:

We'll get back to this conversation in just a moment. But if you're finding this episode helpful... Here's a quick ask. Take a second to follow or subscribe to the Health Curve podcast wherever you're listening. And if someone in your life would benefit from this episode or any of the others you've heard, please send it their way. All right, let's get back to it. We mentioned at the start the executive orders. Are you able to just provide a brief summary as to what we've seen so far?

Justin Ayars:

Well, I was speaking with a group at University of Pennsylvania Nursing, EGOS. They have a wonderful LGBTQ cultural competency organization trying to do research about this very topic. These orders only pertain to federal organizations, federal infrastructure, and businesses that do business with the federal government. However... There's often policy mimicry in the private sector when something so drastically changes in the public sector. And you see first federal contractors, to no surprise, Northrop Grumman and other big ones dropped their diversity equity inclusion initiatives, many of which included LGBTQ individuals and organizations and initiatives. There are other organizations like Capital One and CBS, for example, that are doubling down in response to this for their things like supplier diversity and their DEI programs, because they want to represent the communities they serve. So that the issues that are coming out minute by minute, it seems, I think that a lot of it is shock and awe. The lasting policy implications are yet to be seen. Is there a reason to be concerned? Absolutely. I don't think freaking out helps anyone, but Once we regain our sense of calm, reach out to those who are either in the industry or have a pulse on what's going on so that we can be better informed and make data-driven decisions about whatever changes are coming through.

Dr. Jason Arora:

Right. And so there are these legislative issues that individuals or even groups of professionals may not have as much control over. What stopped the medical system, do you think, from making broader, long-lasting changes? Because I know we have these overarching issues that swing one way than the other. What stopped the profession and the medical community from moving forward? I think

Justin Ayars:

it comes, again, lack of data. Back in December of 2022, I was called by several Blue Cross Blue Shield organizations in different states to help them create RFPs so that they could more actively engage their LGBTQ members and also attract more members. Unfortunately, after going through four months of working with one of them, they assigned the RFP to another organization that basically rainbow-washed their brand, checking a box, not doing the hard work of making institutional cultural changes. At first, I was upset. because I put a lot of work into it, and I thought this organization was trying to do some really positive work for an underserved community. But really, they couldn't, because it's the nation's most undermeasured patient population. And again, it represents every other demographic there is. And without data, specifically SOGI data, sexual orientation and gender identity, and the intersectionality of that with things like social determinants of health, without that data, it's akin to taking 50 years of medical research. That is intentionally or unintentionally excluded certain groups of individuals, usually minority groups. So they keep repurposing this data using AI models, but it keeps spitting out data that has no bearing on the health disparities that they're trying to fix. It's the exact same situation for LGBTQ patients. Particularly payers, they are looking to build better patient models through data analytics that encapsulate sexual orientation, gender identity, social determinants of health, so they can build more enhanced disease trajectories, better financial risk scoring, and ways in which they can engage patients that will increase patient engagement with health systems, rebuild a sense of trust, which is the ultimate currency in the healthcare marketplace so that patients can perceive healthcare as something not just achievable and attainable and accessible, but trusted so that they go seek care. And that in the long run will help them live longer, healthier lives and save all of us money.

Dr. Jason Arora:

Let's talk about solutions, because that's ultimately what we want folks to take away once they've understood the problem and they understand that they may not be alone. And maybe we start with a quality MD, but also it'd be good to understand some of the other solutions out there that are helping change things. So can you tell us a bit about that?

Justin Ayars:

Certainly. First, I'd like to tip my hat to our two colleagues out there, Plume Health and Folks Health. They've been around a little bit longer than we have. They've raised more money than we have. And they're doing absolutely fabulous work for transgender individuals across the country. Unfortunately, recent political and policy actions are specifically targeting transgender individuals. I would highly encourage our trans friends to look up these organizations, VolksHealth, folx and plume health to see if they might be able to provide some solutions that their specific health care needs be they mental physical or otherwise the transgender community makes up only about four percent of the broader lgbtq space so we certainly do serve transgender individuals but we tell them If you need more than what we can offer, we would absolutely encourage you to visit our colleagues over at Fulks and Plume because that's what they do best. And it's kind of like, I would never start a black maternal health company because I've never lived that problem or walked in those shoes and I should be laughed out of every room for doing so. But our team has lived the problem we're solving. as gay, lesbian, bisexual individuals, queer individuals, we were able to deliver culturally competent care. We take training programs from some of the best in the country. And because of the burnout I mentioned earlier that providers are having, we've broken it down into digestible increments, the training, so that the providers on our national telehealth network in all 50 states, they can't be found or discovered or matched with doctors, patients can't be, unless those doctors have gone through our training program. And that's a way that we ensure that the patient receives the best culturally competent care possible. Some identify as LGBTQ, the providers, most don't just because of math, but it's good to know that they have that training. And what's wonderful is that the providers themselves are absolutely thrilled to one, have the training because they feel more confident when someone who identifies as LGBTQ comes to their practice. And at the same time, by working with us, we're driving that invisible patient population to their digital doorstep, and they have the tools and resources ready to serve that patient population. So it's a really wonderful thing, and I think that the three main companies that serve LGBTQ healthcare from a telehealth perspective are QualityMD, and then again, our friends at Fulx and Plume. The other larger entities out there, the Teladoc, BetterHelp, CVS, Amazon, They do great things for sort of general primary care. They all require some form of insurance and they're all typically more expensive. But we know that 60% of our community are uninsured or underinsured. And that's why we don't take insurance, yet we still are able to deliver telehealth and offer prescription medications that is significantly cheaper than managed care plans.

Dr. Jason Arora:

Any other solutions that people should know about if they're looking for more help with this issue or even just more information?

Justin Ayars:

Certainly. There are plenty of organizations out there, nonprofit organizations, advocacy organizations. The Trevor Project is wonderful for LGBTQ suicide, particularly for youth. And there are others out there that deal with youth. We don't. We only serve those over 18, primarily because as a startup, there's a lot of legal and regulatory issues when dealing with minors that we frankly just don't have the capacity to deal with and others do very well. So because our community is It's very interconnected. We want to have that rising tide lifting all boats. And so even on our website, we list a bunch of organizations and even competitors like folks in Plumac, and I see them as colleagues, because we're in the business of trying to elevate the health and wellness of our LGBTQ community and our straight allies and excluding anybody. would not make sense because that's not how we do business. There are lots of resources out there and we encourage people to check them out through our website and even just a basic Google search. There's tons of information.

Dr. Jason Arora:

And with an increasing number of solutions, how have things improved in recent years in terms of access to care?

Justin Ayars:

I think they've improved in that there's more awareness. What's challenging from a patient perspective is, so a doctor they know has gone through training, but then It's up to the patient to find that doctor or the doctor's gone through training and it's up to the doctor to then find the patient. So many of the training organizations that do very good work stop there because that's their forte. They don't take the next step to make the connection like we do. It's a step in the right direction, but it doesn't complete the patient journey process. Some of them also stop when it comes to in dealing with insurance companies. as unfortunately the recent murder of United Health Group's CEO, that brought a lot of the insurance inequities across the board in America top of mind. And it's unfortunate it took that to happen, but the fact that we're talking about it is a good thing. And very few people read what their massive insurance plan covers and what it doesn't. And employers typically go for the cheapest insurance plan possible that rolls through town in any given year. And it changes often. And just because you're covered doesn't mean you're covered. You might get to the doctor, hand them your card, think you're fine, and get hit with a surprise medical bill after paying a high premium, meeting a high deductible, paying a high copay, and then you're still denied your claim. You have to fight for it. So things have improved, but in terms of the bigger healthcare system, there is a lot of change that needs to happen. So while awareness is up, the ability to deliver the culturally competent care is still stagnant.

Dr. Jason Arora:

So what can allies do to better advocate for LGBTQ health equity access? What would you ask for more of?

Justin Ayars:

Be aware of the challenges that are out there for our community. And you might not have walked in our journey, but if you have family or friends or just care about human beings, then it's important to stay informed. But also, It's important not to fall into the, oh, I read the headline, therefore I know what's going on, now I'm going to go out and do this. Dig deeper, think critically, and be a source of real information for especially if you're a community leader or a member of your family or friend group that people go to for information and advice, take that responsibility seriously and have the right information rather than just the bullet points that the too long, didn't read, isn't good enough. So that's step one. Step two is drive your friends and family and others to resources like EqualityMD, Folks, Plume, Trevor Project, and others. And let people know that you're there for them and can help them. It's sometimes those small acts of kindness that can mean the world to people, particularly in the realm of mental health. And it's important to note that a lot of the bigger companies getting into the healthcare game, like Amazon with their recent acquisition of One Medical a couple years ago, they don't treat mental health conditions. That's not what One Medical does. They do primary care. 80% of our community says mental health is their primary healthcare concern. And that, of course, affects all kinds of other elements, physiologically speaking. But just back to your question, what can allies do? Be aware, dig beyond the headlines, and serve as a source of inspiration, hope, and guidance when you can for those you know or for those in need, be that in person or even online.

Dr. Jason Arora:

The things we see and we learn from for the LGBTQ community, whilst not all of them are present across other countries, underserved populations or minority groups or folks who are negatively impacted by social determinants of health. But there is some overlap, isn't there? And so other community leaders of underserved populations, I think, should also pay attention, maybe reach out, maybe communicate, because I think these different underserved groups can help each other with resources, with learnings and other things, too. I think we've talked about this before, haven't we?

Justin Ayars:

Well, absolutely. And I think The entrepreneurial ecosystem, which is very much alive and well in America, has, since the pandemic, produced some wonderful innovative companies, say, for the Hispanic community. There are two that pop into my head, Zocalo Health and Mi Salud Health. They do wonderful things for a community that's underserved and growing. For the African-American community, there's several options. One is HUGE, and one is HUGE for her, for maternal health care. doing absolutely wonderful things. But there's, as you mentioned, there's certainly overlap with LGBTQ in every other underserved community. The Veterans Affairs Administration reached out to me a couple of years ago asking if we could help. And that's a huge responsibility. So we didn't take that on then. But there are opportunities for all of us to come together and see what we can do to help each other. And it's not necessarily about making as much money as possible, but providing resources for the community because you can do really well by doing really good things for people in need.

Dr. Jason Arora:

What are the one or two takeaways you would give to folks from the LGBTQ community who are listening to this and need some help? First,

Justin Ayars:

breathe. Just pause and breathe. It might seem like a shitstorm right now, and it's a very unusual time in which we live, but a lot of Politicians throw all the spaghetti at the wall and just see what sticks and only a few things do. Now, granted, it's going to be harder for many in our community, but just take time to breathe, learn the facts, and don't panic and realize that even before anything changed starting this month, there were solutions out there that you might not have known about. So take time to just look at what's out there, do your homework, and try to rationally go through what options you have that you can afford, that you can trust, and that you feel comfortable with. And when in doubt, reach out to those organizations, those nonprofits, those startup organizations, and see how they might be able to help you. You'd be surprised how many people reach out. And I'm glad to answer questions from individual patients or patients-to-be. about what we do and why we do it, because it's that important, perhaps now more so than ever. So one, breathe and do your homework. And two, don't forget to rely on each other. You're not alone in this. And seek counsel from those that you trust, and you'll realize that this too shall pass.

Dr. Jason Arora:

Thank you so much, Justin. We're very grateful to have had you on the show. You're so knowledgeable about this, and I know you've been working very hard for many years to try to help solve this problem. So count me as a continued supporter, and we'll continue to spread the word as well. So thank you so much.

Justin Ayars:

Thank you, Jason. It's been a pleasure.

Unknown:

Thank you.