Name:
Stephen L. Boswell, MD, FACP
Current Occupation:
President and CEO of Fenway Health
Residency:
Mount Auburn Hospital, Cambridge, Massachusetts
Medical School:
University of Washington, Seattle, Washington
Dr. Stephen Boswell began working at the Massachusetts General Hospital鈥檚 HIV clinic during the height of the AIDS epidemic in the 1980s. Now, he鈥檚 continuing to advance the quality of LGBTQ health care as the President and CEO of Fenway Health in Boston, Massachusetts.
鈥淚 became fascinated by medicine:鈥
Dr. Boswell grew up in Spokane, Washington, a medium-sized town in the eastern part of the state. As a young man, he earned the rank of Eagle Scout and spent his free time exploring the region鈥檚 natural beauty through hiking, camping, and skiing.
Dr. Boswell participated in band in school and developed a passion for math and science, eventually earning bachelor鈥檚 degrees in chemistry and chemical engineering from the University of Washington. After graduation, he was exposed to the daily routines of physicians through his work as an engineer.
鈥淢y particular area of expertise was in mass transfer, and I worked for a company that manufactured hemodialysis equipment. I used to design blood pumps and dialysis membranes, and we started taking those devices into clinical settings. I became fascinated by medicine more generally in the different kinds of challenges that medicine sees, including the technical issues, but the interpersonal and policy issues were fascinating to me,鈥 Dr. Boswell said.
Eventually, his interest in these subjects inspired him to study internal medicine when he returned to the University of Washington to pursue a medical degree.
鈥淎fter the first two years of medical school, I just became increasingly interested in adult medicine. I went to a school that certainly offered family practice, but I was also doing a Master of Public Health and became increasingly interested in public policy issues relating to health care delivery,鈥 he said.
As he learned more about health policy and management, Dr. Boswell made the decision to become a member of ACP. In 1993, he became a Fellow of the College.
鈥淚t鈥檚 an amazing group of people and clearly the professional organization with which I am most engaged at this point. It鈥檚 been a huge resource for maintaining CMEs or staying up to date on issues鈥攂oth issues technical and clinical, but also larger policy issues as the ACP has become increasingly engaged in many of those, and represents internists at the federal level and state level quite well,鈥 he said.
鈥淧art of our responsibility:鈥
When Dr. Boswell was chosen to be a Kaiser Scholar at MIT in the 1980s, he began working part-time in the HIV clinic at the Massachusetts General Hospital and eventually became the clinical director of the hospital鈥檚 HIV program. He continued working there until 1994, when he became the medical director at the Fenway Community Health Center in Boston.
鈥淚t鈥檚 an important community health center that serves a large number of LGBTQ people, so early on, even before I got here, Fenway was well known for providing very culturally-competent care to young people and to LGBTQ people. As a consequence, some of the first cases of HIV and AIDS were seen here because such a disproportionate number of people who were receiving care were gay men,鈥 he said.
As he assumed higher leadership roles at Fenway, Dr. Boswell enjoyed the opportunities to work in many different areas of health care and medicine. In 1997, he was appointed President and CEO of the organization.
鈥淚鈥檝e had opportunities to work with presidents and to be in meetings in the oval office when I was on President Clinton鈥檚 HIV and AIDS Advisory Council, so there鈥檚 been a lot of policy work that I have enjoyed. I love the clinical work that I do, and I have a couple of NIH grants. I鈥檓 an epidemiologist by training so I get to do research and participate in that as well. I get to run a big organization, which is always fun, especially when there鈥檚 so much change happening鈥攊t makes so many things possible in terms of improving care delivery. It鈥檚 a very exciting time to be in my position.鈥
Dr. Boswell believes that the growing awareness of LGBTQ issues in the United States helps to advance general improvements in LGBTQ care across the country, and by developing research in a clinical environment, health centers like Fenway are an important resource for the greater medical community.
鈥淲hat we鈥檝e been moving towards is trying to encourage everyone to understand who they鈥檙e caring for, so we need to also track sexual orientation and gender identity, because it鈥檚 by tracking and studying those numbers that we come to better understand how to improve our care for those communities. We鈥檝e been advocating for that a long time and we鈥檙e one of the centers that conducts a large amount of research related to the care of those communities.鈥
Due to the high volume of LGBTQ patients at Fenway, the center has become a destination for physicians who seek to refine their skills in caring for the LGBTQ community.
鈥淚n order for people to become much better at caring for people who are LGBTQ, they need to be able to know how to ask questions, to understand the culture that people are coming from, and then to also understand the technical issues in caring for LGBTQ people. We have limitations in regards to how much of training we can do, but we do see it as part of our responsibility to try to help those people who seek out experiences in learning to care for the LGBTQ community.鈥
鈥淲e鈥檝e made a lot of progress:鈥
Like any other population, the LGBT community has its own set of characteristics that require health care to be delivered in ways that are sensitive to its specific needs.
鈥淭here are technical issues around caring for the LGBTQ community that are clearly important for clinicians to understand鈥攕ome of those relate to preventing HIV transmission in gay men, how to treat STDs appropriately, and having all of the tools at hand that you鈥檇 need to actually treat those STDs efficiently and correctly,鈥 Dr. Boswell said.
Organizations like Fenway have also worked to advance the quality of health care available to the transgender community. Recently, Fenway worked with the Human Rights Campaign and the Center for American Progress to create a provision in the 2017 Meaningful Use Criteria ensuring that certified electronic medical records in the United States be able to record sexual orientation and gender-identity.
鈥淭here鈥檚 a great deal to know about how to provide that care appropriately, and not all of these things are technical with regard to the actual clinical management of the patients, but the environment that you create that鈥檚 respectful of the transgender-community鈥攗sing correct pronouns, preferred names, having flexibility in your electronic medical record to accurately describe the patient that you鈥檙e caring for are all things that we鈥檝e been working on for the last ten or twenty years, and we鈥檝e seen significant progress in the last few years,鈥 he said.
Treatment of patients with HIV and AIDS has drastically improved since Dr. Boswell began working part-time at the Massachusetts General Hospital鈥檚 HIV clinic in the early 1980s.
鈥淣ow, it鈥檚 possible in many circumstances to give people one pill a day to manage their HIV infection. We鈥檙e looking at additional approaches to this that could potentially, one day, be quite useful鈥攚e鈥檙e looking at long acting agents that are injectable. It might be possible someday to give someone an injection every few months that contains a regimen designed to maintain control of an infection, and patients might not even have to take daily pills. I think the overall movement is towards continuously trying to improve the ease of controlling the infection,鈥 he said.
As many of these advancements were happening, Fenway collaborated with ACP on 鈥,鈥 a comprehensive textbook designed to address gaps in knowledge surrounding LGBTQ issues for health care professionals across the country.
鈥淎 number of years ago, we realized that there were significant enhancements to the health care of the LGBT community that just weren鈥檛 well understood by the larger medical community, so we decided to take it upon ourselves with the ACP to produce the first medical textbook for the care of LGBTQ people about fifteen years ago. We鈥檙e now in the second edition of the book, and we keep adding content and refining the text overall,鈥 he said.
鈥淚 would consider it home:鈥
When he鈥檚 not practicing medicine, Dr. Boswell prefers to remain active through outdoor recreation and traveling.
鈥淚 still love to ski, I love to travel. My husband and I travel around the world whenever we can鈥攖hose are really the major things that we enjoy,鈥 he said.
Dr. Boswell and his husband seek to gain new perspectives by immersing themselves in different cultural experiences when they travel.
鈥淎lmost every new place is always fun for us鈥攚e like to see things that we鈥檝e never seen before. Of the places that we鈥檝e been, Europe is always fun and interesting, Africa is a very special place, South America is also fascinating and we like differences in culture. There are still a fair number of places we haven鈥檛 been, we鈥檙e still thinking about some of those trips and where we want to go,鈥 he said.
After spending his childhood on the West Coast and traveling all over the world, Dr. Boswell loves returning to the city where he鈥檚 worked for over thirty years and the place that he now considers home.
鈥淚鈥檝e lived here now longer than I鈥檝e lived anywhere else in my life, so Boston really very much is home. It鈥檚 where my entire professional career鈥攚ith the exception of some of my early engineering work in the Bay area in California鈥攙irtually all the rest of my professional career has been here,鈥 he said.
鈥淚t鈥檚 a wonderful academic city, a beautiful old city with a great history, wonderful people, fascinating people, very dynamic city鈥攁 lot of exciting things happening here, some of the greatest academic institutions in the world are here. It鈥檚 a vibrant, great city, and I would consider it home.鈥