More on Doctoring With Disability

This post follows on our February post. As medical students enter a profession focused on caring for others, we are often encouraged to conform to its standards. The perspective shared in “Doctoring With a Double Disability” by Dr. Carolyn Stern highlights the unique challenges faced by medical students and professionals with disabilities or complex medical histories (1). Dr. Stern, a Deaf family physician, describes the obstacles she encountered before the pandemic, relying heavily on visual cues such as facial expressions and body language to communicate with patients. During the pandemic, when masks obscured these critical visual cues, her ability to communicate was severely impaired. This forced her to advocate for full-time interpreters and adapt her work environment to accommodate her needs.

Dr. Stern's experience is a microcosm of the broader challenges faced by medical students and medical professionals with disabilities. The medical field often prioritizes able-bodied norms, neglecting the diverse needs of its practitioners. This reflects a larger systemic issue where medical education and practice demand conformity to standards that may not accommodate everyone. In short, the standard is to match the work of our able-bodied peers without available support.

In medicine, caring for the caretaker is often overlooked. As discussed by Dr. Stern, reasonable accommodations are essential for health care providers with disabilities to practice effectively. However, for medical students and professionals, accessing these accommodations is often laborious and requires a high level of self-advocacy. The process can involve navigating bureaucratic hurdles, facing stigma, and overcoming a lack of awareness or understanding among colleagues and administrators. Despite these challenges, accommodations such as modified work environments, assistive technologies, and flexible scheduling can make a significant difference in the ability of health care professionals with disabilities to perform their duties effectively.

Although 1 in 4 individuals in the United States lives with a disability, this prevalence is not reflected among practicing physicians, of whom only about 3.1% report having a disability​ (2)​.  

This discrepancy in the prevalence of physicians with disabilities is significant and troubling for several reasons. First, it suggests that many physicians may fear disclosing their disability status or complex medical history due to potential stigma or discrimination. This fear can lead to underreporting and a lack of visibility for disabled professionals within the medical community, ultimately hindering efforts to create a more inclusive and supportive environment. Second, the lack of representation may indicate that we are not adequately supporting physicians who identify as having a disability, leading to higher attrition rates within the profession. As illustrated by Dr. Stern’s experience, physicians with disabilities face numerous barriers, including inaccessible work environments, insufficient accommodations, and a culture that prioritizes able-bodied norms. Without proper support, these physicians may find it difficult to sustain their careers, depriving the medical field of diverse perspectives and expertise.

The root of this underrepresentation may also be traced back to barriers during medical school training and the admissions process. A comprehensive analysis revealed that only 2.7% of medical students in MD-granting programs reported having a disability, a figure that increased to 4.6% after 3 years, showing a relative increase in disability disclosure among students​ (3)​. This underreporting is often due to the high-stakes nature of medical education and a pervasive “grind culture” that discourages disclosure and support-seeking behavior.

Moreover, medical schools' practices regarding disability disclosure and accommodations often do not align with the guidelines provided by the Liaison Committee on Medical Education and the Association of American Medical Colleges (3, 4)​. For instance, a 2020 survey found that 35% of medical school practices did not comply with recommended standards for disability support​ (4)​. The lack of standardized procedures and adequate support mechanisms makes it difficult for students with disabilities to access the necessary accommodations, leading to increased stress and attrition​.

Prospective medical students with disabilities also face numerous barriers. These include technical standards that require applicants to demonstrate certain cognitive, behavioral, and sensory abilities without assistance; inconsistent disability support systems; and a lack of specialized knowledge about accommodations among disability resource professionals ​(3, 4)​. For applicants, these barriers create an environment where students with disabilities must navigate additional challenges to gain admission and thrive in medical school​.

The Americans with Disabilities Act has significantly advanced inclusion in society. As medical students with disabilities and complex medical histories, we celebrate these advances and highlight the work that remains.

References

1. Stern C. Doctoring with a double disability. Ann Intern Med. 2021;174:1630-1631. [PMID: 34633832] doi:10.7326/M21-2570 
2. Nouri Z, Dill MJ, Conrad SS, et al. Estimated prevalence of US physicians with disabilities. JAMA Netw Open. 2021;4:e211254. [PMID: 33710286] doi:10.1001/jamanetworkopen.2021.1254
3. Marzolf BA, McKee MM, Okanlami OO, et al. Call to action: eliminate barriers faced by medical students with disabilities. Ann Fam Med. 2022;20:376-378. [PMID: 35879081] doi:10.1370/afm.2824
4. Meeks LM, Case B, Plegue M, et al. National prevalence of disability and clinical accommodations in medical education. J Med Educ Curric Dev. 2020;7:2382120520965249. [PMID: 33178890] doi:10.1177/2382120520965249

Andres F. Diaz, BS

Andres F. Diaz (he/him) is an MD/PhD student at the University of Arizona College of Medicine – Tucson. He is passionate about the optimization of adoptive cell therapies and immunotherapies for low-resource settings, especially in the context of addressing global pediatric cancer care disparities. Beyond his academic endeavors, Andres is involved in STEMM graduate student mentorship and wellness through his work at the National Academies of Sciences, Engineering, and Medicine (NASEM) as well as his leadership in the American Medical Student Association (AMSA). In his free time, Andres enjoys playing soccer, cooking, and reading science fiction.

Oak Sonfist, BA

Oak Sonfist (they/them) specializes in medical school education reform, focusing on disability rights advocacy, transgender health care, rural health, trauma-informed care, and clinician mental health and well-being. Oak, a rising 4th year osteopathic medical student, recently completed an Education and Advocacy Fellowship with the American Medical Student Association. Oak continues advocacy efforts to foster growth and deeper understanding within the medical community. Oak enjoys painting and hiking with their dog Prudence.