An estimated seven out of ten LGBT+ people have experienced discrimination from a medical provider, according to John Hopkins Medicine.

Experiences for Trans and gender-nonconforming individuals can often be worse, one in five of whom experience being turned away from care because of their gender identity, the National LGBTQ+ Task Force states.

Dr. Pat Vigil, who operates the newly opened Vigil Family Medicine in Tacoma, understands the barriers the LGBTQ+ population faces regarding medical care, both as a primary care practitioner and as an openly Transgender woman.

"I saw what I would call the good, the bad, and the ugly of gender-affirming care," Dr. Vigil said in conversation with the SGN. "Over the years, I saw everything from the older standards when I was working as a medical student all the way to much more modern, informed-consent models. So I've had the chance both professionally and personally to experience a little piece of that."

Dr. Vigil, born and raised in Albuquerque, NM, received her MD and PhD in immunology and microbiology from the University of Michigan's Medical School in Ann Arbor. While working in a lab studying urinary tract infections, she became fascinated with the clinical side of her studies. As she began her clinical rotations, she fell in love with primary care and ultimately focused on that as she completed her residency at the Central Washington Family Medicine Residency Program in Yakima.

"I thought that this was really where my heart was. It was about people, about connections, and about being able to apply that knowledge in a way that actually impacted people's lives and made them feel better. It made them healthier," Dr. Vigil said.

Dissatisfied with the treatment she and other LGBTQ+ people face in medical care, Dr. Vigil saw an opportunity when opening her own practice. From the beginning, she built inclusivity into her practice's foundation.

"When I left my last job after a whole series of these sorts of episodes, I thought, 'I have an opportunity to try to do something different,' and that's what led me to opening my own practice," she said. "I tried to change it from the inside, and that obviously didn't work. The only way really to change this was to be my own boss, to have my own practice. That eventually is what led me down the route to where I am now."

Dr. Vigil has found she's not alone, often reading stories of bad experiences shared in patient intake inquiries. In Tacoma, a city where the option for affirmative care might be more limited than Seattle, patients could also find an LGBTQ+-friendly doctor but still experience exclusionary behavior from other workers they might interact with, starting with the receptionist.

"There's a handful of options, but most of them come with a caveat of getting past the front office staff, or the nurse, or somebody else. If you get to this person, it'll be fine. But it's always getting to that person," Dr. Vigil said.

As part of addressing this, Dr. Vigil is currently the only person working in her own practice, though she said she may hire someone to help with administrative work in the future. "I believe very strongly that a good primary care relationship is between you and your doctor and as few intermediaries as possible."

In addition to focusing on LGBTQ+ inclusion, Dr. Vigil has also implemented ADA accessibility and healthcare inclusion. For the former, she's added an ADA-compliant gender-neutral bathroom in her practice's suite and accommodating exam tables and equipment. For the latter, Dr. Vigil opts for her practice to not accept insurance, operating on a direct primary care model instead.

Instead of requiring insurance and paying a copay after each visit, patients can pay a flat-rate fee based on their age group. Patients under 18 pay $35 per month, ages 18 through 64 pay $75 per month, and patients aged 65 and older pay $100 per month.

"It's kind of like a gym membership," Dr. Vigil said. The option allows those without insurance to seek primary care. Should someone need to use insurance for lab tests or medications, Dr. Vigil does offer that, but she also has contracted with a lab with lower pricing options to eliminate that need as much as possible.

It eliminates a lot of the gatekeeping," she said.

Patients interested in seeking care from Dr. Vigil can find an intake and other relevant information on her website (vigilmd.com). Visitors to her website will find paintings of snow leopards there, artwork that Dr. Vigil made herself and seeks to incorporate into her practice.

"I enjoy ink painting and interacting with artistically inclined people in my practice, as it keeps me grounded and in touch with a side of people that is often ignored in medicine," Dr. Vigil told the SGN. "The ability of art of all forms to help heal is something I try to honor and encourage in my practice."