Gender and sexual minorities (GSM) experience considerably worse health outcomes than heterosexual and cisgender people, yet no comprehensive understanding of GSM health exists due to a dearth of research. GSM leaders in Dallas expressed need for a community needs assessment of GSM health. In response to this call, the Center for Psychosocial Health Research conducted a needs assessment of gender and sexual minority health in Dallas (35 interviews, 6 focus groups). Competency was one area highlighted and shared across existing research. Thus, the current study explored how competency impacts gender and sexual minorities' experience of health care in Dallas. We utilized a consensual qualitative research approach to analyze competency-related contents. The meaning and implications of emerging core ideas were explored. These findings were also used to develop a survey instrument.