Alumna Heather Kim: Providing Affirming Care to LGBTQ+ Youth

By Susan Gallagher

Heather Kim, MD, a 2019 graduate of Duke’s psychiatry residency, went into medicine with an eye toward working with children. She majored in neurobiology at McGill University in Montreal—across the country from her home town of Vancouver—and initially set her sights on neurology or endocrinology.

That plan changed as she began her child psychiatry rotation in her third year of medical school at the Medical College of Wisconsin.

“My first patient had severe mania; they had delusional thoughts and wouldn’t sleep. They started on lithium and then just went back to high school at the end of the week. I thought, ‘This is kind of like magic,’” Kim recalled. “It was not very representative, but it was a pivotal moment where I figured out that I could do this every day and I would be pretty happy.”
Kim also discovered that she relished the opportunity to hear people’s stories, learning about what their lives look like and what gets in the way of them leading a meaningful life. “There are lots of specialties where you can do that, like family medicine, but psychiatry felt like the only space where you have more than 15 minutes to actually talk about these things,” she noted.

Forging Her Own Path in Residency

Having rotated through the adolescent medicine clinic and endocrinology clinic in medical school, Kim knew she wanted to extend her training in gender-affirming care in residency. The fact that Duke’s residency program didn’t offer a rotation in this area didn’t deter her: she partnered with associate professor Marla Wald, MD, to create a gender care psychiatry elective.

Kim and Wald cultivated a collaborative relationship with Duke’s multidisciplinary pediatric endocrinology team, and along with several psychologists, began providing gender-affirming behavioral health care to patients primarily referred from the pediatric endocrinology clinic. 

As her residency drew to a close, Kim worked with Wald to develop a succession plan for the elective. More than five years later, the rotation is still offered to residents, and the department’s capacity to provide gender-affirming behavioral health care has expanded.

Launching a Career in Trans Health

Kim followed up her residency with a child psychiatry fellowship at Yale University’s Child Study Center. She’s now a psychiatrist at Massachusetts General Hospital, where she provides gender-affirming care to trans, non-binary, and gender-questioning children, adolescents, young adults, and their families. 

“I really enjoy [this work] because it combines everything I’m interested in that’s either within or peripheral to medicine,” she said, “like thinking about the physiological impacts of hormones on development and how they impact your mental health and exploring questions about where social constructs abut with medicine. What does it mean to be a girl or a boy, how do we come to know these things, and what happens when our self-concept is different from how others perceive us?”

Kim noted that while many people think of gender-affirming care as providing hormones, performing surgery, or focusing on pronouns and terminology, she seeks to promote a more expansive definition of what LGBTQ+ inclusivity means in a healthcare context. “Gender-affirming care is just being able to respect people for who they are and respecting their autonomy and their agency over their care. And that’s not something that’s specific to trans people—that cuts across everybody,” she said.

Looking forward to the next few years, Kim hopes to conduct qualitative research to advance our understanding of the experiences of LGBTQ+ patients. She wants to engage patients who are receiving gender-affirming care in studies that explore topics such as what gender transition looks and feels like at different points in the process, or what patients experience during the early stages after a gender transition surgery.

“I want to produce more scholarly work on things that patients don’t feel are fully reflected in the academic literature yet,” Kim said. “I’d like to ask patients in the community questions like, ‘What were your experiences going through the transition process? How was your mental health support through the process? What should we be doing differently to help people get better outcomes?’”

Remembering Her Time at Duke

In addition to the academic and clinical rigor of Duke’s psychiatry residency, the program’s flexibility with electives was a key reason she was drawn to Duke to continue her training. 

“I came in knowing I wanted to do trans health, and I was looking for a program where, even if there wasn’t a children’s clinic where I could plug myself into, there would be support for people doing their own thing,” she said. “Many other programs are pretty prescriptive with electives, and others are a little bit too unstructured; I wanted to strike somewhere in the middle.”

Another aspect of the program Kim appreciated is the exposure to a diverse patient population, which helped her understand the impact of social determinants of health. For example, some of her patients didn’t have cell phones or internet connectivity, which limited her ability to reach them. Many of them were also experiencing generational poverty and dealing with systemic racism and harbored “very well-deserved institutional mistrust from decades of mistreatment or lack of treatment.” 

She also looks back fondly on the close friendships she developed with her co-residents. In fact, she still keeps in touch with them through a group text chat, meet-ups at professional conferences, and occasional visits to North Carolina.

Dishing Advice to Trainees

Heather Kim holding her cat
Heather Kim, MD, with her cat.

Now a few years into her post-training career, Kim shared a nugget of advice for trainees and early-career physicians: “Being a healer is a calling, but being a doctor is a job. There’s something deeply profound and satisfying and enriching about being able to help people live better lives,” but the challenges physicians face can lead to frustrations that are sometimes misdirected at colleagues or patients, she said. 

Rather than taking their frustrations out on those around them, she encourages trainees and early-career physicians to consider the structures and systems behind the difficult issues and partner with colleagues to try to improve work conditions.

Despite the inevitable challenges, Kim is enjoying life as a psychiatrist in a Boston hospital. She’s pursuing her passion, providing much-needed mental health support for trans youth, and maintaining a healthy work-life balance. Outside her busy clinic schedule, she finds plenty of time to go to concerts, create art—she makes linocut prints using linoleum blocks—and hang out with her cat and lab-pit bull dog.