Approximately 20 percent of Americans have some sort of disability, but as few as 1-2 percent of doctors do (1, 2). Moreover, most of these doctors became disabled after completing training (2). Only about 1,500 medical school students in the U.S. are currently receiving accommodations for a disability (3). University websites indicate that they aren’t exactly leaping at the opportunity to increase representation, either: two-thirds lack explicit statements on accommodating medical students with disabilities (2). In an article for Slate, Nathan Kohrman calls disabled medical students “one of the most underrepresented groups in American higher education” (1).
Doctors as Superhumans: Why People with Disabilities Have Been Excluded from the Medical Profession
“Historically, doctors have been viewed as superhumans, operating at the highest physical and mental capacity at all hours of the day and night, performing miracles and saving lives,” notes Elana Gordon in a piece for NPR. “There’s an expectation of perfection. But doctors are humans, too” (4).
The superhuman standard puts an excessive amount of pressure on all physicians, but especially those with disabilities. In the days when doctors made frequent housecalls and worked with only basic technology, having a physical disability could be truly prohibitive. However, the medical profession today – in first-world countries, anyway – is more hospital- and office-based, and assistive technology makes it much easier for physicians with disabilities to do their jobs (5). Standing wheelchairs allow surgeons to operate at the same height as the rest of the team (6). Devices that represent flat images with vibrating pins can enable blind doctors to read electrocardiograms. Dialogue transcription helps deaf physicians understand conversations.
And yet, the medical profession has been decidedly unwelcoming of aspiring doctors with disabilities, and legislation regarding this matter is frustratingly vague. The Rehabilitation Act (1973) prohibited universities and other institutions that receive federal funding from rejecting disabled applicants who were “otherwise qualified.” The Americans with Disabilities Act, passed in 1990, clarified that qualified applicants must be given accommodations unless this would “fundamentally alter” their education or cause “an undue burden.” But exactly what constitutes fundamental alterations or undue burden remains controversial. Prospective students are often rejected from medical schools because they fail to meet standards such as motor function ability (1).
In 2016, researchers from the University of Michigan published an article in the American Medical Association Journal of Ethics, explaining how standards could be made more reasonable. The authors suggest that schools use “functional” technical standards that focus on what students can do, allowing for accommodations and modifications, rather than “organic” technical standards, which focus on what they cannot do, and fail to consider how that could be worked around. Additionally, they note that improving accessibility is unlikely to be a safety concern: “Not a single legal case known to the authors has been filed in which patient harm resulted from an accommodation provided to an SWD [student with disabilities]” (7).
How Doctors with Disabilities Can Improve Care for Patients with Disabilities
People with disabilities have increased health concerns but are less likely to receive routine medical care. This is due, in part, to limited financial resources; people with disabilities often face significant barriers to employment. However, it’s also due to a lack of accessibility (1, 8). One study showed that when called to schedule an appointment for a fictional patient who would need help transferring from a wheelchair onto the exam table, more than 20 percent of offices said they could not accommodate the patient (8). Even when doctors agree to see patients with disabilities, they often provide substandard care. As Dhruv Khullar explained in a New York Times article, “Doctors often make false assumptions about the personal lives of patients with disabilities. For example, women who have difficulty walking are much less likely to be asked about contraception or receive cervical cancer screening, in part because doctors assume they’re not sexually active” (2). A paraplegic woman named Bliss Temple told Slate that the first time she had a pelvic exam, the doctor not only failed to question her about sexual activity, but also performed it on the hallway floor because he didn’t have an adjustable table. Temple is now a doctor herself, working to improve access to quality healthcare for people with disabilities (1).
“It is important to sensitize all medical trainees to obstacles to care that persons with disabilities face,” notes Dr. Kenneth Lin in an editorial for Medscape, “but it’s even more important to recognize that doctors with physical disabilities can themselves contribute positively toward removing these obstacles” (5).
Kohrman echoes this sentiment, saying, “Rather than detract from the education of their classmates, medical students with disabilities would provide a constant education about what living with a disability is like to their peers” (1).
Research backs this up. The Association of American Medical Colleges recently teamed up with the University of California, San Francisco on a report about accessibility and inclusion in the medical field. They state that,
“Diversity and inclusion in the medical student body are associated with greater self-rated preparedness to care for minority patients and a stronger commitment to equitable access to care. Additionally, increased physician diversity has resulted in positive effects on patient care and access for marginalized groups, such as low-income people, racial and ethnic minorities, and nonnative English speakers. Our belief is that similar benefits can result from educating and employing physicians with disabilities” (3).
Dr. Gregory Snyder, a physician at Brigham and Women’s Hospital in Boston, has come to understand the importance of representation firsthand. He had a spinal cord injury during medical school, and now uses a wheelchair.
“I would have been this six-foot-tall, blond-haired, blue-eyed Caucasian doctor standing at the foot of the bed in a white coat,” he told The New York Times. “Now I’m a guy in a wheelchair sitting right next to my patients. They know I’ve been in that bed just like they have. And I think that means something” (2).
- Slate -We Need More Doctors with Disabilities
- NY Times – Doctors with Disabilities: Why They’re Important
- AAMC & UCSF Joint Report – Accessibility, Inclusion, and Action in Medical Education
- NPR – For Aspiring Doctors With Disabilities, Many Medical Schools Come Up Short
- Medscape – We Need More Doctors with Disabilities
- ABC News – Real-life ‘Iron Man’: Paralyzed surgeon uses standing wheelchair to perform surgeries
- AMA Journal of Ethics – Medical Schools’ Willingness to Accommodate Medical Students with Sensory and Physical Disabilities: Ethical Foundations of a Functional Challenge to “Organic” Technical Standards
- Annals of Internal Medicine – Access to subspecialty care for patients with mobility impairment: a survey.