thanks for the response aProgDirector, that is helpful.
would a doctor's note suffice?
In general, no. Most residency programs would have you evaluated by Occupational Medicine to best assess your disability, and any specific accomodations that you would need. This is a very complicated area, as the Occ Med doc usually just says something generic, like: "Can't work nights". Then the program decides whether implementing that accomodation is "reasonable" or not. When a residency program says no, then the occ med doc rewrites their report, etc. Better if the residency program and the occ med department are known to each other, can have a discussion about the resident involved, and come to a mutually acceptable conclusion.
So, yes, legally any note from any doc is sufficient to request an ADA disability modification of your job. You would also need to request exactly what modification you were requesting. Then, the program would determine whether it's "reasonable" or not (which is a complex legal minefield). If so, then they make the accomodation. If not, then they fire you -- you gave them documentation that you can't do the job medically, remember?
i
guess i could alter my meds during nightfloat (if i get nightfloat) and take them during the day...i just hope it would work out...if i have night call q every few days, it will be more difficult.
I think you're going to find it difficult no matter what the schedule. Many programs still have some q24h overnight call. If not, then you're likely to have some rotating shifts of some sort. Adjusting your meds is going to be difficult. It's clearly done -- insulin dependent diabetics are medical residents, and managing their sugars with rotating schedules is tricky but doable.
but maybe they could at least give me only 1 nightfloat. At my last program, they gave me nightfloat twice..
This would actually be a very reasonable accomodation to ask for. If some residents get one NF block, and others get two (based on some randomness), then asking for just one would be completely defensible and reasonable.
also, i wonder if they can just count my nightfloat from my past programs and give me credit? ive done 2.5 nightfloats in total as a pgy1.
As L2D has already commented upon, this isn't going to happen. When I take someone into my program, I do so only for an entire PGY year at a minimum, and then you get the entire curriculum despite what you've done in the past. No one is going to give you credit for NF. Don't even ask.
Many places have both night float and periodic call. Some have night float. Others have straight call, q4 or whatever. In many instances you don't get a nights sleep when you are on call or float, period. And you can't be chemically impaired while on call, so if a medicine is making it difficult to wake up, it would make it difficult to make sound medical decisions for your patients as well. Residencies need to make reasonable accommodations for Bona Fide medical conditions, but what you are describing won't be deemed reasonable, both because night medicine is as aPD described an important part of your training, but also because not having you on at night means others will have to be, and so it impairs their curriculum as well. Not to mention the hospital needing the man-hours to get the job done.
It's probably foolish to argue legal points with a lawyer, but I like living life on the wild side.
About the bolded part, it's complicated. The courts have repeatedly stressed that downstream effects on others of an accomodation under the ADA are not considered. So, for example, let's say there's some store open 24 hours, and cashiers are required to work day and night shifts. Someone claims an ADA accomodation because they have sleep apnea, and can't work nights. So, they end up with all day shifts, and now other employees have more night shifts as a consequence. The fact that those employees are "less happy" with their job is NOT an acceptable reason to deny the accomodation. The employer could decide to pay night shifts at a higher rate than day shifts, or have the employee working only days work more weekends, etc.
Now, it's more complicated in a residency program since it's not just a job, but training. In that case, you might be able to make the argument above (that more nights for other residents somehow impairs their curriculum). But only if you show that the actual increase in nights truly creates a curricular problem. If a program has ever built a schedule with one person short, this argument becomes much less valid.
As mentioned above, the hospital "needing the man hours to get the job done" is not a valid ADA argument. The ADA would argue that if other people can be shifted to do that work, then that's a solution to the work hours issue, regardless of how unhappy that makes other employees.
You either are able to do the job or you can't. I wouldn't count on prior night float counting either. A program isnt looking to credit you with all the undesiable shifts and just bring you in to do the cushy ones -- they can find plenty of people who would be happy taking the bad with the good. And, most importantly, you aren't going to do well in residency without the support of your co-residents, and won't have the support of your co-residents if you are not pulling your own weight reasonably. Usually the guy being brought in with the questionable past is the one a program would expect to just quietly buckle down and not start for special treatment. Asking to be credited with night call rather than rolling up your sleeves and saying thanks for the opportunity, let's get to work kind of puts a target on your back. I'm just saying.
Totally agree with this. You're really asking a program to do a favor for you given your past. Any restrictions you put on them are not going to help that. However, I should note that you are not legally required to disclose ADA accomodations prior to accepting a position -- it's totally legal to get the position and then disclose that you need accomodations. Whether that's ethical or not is an open discussion.
i suppose i could also ask for some tid amphetamines from my doctor to take to counter the sleep effects as well especially during call nights. as well as if during night call take the meds at 7am, rather than 8:30pm which is when i take them now..i just hope it works. i used to take amphetamines to wake up, on a qAM basis but i have gotten so used to the meds i dont get as sleepy as i used to, but on and off i do have my days every once in a while where it just takes over my body and puts me out of my misery lol..if i take concomitant amphatamines or even nuvigil which is taken for shift work disorder (i hope my insurance covers it though i think it is pretty expensive). i could even add a little coffee. im pretty sure i can combat everything. i guess in this situation where there is a will there is a way.
SDN is not a place for getting or giving medical advice. However, taking "uppers" to counteract the side effects of "downers" is, IMHO, a really really bad idea.
