Late nights. Early mornings. Hundreds of thousands of dollars in tuition. A decade of your life (sometimes more).
There is no shortcut to becoming a physician. And if that's not daunting enough, consider the additional hurdles that disabled doctors must face --- both in training and in practice.
Sadly, history has not been kind to aspiring doctors with disabilities.
Lisa Iezzoni was told as a medical school student in the early 1980s that she had “no right” to go into medicine because she couldn’t be available 24/7 due to her disability. Today, she is a professor of medicine at Harvard who uses a wheelchair due to multiple sclerosis.
Fortunately, times are changing.
Leading up to Disability Insurance Awareness Month in May, we are highlighting the best professional resources, legal and technological advancements, and other accomodations that are available to physicians with disabilities.
But first, here's a little more background on the subject matter.
The presence of disability in the medical field
According to a March 2018 report by the Association of American Medical Colleges (AAMC) titled “Accessibility, Inclusion, and Action in Medical Education,” the prevalence of students with physical disabilities graduating from U.S. medical schools has historically ranged between 0.15 percent and 0.5 percent.
The same report cited a more recent study that found about 2.7 percent of medical students self-reported a disability to their institutions. This remains low compared with the percentage of people with disabilities in overall undergraduate (11.1 percent) and graduate (7.6 percent) education programs.
Of medical students with disabilities:
- 33.7 percent had ADHD.
- 21.5 percent had a learning disability.
- 20.0 percent had a psychological disability.
- 13.1 percent had a chronic health disability.
- 3.0 percent were visually impaired.
- 2.5 percent had difficulties with mobility.
- 2.2 percent were deaf or hard of hearing.
- 3.9 percent had other functional impairments.
And while more than 20 percent of Americans have a disability, only 2 percent of practicing physicians do. Most physicians with disabilities become afflicted after completing their training.
The acceptance of and support for medical students and physicians with disabilities continues to grow. In fact, there is an ongoing effort to increase the number of physicians with disabilities as a means of improving care for patients with disabilities.
“A primary care doctor who shares my exact diagnosis will inarguably always have a better understanding of my life experience than any doctor without disabilities ever could,” wrote Ace Ratcliff.
A well-known disability advocate, Ratcliff herself lives with hypermobile Ehlers-Danlos syndrome.
“Disability is not a tragedy, and its inclusion in the medical workforce is an indisputable necessity for safe, ethical and diverse 21st-century medicine.”
Her work, among many others, has certainly not gone unnoticed.
How the law is becoming more accomodating to disabled doctors
The challenge for aspiring doctors living with disabilities often begins in medical school.
For example, students with disabilities have reported issues such as:
- Schools not having automatic doors.
- Schools not making reasonable accommodations for taking tests.
The 1990 Americans with Disabilities Act was passed as a remedy for this and other similar issues. The law dictates that people with disabilities can not be “excluded, denied services, segregated or otherwise treated differently,” in higher education or employment.
However, medical education and employment saw little change in the immediate years the law took place. This was primarily due to a clause that provided exemptions in the event that accommodations for disability either “fundamentally altered” education or created “an undue burden.”
“Most notably,” writes Iezzoni in a paper for the AMA Journal of Ethics, “accommodations are not explicitly supported in many schools’ technical standards.”
She adds that medical school technical standards have changed little in the last 40 years. This has “effectively prevented qualified students with disability from becoming physicians.”
Furthermore, physicians who become disabled later in life are often reluctant to report their conditions out of concern for how state licensure boards will react.
However, this fear has diminished in recent years as law has caught up with the reality that physicians with disabilities are valuable in the field of medicine.
For example, in 2013, the 8th U.S. Circuit Court of Appeals ordered Creighton University to fund accommodations for a deaf medical student. A year later, the Iowa Supreme Court ruled that Palmer College of Chiropractic had to make similar accommodations for a blind student to read X-rays.
The problem with the perception of disabled doctors
Another significant barrier for physicians with disabilities is perception. There has long been a belief that, as "life savers", doctors must be perfect --- even superhuman. They must be able to perform at the highest physical and mental capacity at any given time, day or night.
However, there is now a growing sentiment that physicians with disabilities can be more empathetic to the needs of patients with disabilities.
Iezzoni notes two key benefits of having greater representation in the profession by physicians with disabilities.
First, physicians who need accommodations are much more likely to offer the same accommodations to their disabled patients. As an example, only 8 percent of primary care facilities in one study offer a height-adjustable examination table.
The second benefit is that disabled physicians are less likely to:
- Make erroneous assumptions about people with disabilities.
- Have stigmatized attitudes toward people with disabilities.
Needless to say, both could result in serious care disparities.
As stated in the AAMC report:
“When health care providers have life experience that more closely matches the experiences of their patients, patients tend to be more satisfied with their care and to adhere to medical advice... Medical students who identify as having a disability during training carry a disability identity that informs their clinical practice and leads to more culturally competent care.”
Yet, it's important to note that, “access to the profession for people with disabilities has rarely been included in the decades-long focus on diversity in medicine.”
How the profession is becoming more accommodating to physicians with disabilities
Medical professionals, residents and students should know they have options within the profession. Even if their disability prevents them from pursuing certain types of practice.
For example, the Society of Pharmacists with Disabilities advises those who have a physical disability that they can (in most cases) work in retail pharmacy. Although any lack of mobility can make a hospital environment difficult, working in a corporate pharmaceutical company is another option. Other opportunities include:
- Professional societies.
- Medical writing.
- Medical affairs.
Similarly, some disabled nurses may find it easier to work a non-clinical job, such as:
- Quality improvement.
- Patient safety.
- Clinical support.
- Chart reviews.
“No one expects a primary care doctor to perform the work of a cardiac surgeon,” wrote Ratcliff. “Med students with disabilities should be and are capable of specializing in areas that best suit their needs and talents. So long as society is willing to accept that the potential for doctors with disabilities is limited only by the assumption of automatic inability, students with disabilities have every right to attend medical school and flourish as doctors."
If you leave medicine temporarily due to a disability, here are a few things to consider upon your return:
- You may need to renew your medical license. The Federation of State Medical Boards provides licensing requirements for all states.
- If you have left medicine due to disability, health reasons, family responsibilities or to pursue other opportunities, you might want to return to practice after your situation changes.
- You may want to (or be required to) retrain or work with a preceptor to regain your skills. You can find state requirements for physician re-entry at the American Medical Association or your state medical board.
There are a number of well established re-entry and re-training programs for physicians who want to return to practice, including:
- Cedars-Sinai Reentry program
- Physician Retraining and Reentry
- Oregon Medical Board Reentry to Practice
- Drexel University College of Medicine - Physician Refresher/Re-entry Program
- University of Florida - Florida Cares - Physician Remediation
- Texas A & M Mini Residency Program
As you may expect, technology has also disrupted the status quo to better accomodate those practicing with disabilities. Here are a few examples:
- Physicians and residents with partial hearing loss can use amplified stethoscopes.
- Those who have limited mobility are transitioning to a new device for standard patient examinations. It has a long, flexible wire and camera at its tip and a live video feed that plays diagnostic information on the physician’s cell phone.
- Physicians with vision impairment can use devices that represent flat images with vibrating pins to read histories and electrocardiograms.
- On surgery and anesthesiology rotations, deaf students can follow along using a screen of transcribed dialogue.
Organizations that support physicians and medical students with disabilities include:
- Coalition for Disability Access in Health Science and Medical Education. This collaboration among peer institutions aims to improve the student experience with disability accommodations in graduate health science and medical education programs.
- Society of Healthcare Professionals with Disabilities. This organization provides resources and support for disabled physicians, physician assistants, and students. Its mission is to foster a supportive community and to provide resources and tools for disabled health care professionals and students. The society includes subgroups for physicians, nurses and pharmacists.
- Association of Medical Professionals with Hearing Loss. AMPHL provides information, promotes advocacy and mentorship, and creates a network for those with hearing loss who are interested in or are working in health care.
- National Organization of Nurses With Disabilities. NOND represents nurses, students and other health care professionals who have disabilities and chronic health conditions. It works to promote equity for people with disabilities in the nursing profession through education and advocacy.
- ExceptionalNurse.com. This resource network is committed to inclusion of more people with disabilities in the nursing profession.
- American Dental Association’s Center for Professional Success. The ADA offers support for dentists with disabilities.
As an independent disability insurance broker, our team is constantly focused on the ins and outs of your coverage. Making sure you have the best available plan if tragedy strikes.
Here, we switched gears to highlight the ongoing advancements in how society perceives and accommodates physicians with disabilities. The reality for those who practice medicine once their disablity benefits kick in.
From professional, legal and technological advancemnents to the increasingly positive perception of physicians with disabilities, this long-overlooked issue is finally trending in the right direciton.