Perceptions of occupational physicians in supporting transgender and gender-diverse people (returning) at work - a focus group study: The uncharted territory of gender-diverse occupational healthcare

Objectives This study aimed to explore the role of occupational physicians (OPs) in supporting transgender and gender-diverse (TGD) workers during gender transition and return to work (RTW) following gender-affirming (medical) interventions. Design We conducted a qualitative study (ONZ-2023-0026) using focus groups. Setting This study involved OPs in Belgium. Participants Two semistructured focus group interviews were held with 19 OPs working in occupational health services in Belgium in May and November 2023. Purposeful sampling was used, which included OPs with at least 2 years of seniority and experience with TGD people or inclusive company culture. Participants were predominantly white and cisgender, with varying levels of seniority and sectoral coverage. Methods Qualitative data was thematically analysed using Braun and Clarke to find patterned meaning. Results The analysis created four themes: (1) 'What is the right professional attitude?: You never get a second chance to make a good first impression' discusses the aspects of professional attitude alongside ethical considerations; (2) 'Controlled open-mindedness' entails values and views of gender in light of medicine, the individual worker, organisations and society; (3) 'The balance game: "Fingerspitzengef & uuml;hl" (intuitive flair or instinct) without treating' and (4) 'Being gender-bombarded: the need for OP-tailored training and best practices'. These themes highlighted the limited knowledge and experience of OPs regarding gender-affirming care (GAC) and their need for additional training. Participants struggled to find the best gender-inclusive professional approach to support TGD workers as well as employers and require 'best practices'. Implementing overarching legislative frameworks can help OPs and companies create an inclusive work environment considering the differences in occupational sectors and company culture. RTW policies should focus on abilities without medicalisation and stigmatisation and involve multiple stakeholders. Conclusions Occupational medicine can be crucial in improving the health and well-being of TGD workers. However, with the ageing workforce, gender diversity poses new 'hidden' challenges for sick leave management, RTW and sensitive health surveillance. Multidisciplinary training with stakeholders and GAC professionals can enhance occupational practice and equip future OPs with the necessary competencies and confidence.