Disability accommodation during residency/medical school

[bashwell]

That would be an interesting degree, except that you are not able to prescribe and to me, behavioral therapy alone is not worth it.

I've heard some states do allow clinical psychologists to prescribe some psych medications, but I don't know the specific details.

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[bashwell]

Sour grapes because of your accelerated 3 year program? I'm sorry it's not working out so well for you. No need to be condescending to others because of it.

Respectfully, I don't think @Promethean was being "condescending" at all. I think he was honestly attempting to give you a realistic take about what you're facing. Several people have said it's going to be tough, an uphill battle for you, which is basically what he is saying too, I think. And in any case, as a doctor, it's probably good to develop a thick skin. This is just an online forum after all. People might not put things the way they would in person, but I think most of the intentions here to help you have been good.

 

[Jc2008]

1) I think we are at something like 30-40 credits a semester? That is like 7-9 classes of varying values. The exact curriculum will vary by school. We started out with 2-3 intense months of Anatomy, Histology, and Embryology. There were probably some other classes mixed in (Medical Jurisprudence, that sort of thing.) Anatomy was like 10-12 credits? Then we moved on into Biochem, Biostats, Microbiology, Immunology, Physiology, Pharmacology, Pathology in the second half of that first semester. During that first semester, I spent about 40 hours a week in either lecture or scheduled labs, plus another 40 hours a week studying on my own in the library or the lab. The second semester, we started up with systems and are still working through those now into 2nd year. My pathway is big on independent study, so now I am spending about 15-20 hours per week in scheduled labs or meetings, and 40-60 hours in independant study.

2) Mid terms... Finals? Immunology was covered in 8 calendar days. There was one exam. There might have been a quiz. Medical school isn't undergrad. You don't necessarily get 8-16 weeks with material.

There are other programs that have a different structure, but there are none that I'm aware of where you can make your own a la carte schedule like in undergrad. You get the schedule they give you.

3) Highly variable on the school. There are different styles of curriculum.

4) See 3 above. It would depend on the schedule each clinical rotation gave you. Most of them, you'd get started early in the morning and stay into the afternoon/evening. I hear that one of the attendings that I will rotate with expects his students to have done their first rounds a couple hours before he gets to the hospital at 6am, so that when they round with him, they know all there is to know about the patients. You do what he tells you until 4-6pm, whenever he lets you leave. So, 12-14 hour days.

Other, clinic based rotations may look a lot more like 9a-4p, because that is when those clinics have patients for you to see.

You did forget to mention that your schedule is based on a 3 year program.

I'm not being condescending. I'm giving you honest insight into what you are considering getting into. Glad you know how to look at a post history. I didn't tell you any of the extra stuff that goes along with my 3 year program, which I assure you that I have no "sour grapes" about. I modeled my answer off an understanding of what an average 4 year student does at my school. The schedule I described to you is not accelerated. That is what my 4 year classmates were doing. On top of that, I was also spending a day a week in a physician's office as some of my extra stuff.

Look, you can not want to hear it, but you are likely to not be accommodated. I'm not telling you that to be mean, or condescending, or whatever.

I understand that you think it is illegal. And that you believe that you will be able to have your rights enforced. You won't be the first who finds out how hard that is in fact compared to how easy it sounds in theory. The last thing you ever want to do as a medical student / resident is to sue your school / program. That doesn't go well for you. Medicine is a very small world, and you need the good will of those ahead of you to advance in it. You might win a lawsuit and still lose your career.

Hey man, I appreciate you taking the time to reply. I just didn't feel your reply was that respectful, that's all. I don't see how you would know for sure what type of accommodations are granted, particularly for a school you've never attended, conditions you've never had and esp given that it appears you have never used the disability process yourself. You may be surprised if you found out how many of your class mates are getting some sort of accommodation from your school's disability office in a confidential manner. I'm not blaming you for not knowing about this, since you've never had to deal with the issue yourself, but you could show a little more humbleness towards your lack of knowledge on the issue and less "i know it all" bravado. I don't mind being told it is hard, i know that already. I just don't appreciate being told it's definitely impossible by someone with no personal experience or knowledge to back it up and who apparently didn't even read my post closely (1 class??). Furthermore, if you read my original post, you will see I asked for advice from ppl with some actual experience with this type of issue and I stated upfront I am not looking for people to question my decision to pursue this field or my medical treatment. Seeing how you did not pay attention to any of those things, I will assume your borderline condescension is based on lack of sleep and ignorance, rather than malevolence. I'll also assume this is your first grad degree (are you in your 20s?) and that you don't have that much life experience to base your overly negative assertions on. Either that or we are doing a really poor job still of screening those who get into medical school.

Lastly, I have no interest in suing my school. That should not be necessary. I know people who have received accommodations in medical school such as extra time, note takers, 20% extra time on USMLE etc. The system is by no means perfect and I am sure a lot of people feel screwed over, but I don't think this is a universal thing. Painting an overly negative picture of it, based on pure speculation doesn't help anyone.

 

[Jc2008]

Respectfully, I don't think @Promethean was being "condescending" at all. I think he was honestly attempting to give you a realistic take about what you're facing. Several people have said it's going to be tough, an uphill battle for you, which is basically what he is saying too, I think.

agree to disagree bashwell on this...i think questioning my willingness to get different treatments (without any sort of knowledge of my condition or what I've tried and in spite of me taking this issue off the table in the original post) and making blanket statements about what he thinks will happen when I make the request (full denial) , without any personal experience with disability accommodations or understanding of the accommodations law, goes a little too far. It also doesn't help that he didn't closely read my post and assumed i wanted to take 1 class per term....which prompted his overly dismissive answer.

 

[Jc2008]

I've heard some states do allow clinical psychologists to prescribe some psych medications, but I don't know the specific details.

There may be 1 or 2 but it's getting cold reception in most places. There was a movement to make it happen but it got cold water thrown on it pretty quickly.

 

[bashwell]

Fair enough @Jc2008. Another thought that might be helpful is I'm sure there have to be some premed or other counselors or advisors or mentors here on SDN that you could PM and ask? I know you wanted to get residents and attendings to reply, but this doesn't seem like something most of us know much about since it is such a unique situation, hence the SDN advisors etc might be better? Just another thought, hoping it helps!

 

[Jc2008]

Look, between MD and DO schools, we're at >150 different curricula. Some of them (like Duke's) are quite unique. But to generalize, a traditional medical school curriculum is 2 years "preclinical" and 2 years "clinical".

For the "preclinical" years, a typical arrangement typically falls into one of two overarching themes: Subject based or organ based. Some schools do a mix of the two.

Subject based is most similar to college. You have four semesters of M1/M2, and they'll do something like semester 1 you take biochemistry, anatomy, and intro to psych. Semester 2 you take physiology, cell biology, and neuroscience. etc. These are typically graded with some mixture of exams (3-4 per semester per course is probably normal), lab practicals (especially in anatomy), and small group discussions (this is becoming more and more common). Then at some point in there you take an interviewing course, a physical exam course, a medical ethics course, and the rest of the smorgasbord of stuff expected to get done the first two years. If you can find a school that still has this traditional subject based curriculum, it would probably be the most amenable to your preferred method of accommodations. The big problem you'll run into is that typically the second year subjects require you to have completed the first year ones, but perhaps you could find a way to do the two years in 3 if you had a sufficiently accommodating school. My med school used to allow people to do that if they were struggling, back when it had a subject based curriculum.

Unfortunately for you, most schools these days are integrating their curriculums, which will make that nigh-on impossible. The organ-based curriculums are something like a block every 2-6 weeks where you learn all of the anatomy/physiology/histology/whatever of the blank system. Then you have some amount of exams on that system. Then you move on to the next system. Doing a partial block is pretty much impossible. People who struggle in this curriculum (which they say has better outcomes for actually remembering stuff, but I wouldn't personally know) end up inevitably having to completely repeat a year, because it cannot feasibly be slowed down.

For hours expected to be in class, this is also absurdly variable from school to school. In a curriculum with minimal small group learning and recorded lectures, you could potentially get away with being expected to be in class for <10 hours/week (primarily for the smorgasbord of random stuff), listening to the lectures in your pajamas at your own pace. In a curriculum where everything is based on small group learning, you could be required to be in class 20++ hours/week.

M3/M4 is even more variable

Thanks for this, it is very useful. How many hours a week would you say you were spending between studying and attending class and whatever else you needed to do during your first 2 years?

 

[bashwell]

Thanks for this, it is very useful. How many hours a week would you say you were spending between studying and attending class and whatever else you needed to do during your first 2 years?

I tried to treat my M1-M2 like a full-time job. ~40-45 hours per week for everything. Probably more closer to exams.

By the way, many/most med students take Step 1 in the summer after M2 so not sure how you're going to be able to have dedicated time for Step 1 if you're using the summer to catch up on things (assuming that's even allowed).

 

[Promethean]

You did forget to mention that your schedule is based on a 3 year program.

Because what I described to you isn't particular to a 3 year pathway.

My 3 year program paces alongside a 4 year program. We have the same curriculum, at the same time, except when we get to that summer off. Instead of taking that first summer off, we stay and take the courses that we won't get to do at the end of our second year, because we will have already started rotations when our 4 year colleagues are taking those classes.

Whatever. You are welcome to think that I'm terribly disrespectful, taking my time to try to warn you what you are up against. No, I'm not in my 20s. No, this isn't my first career. The advice was free, and you are welcome to treat it as worthless if you'd like. I do have some experience in what I'm talking about. I'm laying in bed beside someone whose nonphysical disability cost her her career in medicine despite her brilliance and spectacular academic performance. I supported her through several attempts to obtain accommodation, so I might have a clue when I tell you that all it takes is one person along the way to decide to stop you, and you will get no further than that.

Med school/residency is kind like trying to climb Mt. Everest. Gravity is what it is. The altitude is what it is. There isn't a disability friendly route up the mountain just because you want there to be one. Yes, you might be able to do it. You might be able to find resources and recruit enough help to make it work. But even people without disabilities die trying. It is going to be a much harder road for you than for most, even if you are only asking for 1 class less and more time for exams.

 

[Jc2008]

Fair enough @Jc2008. Another thought that might be helpful is I'm sure there have to be some premed or other counselors or advisors or mentors here on SDN that you could PM and ask? I know you wanted to get residents and attendings to reply, but this doesn't seem like something most of us know much about since it is such a unique situation, hence the SDN advisors etc might be better? Just another thought, hoping it helps!

hey man I don't know how to give points on this site for great comments, but I would definitely be giving you some if i did your advice is right on point and very thoughtful. Yes, I sort of figured this out after posting this on here and I PM'd one of the experts on the experts forum and waiting for their reply.

 

[Raryn]

Thanks for this, it is very useful. How many hours a week would you say you were spending between studying and attending class and whatever else you needed to do during your first 2 years?

I was an M1 7 years ago in a curriculum that no longer exists at my old med school and was pretty blase about it (which showed in my grades). All of our lectures were recorded, labs were typically optional (anatomy at least a couple from your team of 5 had to be there), and small group discussions were minimal. We typically had a week of exams every month. I treated it like college, going from 5-10 hours the first week to >70 the week of exams. This would not be possible under the current curriculum from what I heart.

M2, exams were more spread out, the curriculum was much more difficult, and we had more small group BS. Probably from 15-60 hours on average. My grades sucked even more than M1.

 

[Jc2008]

Because what I described to you isn't particular to a 3 year pathway.

My 3 year program paces alongside a 4 year program. We have the same curriculum, at the same time, except when we get to that summer off. Instead of taking that first summer off, we stay and take the courses that we won't get to do at the end of our second year, because we will have already started rotations when our 4 year colleagues are taking those classes.

Whatever. You are welcome to think that I'm terribly disrespectful, taking my time to try to warn you what you are up against. No, I'm not in my 20s. No, this isn't my first career. The advice was free, and you are welcome to treat it as worthless if you'd like. I do have some experience in what I'm talking about. I'm laying in bed beside someone whose nonphysical disability cost her her career in medicine despite her brilliance and spectacular academic performance. I supported her through several attempts to obtain accommodation, so I might have a clue when I tell you that all it takes is one person along the way to decide to stop you, and you will get no further than that.

Med school/residency is kind like trying to climb Mt. Everest. Gravity is what it is. The altitude is what it is. There isn't a disability friendly route up the mountain just because you want there to be one. Yes, you might be able to do it. You might be able to find resources and recruit enough help to make it work. But even people without disabilities die trying. It is going to be a much harder road for you than for most, even if you are only asking for 1 class less and more time for exams.

I'm sorry if she had a similar situation and she wasn't able to get through because of that. Had you stated that, I would have viewed your comment differently. Do you think you point of view may have been affected by this? In either case, one person's experience does not apply to everyone. There are quadraplegics, people without arms etc who get through medical school with accomodations every year. Was it hard for them? You bet. Is it guaranteed? Hell no. But is it hopeless, like you picture it? Probably not. Even if that were the case, would you really have wanted her not to try, having her fail before she could even have a chance? I'd be interested in hearing more about her condition and the circumstances (over PM or otherwise) if you care to share. I'm sorry you (and her) had to deal with that. I am sure it was a pretty crappy situation. Hopefully she did not give up as a result and realizes that there are other programs out there, other medical paths (PA, DNP etc), other countries (with less messed up systems). Don't let the arcane stupidity of the system pull her down. There is no reason why a brilliant young woman with spectacular academic performance should not be able to finish school because of a health condition. If that is the case and in fact what happened, there are recourses. Yes, it's not good to sue to your school, except that if she has all but given up and has nothing to lose anyway, it may be worth it just for justice sake. Additionally, if she won, she could get re-instituted or a refund of her money + money lost through the opportunity cost. I would not let this horrible experience shape the advice you give other aspiring doctors. Don't let one tragedy seed doubts in the minds of the many (many ppl read these posts).

Id' also be interested in what school she went to...just so scratch if off my list....

 

[Jc2008]

I'm sorry if she had a similar situation and she wasn't able to get through because of that. Had you stated that, I would have viewed your comment differently. Do you think you point of view may have been affected by this? In either case, one person's experience does not apply to everyone. There are quadraplegics, people without arms etc who get through medical school with accomodations every year. Was it hard for them? You bet. Is it guaranteed? Hell no. But is it hopeless, like you picture it? Probably not. Even if that were the case, would you really have wanted her not to try, having her fail before she could even have a chance? I'd be interested in hearing more about her condition and the circumstances (over PM or otherwise) if you care to share. I'm sorry you (and her) had to deal with that. I am sure it was a pretty crappy situation. Hopefully she did not give up as a result and realizes that there are other programs out there, other medical paths (PA, DNP etc), other countries (with less messed up systems). Don't let the arcane stupidity of the system pull her down. There is no reason why a brilliant young woman with spectacular academic performance should not be able to finish school because of a health condition. If that is the case and in fact what happened, there are recourses. Yes, it's not good to sue to your school, except that if she has all but given up and has nothing to lose anyway, it may be worth it just for justice sake. Additionally, if she won, she could get re-instituted or a refund of her money + money lost through the opportunity cost. I would not let this horrible experience shape the advice you give other aspiring doctors. Don't let one tragedy seed doubts in the minds of the many (many ppl read these posts).

Id' also be interested in what school she went to...just so scratch if off my list....

 

[Jc2008]

Not to dwell on this, and please don't take this personally or me trying to dissuade you.... but if this anxiety and fatigue is so debilitating despite current treatment that can't be changed, then are you sure this path is in your best interest? (More of rhetorical question, don't have to answer it here). Something you need to discuss with you psychiatrist.

Trust me, I'm not playing down you diagnosis or anything but I've known physicians with no previous mental health issues have serious mental health breakdowns either during training or during practice. I think in some cases it can unmask some underlying predisposition to mental illness but to come into it with a significant/debilitating illness is just asking to put your mental health/sanity at jeopardy.

I know Law is demanding as well. My significant other is a lawyer and I saw what she went through during law school, the bar and now practice, though she's told me numerous times it was nothing like what I experienced in med school and residency/fellowship after now watching me go through those.

Again, don't take any of this personally or an attack. Just trying to be realistic and blunt as that's what I'd want someone to be to me if I had similar questions. Honestly I wish I knew what I know now back when I was applying as I would've thought harder about this whole path as the debt, time in training has certainly taken a toll on my health.

I appreciate your previous link , that was interesting. As to your choice to do medicine, for whatever its worth, I think there is no better career in terms of opportunities than medicine, after you finish your residency/fellowship. my parents are docs and the one thing I hear over and over again is the striking difference in your life once you are done with your training. Keep in mind that in many professions, where people work equally hard, there is no light at the end of the tunnel. In law for example, 1/3 of lawyers (who incidentally have 150k on average in debt), are no longer in the profession after 5 years after passing the bar because there isn't enough work for everyone. If they are working, it may not be for more than 60k a year and they can barely finance their debt. medicine is very hard in the beginning but things really look up after your training. You're almost there, so don't lose the faith.

 

[PsychPhDone]

Please note I am posting this here instead of the pre-med forum because I would prefer answers from residents and MDs.

I am in the process of applying to medical school and have a disability. I am trying to ascertain whether I should let this disability dissuade me from going into medicine. My disability is not physical, I can do everything a non-disabled individual can- except that, I suffer from extreme fatigue, a side effect of medication I have to take for my condition. This is not something I can change by trying a different treatment (I've already done that) , so I would prefer to avoid any replies suggesting I try to get better treatment. I'm also committed to medicine, so I am not interested in trying another field.

In order to get through medical school and residency, I would likely be requesting an accommodation consisting of a reduced course load (maybe one class less per term), while in medical school. I would also be requesting reduced hours during residency (likely around 35 per week). In my chosen specialty, psychiatry, the average residency work week is 45 hours...so I would not be working that much less than full time.

I am trying to find out whether there are any other people who in medical school ended up taking a slightly reduced course load and who maybe finished in 4.5 or 5 years instead of 4 and whether there are other people in residencies who are working slightly reduced hours (for medical reasons or otherwise).

My main purpose is to get an idea of how such an accommodation request would be viewed during my medical education and to find out how rare (or not rare) such accommodations are.

I am particularly worried about getting through medical school with a reduced course load but having problems finding a residency, due to having taken longer than 4 years to complete my education (while I know there are laws to protect against such discrimination, there are also stories out there of ppl who were not able to practice medicine as a result of not finding a residency, directly related to their taking longer than 4 years to graduate).

Let's assume my grades, USMLE scores and everything else would be good- the only issue would be that I would need to have the reduced course-load .

I would appreciate feedback from people who are familiar with this issue, as opposed to people just speculating about what may happen (I have done that plenty myself . My sense is that the accommodation would be granted by medical schools (as per ADA) but you would have to explain to residencies why it took you slightly longer to finish school, if they asked (although you would not have to disclose your disability or the accommodation request until after you are accepted into the program). I am less clear of what would happen after you are accepted as a resident. Technically, as your employer, they would have to grant your request for less hours unless there is a very good reason not to (and decrease your salary at the same time). So it may take a little longer to finish the residency (which is OK). But given that this type of situation is not common, I am a little apprehensive and would love to hear from other people who have dealt with something similar or who know of other people who have had a similar situation.

I'm somewhat hesitant to reply to your questions because you've gotten some really great answers so far, and when the answers weren't quite what you wanted to hear, you made that very clear. However, I'm replying in case it's helpful to you anyway. I am not a medical student/resident, but my answers are based in: having completed a PhD in clinical psychology, teaching residents (IM and psychiatry) in my current position, and having treated medical and law students as part of my clinical practica in graduate school.

You are right that accommodations can be made in medical school. I suggest you contact the office of disability services at a school or two you are considering applying to. They can speak with you about some possibilities without you having "proof" of disability or not yet being a student. Different times of year might make this more or less possible for them (e.g., they may be working on students' midterm accommodations right now so might ask you to wait a month), but that would be one suggestion. They should be able to speak to you about what accommodations have been made before successfully, and what may not be possible. For example, when I taught undergrads, they could get quiet space and extra time for exams. However, requests for "unlimited assignment deadlines" and "unlimited absences" were denied as unreasonable (not even by me but by the disability office). I was happy to make whatever accommodations were approved and tried to implement them as directed and fairly.

You will want to find a medical school that has a curriculum that would be amenable to your needs. As others have stated, many are now integrated and would make missing a portion of coursework regularly very difficult in terms of progress. Some schools are lax about lecture attendance and allow you to watch over video. If you are good at that kind of thing, seek that out. Making stuff up over the summer isn't likely at most programs, but ask away.

Your M3 and M4 years will be a challenge. Some rotations will be more suitable to your time limitations than others, as others have said. I worked with my med student clients to work with their administrators to facilitate reasonable ideas for this, and we did this without using the disability office -- people were just reasonable where possible. For example, when working with a student with severe anxiety, we requested starting out with a known friendly preceptor in mostly outpatient IM, rather than jumping into surgery right away. I did my part by working with my client to maximize treatment for anxiety and sleep. Student built confidence and worked his way through rotations with no problems.

Matching into residency with an elongated path through med school may be difficult but not impossible. TDs can better speak to that. For residency, you'll want to, again, be planful about where you apply. There are other threads asking about half-time residencies on SDN - look them up. Psych isn't a terrible path if that's what you want. Yes, your time on certain services will be more time-consuming than others. If you match to a full-time residency, there may be difficulty providing good clinical care depending on how many residents are in the program -- they do have duty hour maxes.

I know a few others have suggested psychology as an alternative path, and you don't aren't interested in that. Prescribing as psych PhD is a possibility in a few states, but it's in its infancy and who knows how far that will reach. I don't recommend this path for you anyway because my hours in graduate school were long (and typical based on SDN threads; years 1-3: 70-80 hours/week, year 4-5: 55-70, year 6: 45-60 not counting dissertation time). I am hesitant to suggest a PA or Psych NP without knowing their time demands, but I'd look into that further if you're interested in prescribing.

My last point is this: I am glad you're putting thought into this, and I hope it works out for you. Beware of the sunk-cost fallacy: yes, other paths may take additional schooling, but if this path isn't going to work, better to choose to leave it now, rather than 4+ years from now. There are no guarantees in life, so get as much info as you can and make an informed decision. Good luck.

 

[Jc2008]

I'm somewhat hesitant to reply to your questions because you've gotten some really great answers so far, and when the answers weren't quite what you wanted to hear, you made that very clear. However, I'm replying in case it's helpful to you anyway. I am not a medical student/resident, but my answers are based in: having completed a PhD in clinical psychology, teaching residents (IM and psychiatry) in my current position, and having treated medical and law students as part of my clinical practica in graduate school.

You are right that accommodations can be made in medical school. I suggest you contact the office of disability services at a school or two you are considering applying to. They can speak with you about some possibilities without you having "proof" of disability or not yet being a student. Different times of year might make this more or less possible for them (e.g., they may be working on students' midterm accommodations right now so might ask you to wait a month), but that would be one suggestion. They should be able to speak to you about what accommodations have been made before successfully, and what may not be possible. For example, when I taught undergrads, they could get quiet space and extra time for exams. However, requests for "unlimited assignment deadlines" and "unlimited absences" were denied as unreasonable (not even by me but by the disability office). I was happy to make whatever accommodations were approved and tried to implement them as directed and fairly.

You will want to find a medical school that has a curriculum that would be amenable to your needs. As others have stated, many are now integrated and would make missing a portion of coursework regularly very difficult in terms of progress. Some schools are lax about lecture attendance and allow you to watch over video. If you are good at that kind of thing, seek that out. Making stuff up over the summer isn't likely at most programs, but ask away.

Your M3 and M4 years will be a challenge. Some rotations will be more suitable to your time limitations than others, as others have said. I worked with my med student clients to work with their administrators to facilitate reasonable ideas for this, and we did this without using the disability office -- people were just reasonable where possible. For example, when working with a student with severe anxiety, we requested starting out with a known friendly preceptor in mostly outpatient IM, rather than jumping into surgery right away. I did my part by working with my client to maximize treatment for anxiety and sleep. Student built confidence and worked his way through rotations with no problems.

Matching into residency with an elongated path through med school may be difficult but not impossible. TDs can better speak to that. For residency, you'll want to, again, be planful about where you apply. There are other threads asking about half-time residencies on SDN - look them up. Psych isn't a terrible path if that's what you want. Yes, your time on certain services will be more time-consuming than others. If you match to a full-time residency, there may be difficulty providing good clinical care depending on how many residents are in the program -- they do have duty hour maxes.

I know a few others have suggested psychology as an alternative path, and you don't aren't interested in that. Prescribing as psych PhD is a possibility in a few states, but it's in its infancy and who knows how far that will reach. I don't recommend this path for you anyway because my hours in graduate school were long (and typical based on SDN threads; years 1-3: 70-80 hours/week, year 4-5: 55-70, year 6: 45-60 not counting dissertation time). I am hesitant to suggest a PA or Psych NP without knowing their time demands, but I'd look into that further if you're interested in prescribing.

My last point is this: I am glad you're putting thought into this, and I hope it works out for you. Beware of the sunk-cost fallacy: yes, other paths may take additional schooling, but if this path isn't going to work, better to choose to leave it now, rather than 4+ years from now. There are no guarantees in life, so get as much info as you can and make an informed decision. Good luck.

Thanks for your extremely thoughtful reply. Not sure why you thought I may not appreciate it, I only have an issue with people who dont actually answer my post intelligently and maturely. You reply is by far the most mature and informative that I have received. What you are describing it what I have been assuming the situation to be. It's something that one has to navigate carefully which I why I'm looking into it. A few questions: what are TDs? Do you have a sense of what it takes to determine whether the path 'will work out' or not? I'm not sure whether getting through a first and second year succesfully gives me a reliable indication of whether I am likely to "work out" in year 3 or 4, given the difference in the years. So I am assuming what you meant, is that I think it out as well as possible, although I am relying on incomplete info and unknowns. Regarding contacting the disability office, that may be worth doing and I will try that based on your advice. Do you think email will be OK as a first contact or would you call them up? I have been thinking they would be sort of reluctant to get into any details with someone who has not even applied yet, but based on what you are saying it may be worth a shot even if they don't provide useful info. Thanks again for your excellent post. Never ceases to amaze me, the high quality of people I meet in mental health settings.

 

[LucidSplash]

I think you could make it through the first 2 years of medical school without accommodations if you were at the right school with the right curriculum structure. My medical school had block scheduling, so we only had one "class" at a time; 2 hours of lecture each morning (recorded and not mandatory to attend) and 2 hours of lab or small group which was mandatory. Plus occasional afternoon meetings for clinical experience, usually once a week. The rest of the time was left up to you to structure your own study schedule. I think something like that could work for someone with your restrictions.

M3 and M4 will be much more difficult. Assuming you are allowed accommodation and make it through that, you need to know that the fact that you had accommodation to complete any part of Med school will be included in your MSPE (Also known as your Dean's letter) which is part of the standard application package for residency. It won't be included in a defamatory way, but it will be in there. So to assume you will apply to a residency and match and only let them know about your need for accommodation after the match is not going to work. Because of programs knowing that info beforehand, likely you will be limited in the number of interviews you receive for residency, if any, even for a specialty like psych.

If that happens, and I see all of that being the most likely outcome (failing to match), then you will be left with an essentially useless degree as well as an additional 200k+ in debt. A medical degre without residency is in most cases just a financial albatross. I think this is probably the biggest hurdle you face in your plan.

 

[ThoracicGuy]

Fair enough @Jc2008. Another thought that might be helpful is I'm sure there have to be some premed or other counselors or advisors or mentors here on SDN that you could PM and ask? I know you wanted to get residents and attendings to reply, but this doesn't seem like something most of us know much about since it is such a unique situation, hence the SDN advisors etc might be better? Just another thought, hoping it helps!

Perhaps an instructor like @Goro can provide insight...

 

[rokshana]

the part that hasn't been discussed is actually being a doctor...working after residency...where there are no work hour limits, patient caps, and so forth...how do you plan to handle that?

and there always seems to be a statement that one has to sign that you have the physical capabilities to perform the activities of a med student, resident, fellow,attending, etc...

while places i'm sure are willing to do some accommodations, i doubt that they have to do so to the point that they feel that one cannot be trained appropriately...

you may very well get a med school to accept and accommodate you, but what happens if you don't match anywhere? then you have a medical degree that has very little value...

and read through the threads about people being dismissed from residency for all sorts of reasons...even if you did match somewhere, they will accommodate to a point, but if your performance effects pt care or the work flow or they think you aren't keeping up, they will find someway to dismiss you and residency programs have great leeway to dismiss a resident.

i wish you good luck, i really do...you wanted the opinion of those out in the real world of residency and medicine instead of your pre-med brethren and you have gotten it...ALL of it, including the concept that maybe medical school and residency are not the best options...you can take it or ignore it.

 

[Goro]

I've read through the entire thread and will offer my comments. I cannot sugar coat anything.

JC, I'm sorry about your woes, but I wouldn't accept you into my med school. One of the criteria we look at is "can this person handle our curriculum?", and my answer is no.

We have a vertically integrated curriculum (which others have mentioned), which means that you don't take the classic Flexner-style cclasswork of Anatomy on Mon/Wed, Physiology on Tues PM, Med Micro on Wed's. You take everything, in an organ systems based approach. And that's just the Basic Sciences. Our Intro to Clinical Medicine course parallels the the science classwork. OMM (not an issue at an MD school), is a separate thing entirely. There is no skipping one class to take next year. There is no two weeks on/two weeks off. Nor are there any classes in the summer. Our Clinical faculty, in fact, disappear for the summer into practice and/or vacation. The PhD faculty disappear into their labs and/or vacation. We don't remediate over the summer either.

We have exams roughly every two weeks. But some med schools have them every week, others in blocks every 3/4/5 weeks. I think that there are only a handful that have a midterm and a final.

I don't think that our 3rd/4th clinical curriculum would accommodate you in the way you want as well, for reasons described by other posters.

Accreditation standards at both MD and DO schools require that med students have to be able of performing to particular technical standards. I think that your med's side effects prevent you from getting there.

I say this as an Adcom member with ~15 years experience, and one whose school has accepted people with severe visual and hearing disabilities, as well as some with movement disorders. When the Adcom accepts people with disabilities, it's because we believe that they can handle med school, and then the ADA requires us to make every reasonable accommodation to allow them to succeed. The ADA doesn't require us to accept disabled persons, only to reasonably accommodate those that do.

Adcoms are also very leery of people who have a "X or bust" mindset to specialties, or anything else.

I strongly suggest PA or NP.

Please note I am posting this here instead of the pre-med forum because I would prefer answers from residents and MDs.

I am in the process of applying to medical school and have a disability. I am trying to ascertain whether I should let this disability dissuade me from going into medicine. My disability is not physical, I can do everything a non-disabled individual can- except that, I suffer from extreme fatigue, a side effect of medication I have to take for my condition. This is not something I can change by trying a different treatment (I've already done that) , so I would prefer to avoid any replies suggesting I try to get better treatment. I'm also committed to medicine, so I am not interested in trying another field.

 

[Jc2008]

the part that hasn't been discussed is actually being a doctor...working after residency...where there are no work hour limits, patient caps, and so forth...how do you plan to handle that?

and there always seems to be a statement that one has to sign that you have the physical capabilities to perform the activities of a med student, resident, fellow,attending, etc...

while places i'm sure are willing to do some accommodations, i doubt that they have to do so to the point that they feel that one cannot be trained appropriately...

you may very well get a med school to accept and accommodate you, but what happens if you don't match anywhere? then you have a medical degree that has very little value...

and read through the threads about people being dismissed from residency for all sorts of reasons...even if you did match somewhere, they will accommodate to a point, but if your performance effects pt care or the work flow or they think you aren't keeping up, they will find someway to dismiss you and residency programs have great leeway to dismiss a resident.

i wish you good luck, i really do...you wanted the opinion of those out in the real world of residency and medicine instead of your pre-med brethren and you have gotten it...ALL of it, including the concept that maybe medical school and residency are not the best options...you can take it or ignore it.

I would be doing my own private part time practice as a psychiatrist after residency. also, about 1/3 of psych positions out there are part time...so that shouldn't be a problem if I got that far

 

[Jc2008]

I think you could make it through the first 2 years of medical school without accommodations if you were at the right school with the right curriculum structure. My medical school had block scheduling, so we only had one "class" at a time; 2 hours of lecture each morning (recorded and not mandatory to attend) and 2 hours of lab or small group which was mandatory. Plus occasional afternoon meetings for clinical experience, usually once a week. The rest of the time was left up to you to structure your own study schedule. I think something like that could work for someone with your restrictions.

M3 and M4 will be much more difficult. Assuming you are allowed accommodation and make it through that, you need to know that the fact that you had accommodation to complete any part of Med school will be included in your MSPE (Also known as your Dean's letter) which is part of the standard application package for residency. It won't be included in a defamatory way, but it will be in there. So to assume you will apply to a residency and match and only let them know about your need for accommodation after the match is not going to work. Because of programs knowing that info beforehand, likely you will be limited in the number of interviews you receive for residency, if any, even for a specialty like psych.

If that happens, and I see all of that being the most likely outcome (failing to match), then you will be left with an essentially useless degree as well as an additional 200k+ in debt. A medical degre without residency is in most cases just a financial albatross. I think this is probably the biggest hurdle you face in your plan.

Are you pretty certain accommodations are revealed in your MSPE? I'll have to look at that. Thanks for the heads up. Either way, it seems to me that legally they cannot disclose what the issue was, only that you had some form of accommodation (it could have been testing in a semi private room b/c of mild ADD or something more serious). The issue would probably be, like you said, any accommodation being viewed as a red flag by residencies and not getting interviews b/c of that. Now if you did get interviews, they cannot ask you about health issues or future/past need for accommodation during the interview and before the offer (i think this is probably respected). So that gets me back to what I thought in first place, and what you said, that it may be hard to find a residency and if I do, the accommodations are not guaranteed. Appreciate the advice, I think your analysis is correct.

 

[bashwell]

By the way, I know some of us (including me) have suggested OP might consider becoming an NP, PA, or clinical psychologist instead. However, these fields might not necessarily allow part-time in the way OP envisions either. Nursing seems like it'd be the most likely of the three to allow part-time in the way OP envisions, but I don't really know for sure.

OP, you're highly qualified (JD/MBA), and that's awesome. But unless you really love medicine (psych), maybe it'd be better to look for other legal or business careers instead? In fact, a lot of doctors are frustrated with medicine these days, and some are even trying to get either a JD or MBA!

 

[Jc2008]

I think you could make it through the first 2 years of medical school without accommodations if you were at the right school with the right curriculum structure. My medical school had block scheduling, so we only had one "class" at a time; 2 hours of lecture each morning (recorded and not mandatory to attend) and 2 hours of lab or small group which was mandatory. Plus occasional afternoon meetings for clinical experience, usually once a week. The rest of the time was left up to you to structure your own study schedule. I think something like that could work for someone with your restrictions.

M3 and M4 will be much more difficult. Assuming you are allowed accommodation and make it through that, you need to know that the fact that you had accommodation to complete any part of Med school will be included in your MSPE (Also known as your Dean's letter) which is part of the standard application package for residency. It won't be included in a defamatory way, but it will be in there. So to assume you will apply to a residency and match and only let them know about your need for accommodation after the match is not going to work. Because of programs knowing that info beforehand, likely you will be limited in the number of interviews you receive for residency, if any, even for a specialty like psych.

If that happens, and I see all of that being the most likely outcome (failing to match), then you will be left with an essentially useless degree as well as an additional 200k+ in debt. A medical degre without residency is in most cases just a financial albatross. I think this is probably the biggest hurdle you face in your plan.

lucidsplash, would you mind sharing what med school you attended? PM is fine. thx

 

[Jc2008]

By the way, I know some of us (including me) have suggested OP might consider becoming an NP, PA, or clinical psychologist instead. However, these fields might not necessarily allow part-time in the way OP envisions either. Nursing might be the most likely of the three to allow part-time in the way OP envisions, but I don't really know for sure.

OP, you're highly qualified (JD/MBA), and that's awesome. But unless you really love medicine (psych), maybe it'd be better to look for other legal or business careers instead? In fact, a lot of doctors are frustrated with medicine these days, and some are even trying to get either a JD or MBA!

I would strongly advise any doctor against getting a JD or MBA. If there is anything worse than working too many hours/other stresses of medicine, it is doing close to the same thing in fields where there is no jobs once you are done with your training and where your loans will be close to the medical schools ones but your salary will be half or 1/3 as much.

 

[Jc2008]

l

 

[Jc2008]

By the way, I know some of us (including me) have suggested OP might consider becoming an NP, PA, or clinical psychologist instead. However, these fields might not necessarily allow part-time in the way OP envisions either. Nursing seems like it'd be the most likely of the three to allow part-time in the way OP envisions, but I don't really know for sure.

OP, you're highly qualified (JD/MBA), and that's awesome. But unless you really love medicine (psych), maybe it'd be better to look for other legal or business careers instead? In fact, a lot of doctors are frustrated with medicine these days, and some are even trying to get either a JD or MBA!

I have a passion for medicine (and not just psych), otherwise there is no way I would be considering this. Everyone in my family is a doc, which is another reason I'm still considering this. Had that not been the case, I probably would have been dissuaded from doing it by the (real) obstacles that exist in my case. And yes, I am still considering legal/business work, but I don't think those careers are panaceas of accommodation either. What a lot of the ppl replying are bringing up are the reality of someone dealing with dealing with this type of issue in any field. most jobs are full time and ppl scoff at part time accommodations. this is something that is just as much an issue in law and business as in medicine. the only difference here is the financial and opportunity cost gamble with trying ones luck on training which may or may not lead to a career.

 

[Jc2008]

By the way, I know some of us (including me) have suggested OP might consider becoming an NP, PA, or clinical psychologist instead. However, these fields might not necessarily allow part-time in the way OP envisions either. Nursing seems like it'd be the most likely of the three to allow part-time in the way OP envisions, but I don't really know for sure.

OP, you're highly qualified (JD/MBA), and that's awesome. But unless you really love medicine (psych), maybe it'd be better to look for other legal or business careers instead? In fact, a lot of doctors are frustrated with medicine these days, and some are even trying to get either a JD or MBA!

Thanks for sticking around in the thread btw. If all else fails, I can always try to get off my meds or lower the dose, except that will not work over the long run, but may be an option for really busy periods. I've dealt with this throughout law school and my MBA and I struggled and somehow made it through, so I don't think its impossible to do in medicine. Now whether it's a wise thing to do, is a different issue... I'm getting an experimental treatment in LA starting next week, so maybe that will make a difference.

 

[LucidSplash]

lucidsplash, would you mind sharing what med school you attended? PM is fine. thx

I don't mind, it is pretty well documented if you do a search. University of Maryland.

 

[LucidSplash]

Are you pretty certain accommodations are revealed in your MSPE? I'll have to look at that. Thanks for the heads up. Either way, it seems to me that legally they cannot disclose what the issue was, only that you had some form of accommodation (it could have been testing in a semi private room b/c of mild ADD or something more serious). The issue would probably be, like you said, any accommodation being viewed as a red flag by residencies and not getting interviews b/c of that. Now if you did get interviews, they cannot ask you about health issues or future/past need for accommodation during the interview and before the offer (i think this is probably respected). So that gets me back to what I thought in first place, and what you said, that it may be hard to find a residency and if I do, the accommodations are not guaranteed. Appreciate the advice, I think your analysis is correct.

Anything that is atypical in terms of time to complete rotations or overall medical school shows up in your MSPE. If you take time off that is unaccounted for, if you remediate, if you take longer than typical to complete a rotation. The types of accommodations you are thinking of asking for will show up. And it is BETTER to have a reason for these things in your MSPE than not having a reason. Gaps/changes in length of training are a BIG DEAL for residency (and fellowship) interviews and if the gaps are not explained that's even worse.

Of note, every application for licensing or accreditation or hospital privileges or any job application you fill out in the future will ask you to disclose anytime your training, from Med school to residency and beyond, was extended or interrupted, and you are expected to provide an explanation for those gaps. It has been on all my residency and fellowship apps, on my application for my full license, on my DEA number application, and on my moonlighting application to get hospital privileges.

 

[Raryn]

I have a passion for medicine (and not just psych), otherwise there is no way I would be considering this. Everyone in my family is a doc, which is another reason I'm still considering this. Had that not been the case, I probably would have been dissuaded from doing it by the (real) obstacles that exist in my case. And yes, I am still considering legal/business work, but I don't think those careers are panaceas of accommodation either. What a lot of the ppl replying are bringing up are the reality of someone dealing with dealing with this type of issue in any field. most jobs are full time and ppl scoff at part time accommodations. this is something that is just as much an issue in law and business as in medicine. the only difference here is the financial and opportunity cost gamble with trying ones luck on training which may or may not lead to a career.

Even speaking as someone whose family members are almost entirely physicians, this is a terrible reason to pursue medicine.

You already have two terminal degrees that you were presumably motivated to pursue for some reason. Yes, you've invested time to go back to school and get the medicine prerequisites, but realistically you're looking at at least 7 more years of training even without anything being extended.... and that's with a three year residency and no fellowship. Add a year for applications, an extra year since psych residency is 4 rather than 3 years, and the possibility of extensions to medical school due to your requested accommodations, and you're looking at the possibility of finally starting your part-time attending job a decade from now. Economically, your reasoning makes zero sense. Even if you get over all the (substantial) humps, you'd almost certainly come out behind the economic position that you'd have right now even if you got a mid-range law or business job. The left handed peak of the bimodal lawyer starting salary distribution is what, $55k? $60k? Even ignoring the time value of money and the possibility of interest on potential loans, you'd take two decades from today to catch up to the zero point.

You're putting yourself in line for a ton of headaches for minimal economic benefit except for your possible passion for the field and meeting familial expectations. The former reason is valid, don't get me wrong: If you truly have passion for the field of medicine, that's great. But you presumably also had passion for Law and Business at various points, so I'd take a long hard look to see how this is different. And familial expectations? Not every child of a doctor needs to be a doctor.

 

[Jc2008]

Even speaking as someone whose family members are almost entirely physicians, this is a terrible reason to pursue medicine.

You already have two terminal degrees that you were presumably motivated to pursue for some reason. Yes, you've invested time to go back to school and get the medicine prerequisites, but realistically you're looking at at least 7 more years of training even without anything being extended.... and that's with a three year residency and no fellowship. Add a year for applications, an extra year since psych residency is 4 rather than 3 years, and the possibility of extensions to medical school due to your requested accommodations, and you're looking at the possibility of finally starting your part-time attending job a decade from now. Economically, your reasoning makes zero sense. Even if you get over all the (substantial) humps, you'd almost certainly come out behind the economic position that you'd have right now even if you got a mid-range law or business job. The left handed peak of the bimodal lawyer starting salary distribution is what, $55k? $60k? Even ignoring the time value of money and the possibility of interest on potential loans, you'd take two decades from today to catch up to the zero point.

You're putting yourself in line for a ton of headaches for minimal economic benefit except for your possible passion for the field and meeting familial expectations. The former reason is valid, don't get me wrong: If you truly have passion for the field of medicine, that's great. But you presumably also had passion for Law and Business at various points, so I'd take a long hard look to see how this is different. And familial expectations? Not every child of a doctor needs to be a doctor.

Raryn, thanks for your reply. Very informed. Yes left handed peak is around 60k...that's only for the people who find work. About 1/3 of people don't find work in law and never use their degrees/drop out. Your analysis is astute, I have made the same analysis myself and although I don't come out ahead financially, I also don't come out behind (although I am deferring income until a later point and arguably not being able to take advantage of exponential investment growth for retirement). I can assure you I am not doing this because my parents wants me to. The reasons I did law and business had to do with immigration difficulties I experienced for a very long time, which made it impractical (if not impossible) to attend medical school. My passion for medicine is real and my passion for law/business are less so. Pre-med and clinical experience has confirmed this over the past 3 years and made me question my decision to do business/law before (as opposed to a PA/NP program which would have been possible even if my immigration issues). Either way, I realize there are big risks involved but I am reluctant to let that scare me out of this path, as that would be something I regret for the rest of my life. I think Id rather try and fail , than fail by never having tried. Although the comments I am getting on here may change my mind, as I am starting to realize that medical school culture may be a toxic place for someone with a disability requiring a reduced workload.

 

[bashwell]

Another quick thought (sorry just reading in between doing many other things) -- perhaps you can go to a local med school and ask someone if you're allowed to sit in for lectures or otherwise have a tour of the med school, see how med students are handling things, etc., which will give you a better idea of how things really are like? And definitely shadow a psychiatrist and see if you like the day to day. I assume your parents can helpfully make recommendations about who to shadow, make connections for you, etc since they're physicians.

 

[BoardingDoc]

I don't have much to contribute here (most of my views fall in line with that of Raryn's recent post) but I wanted to say that this has been the most civil interaction between someone asking a controversial question and people answering, even if they vehemently disagree with Jc2008's plans, that I've seen on this forum in a long time.

 

[Jc2008]

I don't have much to contribute here (most of my views fall in line with that of Raryn's recent post) but I wanted to say that this has been the most civil interaction between someone asking a controversial question and people answering, even if they vehemently disagree with Jc2008's plans, that I've seen on this forum in a long time.

What exactly makes my question so controversial? I sought advice regarding experiences of people who know about a topic which is relevant to my life. I have gotten some good advice mostly, but also some slightly patronizing and ignorant comments from people who don't seem to know much about this topic. I don't think my asking a question about a potential disability accommodation I may request is controversial in any sense, unless one has an underlying bias against people receiving accommodations for non-physical disabilities.

 

[LucidSplash]

unless one has an underlying bias against people receiving accommodations for non-physical disabilities.

This. Not a bias per se but simply alarm bells for those of us that have been through the process. The path to becoming a physician is something that can bring even the most mentally tough people to their knees. So what a lot of people on this thread may be thinking (but uncharacteristically not saying, for SDN standards) is that the accommodations you are thinking of asking for likely fall into the "unreasonable accommodations" category. Not only that, but even with accommodations, I would simply never recommend that someone with a severe and difficult-to-control anxiety disorder pursue medicine. It mentally and physically stresses even those of us without that struggle to our limits. I don't see it as being a healthy choice for you. But heretofore most of us have limited our input to your specific question. For me I recognize you're an adult who will and can make your own decisions and presumably you have other people in your life who are closer to you (i.e. family of docs) to assess your ability to handle the stresses of this life.

But that is what is controversial. We all wish you the best but I suspect many of us think this is a terrible idea. Typically on SDN you'd get a ton of people telling you so, because people tend to try to give their opinions about the life choices of people who ask specific questions rather than respond to the specific questions they ask.

 

[Jc2008]

This. Not a bias per se but simply alarm bells for those of us that have been through the process. The path to becoming a physician is something that can bring even the most mentally tough people to their knees. So what a lot of people on this thread may be thinking (but uncharacteristically not saying, for SDN standards) is that the accommodations you are thinking of asking for likely fall into the "unreasonable accommodations" category. Not only they, but even with accommodations, I would simply never recommend that someone with a severe and difficult-to-control anxiety disorder pursue medicine. It mentally and physically stresses even those of us without that struggle to our limits. I don't see it as being a healthy choice for you. But heretofore most of us have limited our input to your specific question. For me I recognize you're an adult who will and can make your own decisions and presumably you have other people in your life who are closer to you (i.e. family of docs) to assess your ability to handle the stresses of this life.

But that is what is controversial. We all wish you the best but I suspect many of us think this is a terrible idea. Typically on SDN you'd get a ton of people telling you so, because people tend to try to give their opinions about the life choices of people who ask specific questions rather than respond to the specific questions they ask.

Yeah, I guess that's why I found some of the responses condescending. I was not looking for people giving me life choice advice or make value judgments about whether it makes sense for someone with my condition to pursue a stressful career path. I was simply asking for logistics information about how such accommodations could /or could not work in medical school. The fact that people's biases are coming through in their answers. as a result of my question, is not a function of my question being controversial, but rather related to their particular unconscious beliefs about what a prospective doctor "should be like". Also note that I never said anything about having an uncontrolled anxiety disorder, only that I have some fatigue related to treatment for one. For all anyone knows, my disorder is controlled and I have no greater anxiety than anyone else. Again, a bias coming out in the answers. Would it make a difference if my fatigue was due to a bad heart valve? I have a feeling that the question would be perceived much less 'controversially' then, because some of this controversy may be just bias masquerading as genuine concern.

 

[BoardingDoc]

What exactly makes my question so controversial? I sought advice regarding experiences of people who know about a topic which is relevant to my life. I have gotten some good advice mostly, but also some slightly patronizing and ignorant comments from people who don't seem to know much about this topic. I don't think my asking a question about a potential disability accommodation I may request is controversial in any sense, unless one has an underlying bias against people receiving accommodations for non-physical disabilities.

I agree wholeheartedly with LucidSplash's response. The controversial nature also stems from the fact that people who go into medicine do so knowing that it is harder, vastly more time consuming, and requires more sacrifice of oneself than most other careers. While it's clear that your reasons for asking about a 35 hour work week are valid, it is very easy to see it on the other side of the fence as "I want to be a doctor, but I shouldn't be required to do the same amount of work."

 

[rokshana]

I have a passion for medicine (and not just psych), otherwise there is no way I would be considering this. Everyone in my family is a doc, which is another reason I'm still considering this. Had that not been the case, I probably would have been dissuaded from doing it by the (real) obstacles that exist in my case. And yes, I am still considering legal/business work, but I don't think those careers are panaceas of accommodation either. What a lot of the ppl replying are bringing up are the reality of someone dealing with dealing with this type of issue in any field. most jobs are full time and ppl scoff at part time accommodations. this is something that is just as much an issue in law and business as in medicine. the only difference here is the financial and opportunity cost gamble with trying ones luck on training which may or may not lead to a career.

and are all those doctors in your family supportive of you going into medicine?

i'm from a medical family as well and they ALL were of the opinion NOT to go into medicine...and this was over 10 years ago...i'm surprised that they would be in favor of you going into medicine..supportive of you in what you decide to do, after all they are family, but many physicians don't necessarily want their children to follow n their footsteps in this day and age of medicine.

 

[Jc2008]

This. Not a bias per se but simply alarm bells for those of us that have been through the process. The path to becoming a physician is something that can bring even the most mentally tough people to their knees. So what a lot of people on this thread may be thinking (but uncharacteristically not saying, for SDN standards) is that the accommodations you are thinking of asking for likely fall into the "unreasonable accommodations" category. Not only that, but even with accommodations, I would simply never recommend that someone with a severe and difficult-to-control anxiety disorder pursue medicine. It mentally and physically stresses even those of us without that struggle to our limits. I don't see it as being a healthy choice for you. But heretofore most of us have limited our input to your specific question. For me I recognize you're an adult who will and can make your own decisions and presumably you have other people in your life who are closer to you (i.e. family of docs) to assess your ability to handle the stresses of this life.

But that is what is controversial. We all wish you the best but I suspect many of us think this is a terrible idea. Typically on SDN you'd get a ton of people telling you so, because people tend to try to give their opinions about the life choices of people who ask specific questions rather than respond to the specific questions they ask.

Now even assuming this may be a terrible idea (which it may be), I don't see how diversity and

I agree wholeheartedly with LucidSplash's response. The controversial nature also stems from the fact that people who go into medicine do so knowing that it is harder, vastly more time consuming, and requires more sacrifice of oneself than most other careers. While it's clear that your reasons for asking about a 35 hour work week are valid, it is very easy to see it on the other side of the fence as "I want to be a doctor, but I shouldn't be required to do the same amount of work."

I fully agree that is part of the reason. There is an undertow of workaholism in medicine and an assumption that other people may be trying to take the easy way out. That doesn't make it right to suspect me of trying to do that, given that, I stated a valid medical issue. Whether some people abuse the system is beyond the point. My post asked to assume my condition is valid. The answer then may be that although someone with a valid medical condition could *theoretically* get reduced workload accommodations during medical education, this may not work in practice due to the workaholic professional culture and hostility toward any accommodations perceived to lower the level of effort required,.

 

[rokshana]

I am starting to realize that medical school culture may be a toxic place for someone with a disability requiring a reduced workload.

med school (and definitely residency) culture is toxic for someone without any disabilities, nevermind for someone that wants to do something different.

 

[Jc2008]

and are all those doctors in your family supportive of you going into medicine?

i'm from a medical family as well and they ALL were of the opinion NOT to go into medicine...and this was over 10 years ago...i'm surprised that they would be in favor of you going into medicine..supportive of you in what you decide to do, after all they are family, but many physicians don't necessarily want their children to follow n their footsteps in this day and age of medicine.

I'm not sure why that is. My mother immigrated here and redid her residency in her 40s to be able to continue practicing after coming from a 2nd world country. She loves what she does and doesn't want to ever retire. My father is a professor of medicine in Europe and MD, he loves his job. I'm surprised that you would be surprised that my family would support me in going into medicine. They are of the opinion that it's at least worth giving it a shot. I am the one actually most methodical about reaching my decision about this.

 

[LucidSplash]

Yeah, I guess that's why I found some of the responses condescending. I was not looking for people giving me life choice advice or make value judgments about whether it makes sense for someone with my condition to pursue a stressful career path. I was simply asking for logistics information about how such accommodations could /or could not work in medical school. The fact that people's biases are coming through in their answers. as a result of my question, is not a function of my question being controversial, but rather related to their particular unconscious beliefs about what a prospective doctor "should be like". Also note that I never said anything about having an uncontrolled anxiety disorder, only that I have some fatigue related to treatment for one. For all anyone knows, my disorder is controlled and I have no greater anxiety than anyone else. Again, a bias coming out in the answers. Would it make a difference if my fatigue was due to a bad heart valve? I have a feeling that the question would be perceived much less 'controversially' then, because some of this controversy may be just bias masquerading as genuine concern.

Well, you've said that you have tried other treatments but are on this one (with a life-limiting side effect that requires accommodation), your disorder qualifies as a disability, and that you're trying a new experimental treatment soon. As a physician hearing it, that all adds up to a severe condition that is refractory to a lot of treatment options.i never said uncontrolled. I said severe and difficult to control.

And yes, it WOULD be the same if the issue was from a heart valve. If you're going to invest the amount of time and effort into becoming a physician that this takes, you want to be able to practice for a good long time to make it worth it. If someone's physical condition isn't up to it, that's a concern.

We recently had a Med student who needed accommodation because she had a severe vasovagal response to seeing blood. Like all these contingency plans for what we were supposed to do if she passed out. On her required 3rd year surgery rotation. We followed all the rules and she ended up withdrawing of her own volition anyway because she couldn't do the work. I'm not sure if she's trying to get her condition treated or if she's withdrawn. But something like that is kinda a big deal for medicine. Another student withdrew after missing several days of work because he was "just too exhausted to get out of bed." We gave him some slack but it got to the point that it simply wasn't fair to him or the other students because he wasn't around half the time. We would have had to fail him. He seemed to think that because he wasn't planning to do surgery, we should just let him skate through. But you still have to be able to do the basic rotations and learn the basic stuff. There is physical stamina involved in what we do. And with due respect to your other degrees and knowing people who have obtained them, there is something different about the mental stress involved in medicine where the stakes involved are people's lives.

 

[deleted480308]

Yeah, I guess that's why I found some of the responses condescending. I was not looking for people giving me life choice advice or make value judgments about whether it makes sense for someone with my condition to pursue a stressful career path. I was simply asking for logistics information about how such accommodations could /or could not work in medical school. The fact that people's biases are coming through in their answers. as a result of my question, is not a function of my question being controversial, but rather related to their particular unconscious beliefs about what a prospective doctor "should be like". Also note that I never said anything about having an uncontrolled anxiety disorder, only that I have some fatigue related to treatment for one. For all anyone knows, my disorder is controlled and I have no greater anxiety than anyone else. Again, a bias coming out in the answers. Would it make a difference if my fatigue was due to a bad heart valve? I have a feeling that the question would be perceived much less 'controversially' then, because some of this controversy may be just bias masquerading as genuine concern.

It wouldn't make a difference to me. This training process requires a certain number of hours out of everyone and I don't think any program should be forced to make accommodations. I also don't recommend someone with difficulties beyond the avg student to do this to themselves, it's brutal in a way you just can't understand until it's too late and you are in it. You may dismiss opinions you don't like as bias or consider them misplaced concern but you should weigh the potential validity of them separate from that decision.

Medicine breaks people. I've seen psychiatric implications, marriages lost, physical health deterioration, and financial ruin.

 

[Jc2008]

Well, you've said that you have tried other treatments but are on this one (with a life-limiting side effect that requires accommodation), your disorder qualifies as a disability, and that you're trying a new experimental treatment soon. As a physician hearing it, that all adds up to a severe condition that is refractory to a lot of treatment options.i never said uncontrolled. I said severe and difficult to control.

And yes, it WOULD be the same if the issue was from a heart valve. If you're going to invest the amount of time and effort into becoming a physician that this takes, you want to be able to practice for a good long time to make it worth it. If someone's physical condition isn't up to it, that's a concern.

We recently had a Med student who needed accommodation because she had a severe vasovagal response to seeing blood. Like all these contingency plans for what we were supposed to do if she passed out. On her required 3rd year surgery rotation. We followed all the rules and she ended up withdrawing of her own volition anyway because she couldn't do the work. I'm not sure if she's trying to get her condition treated or if she's withdrawn. But something like that is kinda a big deal for medicine. Another student withdrew after missing several days of work because he was "just too exhausted to get out of bed." We gave him some slack but it got to the point that it simply wasn't fair to him or the other students because he wasn't around half the time. We would have had to fail him. He seemed to think that because he wasn't planning to do surgery, we should just let him skate through. But you still have to be able to do the basic rotations and learn the basic stuff. There is physical stamina involved in what we do. And with due respect to your other degrees and knowing people who have obtained them, there isn't something different about the mental stress involved in medicine where the stakes involved are people's lives.

I'm hearing a lot of circumstances where students could probably have benefited from some sort of accommodation but for whatever reason failed to get it. But this is a decision best left for the disability office on a case by case basis. I question whether there is a good reason why a student needs to spend 16 hours on a surgery rotation , when they want to practice outpatient FM or sleep medicine. I think not allowing them to "skate through" has more to do with tradition (I did it so they must do it) rather than a genuine training concerns. I would hate to see the poor soul who did well in all their pre-clinical classes, aced the USMLE, wanted to work doing outpatient preventive medicine but failed out of medical school because they were not capable of holding the extractors for 16 hours a day during a 2 month surgery rotation. Let's at least accept it for what it is, an institutionalized form a hazing based on tradition. Nevertheless it's required, I get it.

 

[Jc2008]

It wouldn't make a difference to me. This training process requires a certain number of hours out of everyone and I don't think any program should be forced to make accommodations. I also don't recommend someone with difficulties beyond the avg student to do this to themselves, it's brutal in a way you just can't understand until it's too late and you are in it. You may dismiss opinions you don't like as bias or consider them misplaced concern but you should weigh the potential validity of them separate from that decision.

Medicine breaks people. I've seen psychiatric implications, marriages lost, physical health deterioration, and financial ruin.

I think the way you state it here is accurate. I am considering this very seriously, separate from my concerns about bias. Point well made.

 

[ThoracicGuy]

I'm hearing a lot of circumstances where students could probably have benefited from some sort of accommodation but for whatever reason failed to get it. But this is a decision best left for the disability office on a case by case basis. I question whether there is a good reason why a student needs to spend 16 hours on a surgery rotation , when they want to practice outpatient FM or sleep medicine. I think not allowing them to "skate through" has more to do with tradition (I did it so they must do it) rather than a genuine training concerns. I would hate to see the poor soul who did well in all their pre-clinical classes, aced the USMLE, wanted to work doing outpatient preventive medicine but failed out of medical school because they were not capable of holding the extractors for 16 hours a day during a 2 month surgery rotation. Let's at least accept it for what it is, an institutionalized form a hazing based on tradition. Nevertheless it's required, I get it.

You learn alot about specialties that you rotate on as a student that are not your own as a resident. I see surgery rotations as the only way that future internists and FPs get to see what goes on with the surgical side of medicine. They have patients that will need surgeries or have had surgeries and it helps to give them some insight into what the patient may expect. You wouldn't believe the number of patients that I've had that wanted to talk to their family doctor prior to agreeing with surgery. It's not a wasted experience that is only built on an idea of hazing future doctors.

As a resident, I knew most of my students wouldn't go into surgery and that's ok. As long as they showed an interest in what they were doing and tried to learn something, that was the important thing. Most surgery student rotations are not 16 hour days of retractor holding...

 

[rokshana]

I question whether there is a good reason why a student needs to spend 16 hours on a surgery rotation , when they want to practice outpatient FM or sleep medicine.

you question it, because you aren't familiar enough with the process to see the value of it.

While people think they know what they want to do entering medical school, 3/4 of students change their mind during medical school.

 

[emergencycat]

I DMed you about this.

 

[LucidSplash]

I'm hearing a lot of circumstances where students could probably have benefited from some sort of accommodation but for whatever reason failed to get it. But this is a decision best left for the disability office on a case by case basis. I question whether there is a good reason why a student needs to spend 16 hours on a surgery rotation , when they want to practice outpatient FM or sleep medicine. I think not allowing them to "skate through" has more to do with tradition (I did it so they must do it) rather than a genuine training concerns. I would hate to see the poor soul who did well in all their pre-clinical classes, aced the USMLE, wanted to work doing outpatient preventive medicine but failed out of medical school because they were not capable of holding the extractors for 16 hours a day during a 2 month surgery rotation. Let's at least accept it for what it is, an institutionalized form a hazing based on tradition. Nevertheless it's required, I get it.

Did you not read the part about how we did try to give them accommodations? The student schedule here is not at all the same as the residents. They are treated very fairly and many students prefer to rotate here than at the main campus because of our "kindler gentler" approach. And a student going into family needs to know about surgery because he will have patient who have surgery. And he needs to know about perioperative care because he will have patients with gallbladder disease that gets worked up (by him) and colon cancer and thyroid problems. And the postop management to know warning signs to look out for for complications. Because many times patients call their primary care doc first. Individual medical schools don't make up the core competency areas/rotations that are demanded of medical students. Those are set by the AAMC. To be accredited, medical schools have to follow their standards and so we have to follow their standards in clinical rotations.

I'm not trying to fight with you. I haven't denied that you have a disability. Ive tried to give you thorough responses to your questions. Even this topic Inonlt replied to because you asked why this would be a "controversial" topic. To be fair, controversial probably isn't the right word. Having the potential to be inflammatory is probably a better description. No one here has any bearing on your acceptance to medical school or even make the rules we are explaining to you; we only live in the system and are giving you our perspective on your plans based on that.

Also, if anything, the first couple of years of medical school are less useful than the second half. I honestly don't care all that much how someone did on their USMLE. It tells me very little about someone's ability to be a good doctor and when I interview candidates (Wednesday first interview day for us) I only see it as a means to know if they are likely to be able to pass future tests like their inservice and their boards. How they do in clinical is much more important.