The Impact of Restrictive Legislation on Gender-Affirming Care Providers in the United States: A National Survey

Abstract Introduction The wave of legislative restrictions on gender-affirming care for youth in the United States has placed considerable strain on healthcare providers, intensifying emotional labor and increasing risks of occupational distress. This study explored professional quality of life among gender-affirming care providers, with a focus on differences based on state-level legislative restrictions and clinician identity. Methods This cross-sectional survey study collected data from a national sample of healthcare providers ( N = 142) April–August 2024 using validated measures, including the Professional Quality of Life Scale (ProQOL), the Kessler Psychological Distress Scale (K6), and the Brief Resilient Coping Scale (BRCS). Results Results indicated most providers reported mild levels of burnout and secondary traumatic stress, and those working in states with legislative restrictions experienced significantly higher levels of compassion satisfaction. Providers who self-identified as trans or gender-expansive (TGE) reported greater secondary traumatic stress and symptoms of distress compared to their cisgender peers. Conclusions The findings underscore the need for healthcare organizations to proactively support clinicians by offering targeted interventions and fostering inclusive environments that mitigate the broader sociopolitical pressures. Policy Implications Healthcare systems must implement structural supports that promote clinician well-being, particularly for TGE providers, in the face of hostile policy environments. At the policy level, there is a pressing need for legislation that safeguards access to gender-affirming care and protects the rights and safety of both patients and providers. Policymakers should consider the unintended workforce consequences of restrictive laws, including increased provider distress and potential threats to retention in already strained healthcare systems.