Disability accommodation during residency/medical school

[LucidSplash]

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Additionally, students spend much less time holding retractors and driving camera than you think. They round on patients in the morning and follow them in their periop course. They participate in team teaching rounds with the attending or fellow and the rest of the team. They learn basic things like changing dressings, pulling drains, removing sutures (all of which they will use in FM and other specialties). They learn basic suturing and procedures like placing NGTs, catheters, and other basic priciples of medicine. They get multitudes of formal lectures with attending as well as minilectures by me and my team to help them understand what is going on. Just like I learned a lot of useful information on my FM/IM/Peds/Neuro/ObGyn/Psych rotations. Not the least of which is how to identify when someone needs a consult in an area that isn't my specialty and how to communicate with that physician about my concerns in an educated way.

 

[LucidSplash]

Also, an idea. I do believe you have a passion for healthcare. But you also seem to have a passion for law in the area of the disability laws, etc. A possible area that you could explore if you decide not to try for medical school. Being serious here: same advice Is give my brother/sister in the same position.

 

[nlax30]

So obviously no one here has the exact same issue to over advice on the logistics of this but what we DO have is the experience of going through the training and so many of us feel that that experience is useful to someone looking at pursuing that particular training. Honestly it's probably some of the same advice I'd give to someone who is a little older with those same degrees looking at going back and doing med school. Sure there are positives and only you know in your heart if that's the only thing that would fulfill you, but it wouldn't be fair to want that person about the struggles, hardships and financial issues they can face. Especially if everyone else in their life is saying, "Sure, go for it!". Giving up another 6, 7, 8 years of your life to training and incurring $200,000+ in debt is not the time to realize that you got in over your head with unrealistic expectations.

So please don't take any of this advice on here as attacking or condescending as this has been a very nice and civil thread. I think a lot of us just feel that probably a majority of people going into the field have unrealistic expectations of this whole process and the potential toll it can take.

I do like the suggestion above of maybe looking outside the box in using your degree. I have a friend who went to law school though became interested in healthcare and now works in an admin capacity with a local teaching program.

Law job market can be tough, at least it was when my wife was looking many years ago, but the law degree does open other varied opportunities that others don't have.

 

[girlofgrace7]

Agree with the posters above. The reason for the fatigue (whether physical or mental) matters much less than the accommodations that will be required to complete training. I had many classmates with type I diabetes, anxiety/depression, a neuromuscular disorder, hypoplastic left heart syndrome s/p repair, cancer survivors, etc., but they were able to make medical school and residency work in a relatively uninterrupted way (and for the most part, unaccommodated other than maybe having to lose interview time 4th year to make up a rotation that happened during a surgery/hospitalization). The key is whether you can meet the requirements without making yourself miserable or more ill in the process. I've had anxiety and depression for as long as I can remember (but was too headstrong to take medication for it until 2nd year of residency) as well as hypothyroidism that makes me really fatigued. That said, when patients are sick and need to be cared for, unfortunately our health/well being tends to fall by the wayside. Law and business are difficult and great fields, but they are very different from medicine in that someone's life isn't on the line (which will likely exacerbate your anxiety disorder), they tend to be much less emotionally taxing (dealing with angry patients/families, patients dying, sad cases), and your time is never really your own because your patient comes first.

If you're wondering how med school curriculums work, look on med schools websites. Each school is so different in how they structure it. At my med school, it was usually 1-2 classes at a time (anatomy, metabolism and genetics, etc.) the first year plus a few longitudinal classes that met here and there. Second year was one organ system at a time (cardiology for 4 weeks, respiratory for 4 weeks, etc.). Our schedule required a lot of case-based learning, labs, etc. that couldn't be done on your own. Third year, you're mostly at the mercy of your residents and attendings. You can leave early I'm sure, but the bulk of your grade will come from how much you impress those people (and all of those evaluations will be sent to residency programs you apply to in your dean's letter). Fourth year shouldn't be a problem at all for you since you get to choose most of your rotations and can make them mostly clinic or whatever with the exception of like 4 weeks of surgery and an inpatient acting internship.

 

[NotAProgDirector]

I'm a bit late to this discussion, but perhaps can add something from a residency viewpoint. I've had several residents with disabilities, and I've tried to reasonably accommodate all of them. Some more successfully than others.

The ADA is a complicated law, and the reference at the top of this thread (in the first few posts) is a nice summary as to how it might affect residency programs. In the law, like medicine, there are few absolutes -- so it's impossible to say with 100% certainty what's legal, or required, by the ADA in any specific situation. However, a few generalities may be helpful in helping you think this through.

First, let's not lose sight of the purpose of the ADA -- to allow disabled individuals, with reasonable accommodations, to perform at the same level as non-disabled individuals. So, if you're a cashier and you have a back problem, and sitting on a stool fixes that problem, and having you sit on a stool doesn't create any huge hardship for me as an employer, then I have to accommodate that request. Where it starts to get sticky is when your accommodation is a request to change the nature of your job.

In general, the ADA is much more expansive in a schooling situation. A medical school might be required to decrease the number of classes you take per semester, for example -- assuming that the school doesn't use an integrated curriculum where this becomes impossible. During your clinical years they might decrease your clinical workload, give you more days off, etc -- all because as a student you're not fulfilling any essential function, you're just there to learn. If it takes you longer to learn the material at a slower pace, that's a completely reasonable accommodation.

When you come to residency, the rules change. The ADA becomes more strict, because now as an employee you're performing a service for your employer. Much of the conversation revolves around a single issue -- does the requested accommodation conflict with the essential functions of the job? If so, by requesting the accommodation you make yourself ineligible for the position, so any ADA protection ends. That is the point of many of the examples in the link on the first page. This is a very complicated concept, so perhaps some examples are in order.

Let's look at your situation. First, let's define what a typical residency work schedule would look like. You would have "busy" months and "elective" months. On elective, you'd work from 8-5 M-F with most weekends off. Let's assume that's a workable schedule for you without modification. On "Busy" months, you'd work 60-70 hour weeks, have 1 day off per weekend on average. You might work both weekend days one week, and then have 2 days off another, so that would be working 12 days in a row. You might also have a mixture of day and night shifts -- perhaps weeks with 5 night shifts in a row (often called "night float"). Although busy and elective months would be spread out as much as possible, it's likely the number of busy months might be much more than elective ones (especially early in training), so you should expect to do several busy months in a row. This is very vague, but is probably typical for many residency programs esp in psych. Remember that four months of psych internship or so is usually done in IM.

You have some illness which makes you fatigued, such that you do not think you can work a full schedule. So, what accommodations do you suggest would work? I see several options:

1. You get scheduled for a usual full schedule, and any time you feel fatigued you call in "sick". This is not acceptable. The ADA considers showing up for work regularly and reliably an essential function, esp in healthcare where a regular and reliable staffing is critical to patient safety.

2. You request to have "part time" work where your hours are 50% all the time. If training was simply morning and afternoon clinic, and then you'd only have morning clinic, this might work. But when you're working on the inpatient service, you can't just work 1/2 a day. This isn't menial labor that someone else can pick up what you've left off. You need to be present for your whole shift, and I can't redefine the shifts around your needs.

3. You request "part time" work where you work at 100% speed for 2 weeks, then have 2 weeks off. This is much more reasonable than options #1 and #2. I see two major problems -- I'd need to find someone else willing to work the other 50% (which is possible but not likely), and I'm not certain that this would actually address your disability (although that may be incorrect).

4. You request no night shifts. This is a non starter. Night shifts are a curricular part of training. medicine at night is different from medicine during the day. You can't just miss nights.

5. You work 100% during the week. But you need time off to recover, perhaps both weekend days each weekend. You're willing to swap -- so on elective months you'll work some busy weekends, to give yourself some additional rest time during the busy months. This is closer to a reasonable option. However, I still think it's problematic for several reasons, mainly one of continuity. It's better for patients if the same people care for them over an extended period of time. So, if you make more coverage swaps in the schedule, this can create problems for patients and your coworkers. All that said, this is probably the best solution of all of those I've detailed, and would have some chance of passing legal muster. Note that it still gives you 12 workdays in a row when on your electives, and if busy months outnumber electives you simply don't have enough weekends to make it work.

Perhaps I'm missing some other option, I'm happy to discuss. Several other problems with this plan:

A. Residency programs have strict caps on the number of residents allowed at all times. If you were to complete a residency at 50% speed, unless I have a matching resident at 50% I'm always going to be short workers. The ADA does not require employers to hire new people to do the work that someone with a disability can't.

B. Residency contracts are one year at a time. If I'm not happy with your performance, I can simply decide not to offer you a contract for the next year. I'm not certain whether the ADA protects you from this or not. Perhaps there's an "implied" contract for your second year. But maybe not.

C. If you end up in a disagreement with your employer about all of this, they will simply fire you and then plan to fight it out in the courts. And you've mentioned above that you don't want that, and courts take forever to settle things.

So, bottom line:

1. Getting a spot with limits on how much you're able to work will greatly limit your ability to obtain a position.
2. Going to a top notch program, being a star performer, and applying to less competitive / more flexible programs will increase your chances of success.
3. Although it's legal to hide your disability until you're hired, there is a price to pay for that. If your employer feels they cannot (and do not have to) accommodate your disability because it would alter the essential functions of the position, you will be let go. You'll then need to sue, or to reapply. Alternatively, you could be 100% open about the situation -- in that case you'll presumably get less interest/offers, but programs that do consider you know what they are getting into and will be much more willing to work with you on the issue. Also, if you're open about the situation and someone takes you, they then will have a much harder time convincing a court that they cannot accommodate your disability -- since they hired you with full knowledge of the situation.

 

[Gastrapathy]

aPD always gives great advice but...if you tell people about your disability and they know you are a lawyer, that combo is going to turn a lot of people off.

 

[NotAProgDirector]

... a good point. I should have finished with summary point #4:

4. This is a very bad idea, and will likely end badly. Any problems in medical school (i.e. failing anything), poor step scores, poor clinical evaluations, etc will all sink your chances further.

 

[Jc2008]

I'm a bit late to this discussion, but perhaps can add something from a residency viewpoint. I've had several residents with disabilities, and I've tried to reasonably accommodate all of them. Some more successfully than others.

The ADA is a complicated law, and the reference at the top of this thread (in the first few posts) is a nice summary as to how it might affect residency programs. In the law, like medicine, there are few absolutes -- so it's impossible to say with 100% certainty what's legal, or required, by the ADA in any specific situation. However, a few generalities may be helpful in helping you think this through.

First, let's not lose sight of the purpose of the ADA -- to allow disabled individuals, with reasonable accommodations, to perform at the same level as non-disabled individuals. So, if you're a cashier and you have a back problem, and sitting on a stool fixes that problem, and having you sit on a stool doesn't create any huge hardship for me as an employer, then I have to accommodate that request. Where it starts to get sticky is when your accommodation is a request to change the nature of your job.

In general, the ADA is much more expansive in a schooling situation. A medical school might be required to decrease the number of classes you take per semester, for example -- assuming that the school doesn't use an integrated curriculum where this becomes impossible. During your clinical years they might decrease your clinical workload, give you more days off, etc -- all because as a student you're not fulfilling any essential function, you're just there to learn. If it takes you longer to learn the material at a slower pace, that's a completely reasonable accommodation.

When you come to residency, the rules change. The ADA becomes more strict, because now as an employee you're performing a service for your employer. Much of the conversation revolves around a single issue -- does the requested accommodation conflict with the essential functions of the job? If so, by requesting the accommodation you make yourself ineligible for the position, so any ADA protection ends. That is the point of many of the examples in the link on the first page. This is a very complicated concept, so perhaps some examples are in order.

Let's look at your situation. First, let's define what a typical residency work schedule would look like. You would have "busy" months and "elective" months. On elective, you'd work from 8-5 M-F with most weekends off. Let's assume that's a workable schedule for you without modification. On "Busy" months, you'd work 60-70 hour weeks, have 1 day off per weekend on average. You might work both weekend days one week, and then have 2 days off another, so that would be working 12 days in a row. You might also have a mixture of day and night shifts -- perhaps weeks with 5 night shifts in a row (often called "night float"). Although busy and elective months would be spread out as much as possible, it's likely the number of busy months might be much more than elective ones (especially early in training), so you should expect to do several busy months in a row. This is very vague, but is probably typical for many residency programs esp in psych. Remember that four months of psych internship or so is usually done in IM.

You have some illness which makes you fatigued, such that you do not think you can work a full schedule. So, what accommodations do you suggest would work? I see several options:

1. You get scheduled for a usual full schedule, and any time you feel fatigued you call in "sick". This is not acceptable. The ADA considers showing up for work regularly and reliably an essential function, esp in healthcare where a regular and reliable staffing is critical to patient safety.

2. You request to have "part time" work where your hours are 50% all the time. If training was simply morning and afternoon clinic, and then you'd only have morning clinic, this might work. But when you're working on the inpatient service, you can't just work 1/2 a day. This isn't menial labor that someone else can pick up what you've left off. You need to be present for your whole shift, and I can't redefine the shifts around your needs.

3. You request "part time" work where you work at 100% speed for 2 weeks, then have 2 weeks off. This is much more reasonable than options #1 and #2. I see two major problems -- I'd need to find someone else willing to work the other 50% (which is possible but not likely), and I'm not certain that this would actually address your disability (although that may be incorrect).

4. You request no night shifts. This is a non starter. Night shifts are a curricular part of training. medicine at night is different from medicine during the day. You can't just miss nights.

5. You work 100% during the week. But you need time off to recover, perhaps both weekend days each weekend. You're willing to swap -- so on elective months you'll work some busy weekends, to give yourself some additional rest time during the busy months. This is closer to a reasonable option. However, I still think it's problematic for several reasons, mainly one of continuity. It's better for patients if the same people care for them over an extended period of time. So, if you make more coverage swaps in the schedule, this can create problems for patients and your coworkers. All that said, this is probably the best solution of all of those I've detailed, and would have some chance of passing legal muster. Note that it still gives you 12 workdays in a row when on your electives, and if busy months outnumber electives you simply don't have enough weekends to make it work.

Perhaps I'm missing some other option, I'm happy to discuss. Several other problems with this plan:

A. Residency programs have strict caps on the number of residents allowed at all times. If you were to complete a residency at 50% speed, unless I have a matching resident at 50% I'm always going to be short workers. The ADA does not require employers to hire new people to do the work that someone with a disability can't.

B. Residency contracts are one year at a time. If I'm not happy with your performance, I can simply decide not to offer you a contract for the next year. I'm not certain whether the ADA protects you from this or not. Perhaps there's an "implied" contract for your second year. But maybe not.

C. If you end up in a disagreement with your employer about all of this, they will simply fire you and then plan to fight it out in the courts. And you've mentioned above that you don't want that, and courts take forever to settle things.

So, bottom line:

1. Getting a spot with limits on how much you're able to work will greatly limit your ability to obtain a position.
2. Going to a top notch program, being a star performer, and applying to less competitive / more flexible programs will increase your chances of success.
3. Although it's legal to hide your disability until you're hired, there is a price to pay for that. If your employer feels they cannot (and do not have to) accommodate your disability because it would alter the essential functions of the position, you will be let go. You'll then need to sue, or to reapply. Alternatively, you could be 100% open about the situation -- in that case you'll presumably get less interest/offers, but programs that do consider you know what they are getting into and will be much more willing to work with you on the issue. Also, if you're open about the situation and someone takes you, they then will have a much harder time convincing a court that they cannot accommodate your disability -- since they hired you with full knowledge of the situation.

Aprogdirector thanks for your great post. I appreciate the detail and options. I do believe I would be able to swing busier months at times. option 5 sounds best probably although I could probably do 3 as well, although I don't need to cut my time by 50%. One thing that I believe is different is what happens if you don't disclose and then make the request after being accepted. They can definitely deny it, but you don't get fired if they do, as long as you're willing to try the regular schedule w/o accommodations. Of course, you have the right to quit, but I don't think that would be beneficial. Thanks again.

 

[Jc2008]

So obviously no one here has the exact same issue to over advice on the logistics of this but what we DO have is the experience of going through the training and so many of us feel that that experience is useful to someone looking at pursuing that particular training. Honestly it's probably some of the same advice I'd give to someone who is a little older with those same degrees looking at going back and doing med school. Sure there are positives and only you know in your heart if that's the only thing that would fulfill you, but it wouldn't be fair to want that person about the struggles, hardships and financial issues they can face. Especially if everyone else in their life is saying, "Sure, go for it!". Giving up another 6, 7, 8 years of your life to training and incurring $200,000+ in debt is not the time to realize that you got in over your head with unrealistic expectations.

So please don't take any of this advice on here as attacking or condescending as this has been a very nice and civil thread. I think a lot of us just feel that probably a majority of people going into the field have unrealistic expectations of this whole process and the potential toll it can take.

I do like the suggestion above of maybe looking outside the box in using your degree. I have a friend who went to law school though became interested in healthcare and now works in an admin capacity with a local teaching program.

Law job market can be tough, at least it was when my wife was looking many years ago, but the law degree does open other varied opportunities that others don't have.

thanks nlax, this was helpful. I have actually looked into disability law and its a possibility, among a few others. I would prob try some other medical route first tho.

 

[Jc2008]

Also, an idea. I do believe you have a passion for healthcare. But you also seem to have a passion for law in the area of the disability laws, etc. A possible area that you could explore if you decide not to try for medical school. Being serious here: same advice Is give my brother/sister in the same position.

Thanks for your latest posts. Some good points and advice. Much appreciated. I have looked into disability law, I am actually doing something related to that right now.

 

[Jc2008]

Hey @Jc2008, maybe an analogy will be helpful?

Imagine if someone decided they really wanted to become a surgeon at age 50. They'd have to go through med school, residency, fellowship. By then they'd be over 60. So they'd start as a new attending at age 60+, trying to build a practice, make partner, take call, etc.

Also we know it's illegal to discriminate against age.

Now suppose this older person starts a thread here on SDN asking for advice. Not only about whether they should pursue medicine, but also whether med schools and residency programs are likely going to allow them to go part-time? That's because 50 year olds can and sometimes do face legitimate difficulties with their health, deteriorating stamina, vision, dexterity, perhaps even some chronic diseases, etc., that most 20 year olds probably don't face.

So people reply and say, not saying this 50 year old person can't do it or shouldn't do it. But there are likely going to be pretty big challenges on the road ahead. And the part-time thing might not work.

Similarly, I don't think most people are saying you don't have a legitimate disorder, nor that it's not illegal to discriminate against you, nor that you can't necessarily succeed, nor that you shouldn't try, and so on, but they're trying to relate to you the challenges you'll likely face. In light of these challenges, is it the most prudent decision for you?

I think that's where most people here are coming from, at least from what I can tell.

I like your analogy, I think those are good points and I also like the later posts. I think the way I worded my question initially is too broad. But I received some good posts and some great PMs today so I'm happy with what I've learned here, even if I don't always agree with how things are done.

 

[Goro]

I want to follow up my young colleague's wise words with the observation that the #1 reason my school loses students to LOA, dismissal or withdrawal is to mental health issues. People need to approach a career in Medicine eyes open.

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

 

[PsychPhDone]

what are TDs?

Training Directors. Might be called Program Directors. Too many acronyms -- either way, I mean residency directors. Seems the esteemed aProgDirector replied to your thread.

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.

The best indication of whether your plan is likely to work out is if you've generated reasonable solutions to all stages ahead of you. First and second year success doesn't equal third and fourth year success doesn't equal residency success. I think it's only likely to work out if you really thoroughly investigate everything now. When making a big investment of money and/or time, I usually encourage people to identify the most likely potential roadblocks ahead of time - NOT one step at a time. Are these problems something that can be reasonably be solved (i.e., without reliance on luck)? Be sure to anticipate these obstacles for med school, residency, and jobs -- they've already been articulated clearly on this board.

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.

Go to their contact page. If they have suggestions for whom to email for what, email is fine. Otherwise call and say you're a prospective med student and wanted to speak with a counselor who is familiar with accommodations for med students.

Best of luck, whether it's with medicine or some other path.

 

[AdmiralChz]

This has been an interesting thread to review, but some things jumped out at me while checking it out. I hate to be direct, OP but some of these quotes you posted ring some alarms.

Could someone fill me in on the schedule I should expect each year of med school assuming no accomodation? This would be helpful:
1) How many classes each semester, each year? In how many of those classes can I expect grading to be based on exams?
2) Are there finals + midterms or just finals?
3) What hours should I expect to be in class and what would my daily schedule look like?
4) What would my daily schedule look like during year 3 and 4? How many hours at each activity and total per week?

Here is the question of medical school and how flexible it is. As @Raryn, @Goro, and others have said, Medical school is not as straight-forward as Undergrad/Law/Business school. These questions show a complete lack of understanding of the structure of preclinical and clinical training which you must have if you are going to jump in. Medical school is often described as "drinking from a firehose" with the incredible amount of information thrown at you, and there is no way around being responsible for ALL of it. I am concerned that you are heading towards medical school without abandon but I'm not sure you understand how Medical School is organized.

2) Schools do not have to be "interested" in accommodating. They have to follow the law. They cannot ask for need for accommodation during interview and you are not required to disclose it and they cannot retaliate (hard or soft retaliation) for your not telling them upfront. If that were the case, nobody with health problems would be graduating anywhere. Furthermore, they have a built in incentive to make it work b/c you're paying them and not the other way around.

I am sure Goro and others can elaborate because I'm a little rusty on the data, but it is generally accepted that it costs schools far more to train you in medicine than your tuition so the logic here is a little flawed.

I know people who have received accommodations in medical school such as extra time, note takers, 20% extra time on USMLE etc.

While such things I am sure are available, I also know notations appear on your transcript about it. No, your personal health information is not released, but when we get residency applicants every so often their USMLE score comes with a bit of an asterisk saying that accommodations were provided to the student. People can interpret this as they want, and for some programs this may be a red flag if it's paired with other information in the MSPE (e.g. a potential 6-year medical school track). For reasons @aProgDirector stated above, this may very well turn people off to your application and there isn't really anything you can do to "prove" bias there.

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 think you'd be surprised how many qualify for disability assistance and don't go for it. Out in the world of having an actual job outside of school (which you have been in almost continuously it seems, unfortunately), particularly in medicine, work ethic and production is supremely important. I had very severe ADHD (diagnosed as a child) which caused severe study and test anxiety, but I had to overcome that and deal with it because no one is really going to care when the crap hits the fan as a physician. If you can't be counted on to act in an emergency (and yes, there are emergencies in Psychiatry - see active suicidal ideation, acute mania on an inpatient ward) or worse, refuse to place yourself in such a situation (you'd have to be exposed to these things during residency at the VERY least) then you are doing your colleagues and, more importantly, your patients a disservice.

It looks like 10-15% of advertised residencies (at least in PEDS) are part time, so that's a good sign.

I've never personally heard of a "part time" residency. Occasionally life events happen - people get sick, severe illness in the family - which forces people to take leaves of absence, but part time during residency doesn't work for the reasons everyone else has brought up. For pregnancy in almost all programs, you are essentially forced to take all of your vacation (3 weeks) plus sick leave (1 week) and any additional time (2-4 weeks) will be taken as unpaid leave and added on to your residency at the end. Some of my colleagues have worked out a "research" block during a potential unpaid interval but, at least in Anesthesiology, our certifying board allows a maximum of 3 months of research in a standard 4 year track. Almost everyone that has a child or has a severe life event in residency that I know has ended up owing some time at the end. [EDIT: might be 6 months in 4 years, but the point is the time spent in research cannot be unlimited]

Also, resentment keeps coming up. I don't think anyone here is being resentful but some have mentioned that people may resent me for being part time. That unfortunate, but it's not a consideration, because resentment from some quarters will always exist towards someone requesting an accommodation. I've had people be resentful towards me at my current job and in law school.

To me, this is perhaps the most alarming. It's a lack of professionalism and courtesy to your colleagues. You really don't seem to mind that your colleagues, particularly in residency, will have to work more in terms of call and days worked because of your condition. That won't generate just resentment, it could result in open revolt.

Then there is the patient care aspect. If you work half a day on an inpatient ward (including psychiatry ward), you'd have to regularly hand off care of your patients to another provider. Increasing hand offs and turnovers in patient care are one of the biggest dangers facing clinical medicine right now. It's been shown in the surgery, anesthesiology and critical care literature that more hand offs is associated with worse clinical outcomes. I'd expect the same to be true in the emergency room and on inpatient wards, but I do not typically rotate there. The same is true in nursing, which is why there is a trend to 12 hour instead of 8 hour shifts, particularly on inpatient/critical care units.

I really don't mean to be blunt or offensive to you, OP so please do not take this as a direct attack. But I really am troubled by your lack of full understanding of the gravity of what you are suggesting for your future. I would strongly advise you to sit with an academic advisor, likely from a local medical school, and lay out your situation and get his or her input. Most of what I and others have said is anecdotal, but @Goro and @aProgDirector have more practical experience which continues to be largely brushed aside. Finally, someone brought up Technical Standards which each school has - I am not sure fairly certain the solutions you have proposed would not fulfill them for my medical school (a large public university). Your solutions for residency likely wouldn't be acceptable at my institution either (a large, public research-based hospital). Best of luck, do some serious soul searching about this.

Last bit of advice - our PAs and NPs routinely work no more than 40 hours a week and several work on a PRN ("as needed") or part-time basis. I honestly think this is a better solution for you, but the schooling may very well be equally resistant to augmentation.

 

[Goro]

More like drinking from a fire hose while running after he fire truck.

Here is the question of medical school and how flexible it is. As @Raryn, @Goro, and others have said, Medical school is not as straight-forward as Undergrad/Law/Business school. These questions show a complete lack of understanding of the structure of preclinical and clinical training which you must have if you are going to jump in. Medical school is often described as "drinking from a firehose" with the incredible amount of information thrown at you, and there is no way around being responsible for ALL of it. I am concerned that you are heading towards medical school without abandon but I'm not sure you understand how Medical School is organized.

This is true for MD schools. A decent research department can make more money on indirect from a few RO1s than an entire class paying tuition.
DO schools, lacking the research infrastructure, can get away with a tuition-driven system.

I am sure Goro and others can elaborate because I'm a little rusty on the data, but it is generally accepted that it costs schools far more to train you in medicine than your tuition so the logic here is a little flawed.


I think it may be the other ay around, based on chats I've had with our Deans of Student Services. Students who request accommodation have to prove their needs, on their dime. And year to year I'd say maybe 2-4 pole, tops, at my school, get accommodations ....mostly in the form of a quiet test room or extra time. The OP's need for accommodation would lead to dismissal for the inability to perform specific technical standards. Students have to sign an agreement that they can perform the tasks we expect of them, and going through md school with two weeks on, two weeks off won't work.


I think you'd be surprised how many qualify for disability assistance and don't go for it. Out in the world of having an actual job outside of school (which you have been in almost continuously it seems, unfortunately), particularly in medicine, work ethic and production is supremely important. I had very severe ADHD (diagnosed as a child) which caused severe study and test anxiety, but I had to overcome that and deal with it because no one is really going to care when the crap hits the fan as a physician. If you can't be counted on to act in an emergency (and yes, there are emergencies in Psychiatry - see active suicidal ideation, acute mania on an inpatient ward) or worse, refuse to place yourself in such a situation (you'd have to be exposed to these things during residency at the VERY least) then you are doing your colleagues and, more importantly, your patients a disservice.

 

[Promethean]

I'd planned on wandering off and letting you dismiss what I'd tried to tell you, but I want to make one more go of it.

Medicine is different than anything else you've done or thought to do. What works or makes sense in any other field may not apply. That isn't an opinion statement about how it should or shouldn't be. It is a fact statement about the actual circumstances which prevail in this profession and in the education and training that leads into it. Medicine is not a path which is accommodating, for several reasons.

1) Medicine loves tradition, and unfortunately one its traditions is an expectation that physicians be superhuman. There is a culture within and without the profession that expects students and trainees to work longer, endure more, and sacrifice without complaint. The very idea of accommodating disability runs counter to that culture, because it acknowledges human frailty - a trait which physicians, as humans, undeniably have... and which they never the less are expected to deny. This may be something which needs to change, but it hasn't yet.

2) There is significant stigma surrounding mental/behavioral health diagnoses. In some states, having a documented history treatment for a psychiatric illness can cause delays in obtaining a license, if it can be done at all. This means that these issues go under treated in physicians, and that is a circumstance which is only just beginning to really be addressed. I'm active in mental health advocacy at my school and beyond, and let me tell you there is still so much work to be done. There are still a lot of people who would argue that it is acceptable to discriminate against a physician with a mental illness. Some of those people are going to be in power over you, in medical school and in residency. That is an unfortunate truth.

3) Medicine is a narrow track. If you stumble off at any point in the process, you don't get to just get back on. If one medical school dismisses you, another will not take you on. (Well, there's always the Caribbean...) If you complete medical school, you may find yourself unable to find a residency. At all. If you get into one, and are fired or don't have your contract renewed, you are unlikely to find another spot, and if you do, it may not even be in the specialty that you had wanted. There are innumerable risks and challenges along the way, and any one of them could be adequate to end your progress and close off the hope that you could take another approach.

You assumed that my mention of your treatment plan meant that I was challenging it or saying that you should do anything differently that you have, when that wasn't my intent at all. I was naming it as one of the parameters which makes your situation difficult, but not telling you what you should do about that. It is a fact, which I was acknowledging, as when I later drew the analogy that gravity and altitude are among the factors which make Everest hard to climb. I see your ambition as an unstoppable force, and medical school/residency as an immovable object. I'm trying to warn you that there will be a collision, and that I believe the physics of this event do not favor you.

You assumed from what I said that my significant other flamed out of medical school. She did not. She is an MD/PhD who is doing telephone based customer service for a living. She made it through to get her degrees, but ended up with an inpatient psych admission during intern year. And then a few suicide attempts after, as she coped with the enormity of grief over what she had lost, as she learned how impossible it was to find a way back onto the track. (She is doing *much* better now, not least because she has stopped trying to re-enter the fields for which she had trained.) Medicine is a very small world. You talk about resentment as though it is a trivial matter, because you don't appreciate how much power an off-the-record phone call from a Dean, an PD, etc. can have to make or break a career.

I will say it one last time: You may be able to make something work out, and I would be one of the folks cheering most for you if you can. I have a very personal reason to support making medical education and training more humane, so that there are fewer casualties of the process like this person who I love who was broken by it. But you'd better be damned sure that you are doing this for the right reasons, and that you have an incredible safety net and a solid back up plan. "I'm not willing to even consider other options" can be code for "I'm determined" or it can mean "I'm going to self-destruct if this doesn't work." I've seen a lot of the latter, and that is why I have taken my time to try to warn you.

I get that you just wanted logistics about how to do what you want to do, and I am glad that others have provided those answers. I certainly don't want you to think of me as adversarial to you, in case I could ever be helpful to you in any way. I wish you all the best in your endeavors and hope you will keep us informed of your progress.

 

[NotAProgDirector]

Aprogdirector thanks for your great post. I appreciate the detail and options. I do believe I would be able to swing busier months at times. option 5 sounds best probably although I could probably do 3 as well, although I don't need to cut my time by 50%. One thing that I believe is different is what happens if you don't disclose and then make the request after being accepted. They can definitely deny it, but you don't get fired if they do, as long as you're willing to try the regular schedule w/o accommodations. Of course, you have the right to quit, but I don't think that would be beneficial. Thanks again.

You are correct. If you request an accommodation and it is declined, then you can continue working without it. If your request includes multiple accommodations, my answer might be to support some and not others.

All that said, I'm concerned you're seriously underappreciating how difficult the path you've laid out is. You could easily end up much more in debt, and at another dead end. Tread carefully.

 

[ssttrrbbk]

There are part time residencies but you usually have to split with another resident. That would include fifty percent pay and you could not work eighty percent. Your residency would also be double the length in years. Part time residencies are rare.


My personal two cents is that I got accommodations after an accident 3rd year for a rotation. It was a fight with the department and the only accommodation was that I delay my test and not do call. That was a huge fight and I can't say I got it. They told me I had to take the test then but could retake if I failed. It was such a frustrating and tiring process after two weeks off and three days in the hospital that I almost gave up and was going to re do the rotation I was already 10/12 weeks into. The dean was on my side and tried to advocate but they don't have a lot of control of how people treat you on rotations.

As of residency aprogdirector had great points. Ultimately it's hard because they can't have someone else do the other twenty percent to your eighty percent for inpatient rotations.

 

[mvenus929]

A few additional points--

I'm a 3rd year peds resident with no preexisting issues. I'm always exhausted. I'm on an outpatient rotation now, but because we still have to take jeopardy call and help cross-cover on weekends so our friends on the wards can have some time off, I'm still running low on sleep. To say nothing about the switching back and forth between days and nights in rapid succession. I cannot fathom how someone with baseline issues with fatigue would make it through residency. Med school, maybe. But not residency. And I'm in peds.

There are more logistical issues than you think for a part-time position. For one, they would have to take fewer residents overall even if you had someone to share your time with you, because you two would spend two years as an intern, two years as a second year, etc. It's not as simple as taking two people for one position and moving you up and back down 3-4 years later. So the year after you start, they'd have to take one less intern because they'd still have someone in an intern position. You'd be able to move up to second year with that class, but then the following year, they would need one less person going to the second year, and so on. And I can't imagine how it would be any easier to let you work 80% time. That might work once you're past residency, but that's it.

 

[0ncogene]

http://www.medscape.com/viewarticle/870793?src=soc_fb_161113-pm_mscpedt_news_biz

'Whistleblowers' Say Medical Residency Discriminates When Illness Strikes

 

[NotAProgDirector]

I'm not sure that the examples in this article help very much. Overall I find the article poorly written, and several of the examples have significant holes in the story.

The three cases in the article are:

1. A woman who is a PGY-4 surgical resident who becomes paralyzed after a spinal infection of some sort. Her issue really comes down to several issues: A) can the program develop safe techniques such that she can operate, and is she still able to operate at the PGY-4 level (or due to her new disability, does she need additional training to compensate for it), B) is the cost of whatever equipment is needed for her "reasonable", and C) can she be accommodated into the program after a long absence.

I can't comment on A or B -- that's up to a surgical program to decide. But I know there are paralyzed surgeons who can operate, so it can be done - but will depend upon the level of the paralysis, etc. But C is a real problem. Each surgical program has a certain number of chief residents who need a specific number, and types, of cases. Now that this resident has been out of training for years, it's not so easy to bring her back for the 100+ cases she's missing. I'm assuming that a chief is involved with every case taken to the OR. If so, adding her into the schedule might take enough cases from other chiefs such that they don't have enough - and that's not fair either. Plus, as mentioned, she might need additional cases to ensure that she's actually competent. So it's not so straightforward to just bring her back. (If the program has OR cases where no chief is involved, then that's a different story -- she could then work those extra cases).

Note that had she been an IM resident, this likely wouldn't be a problem at all. If one of my residents was in the same situation and wanted to return 1 year later, we'd make it happen. I have plenty of "extra cases" to manage -- multiple uncovered hospitalist teams -- so there's always clinical work to be done. The problem here is that the total number of surgical cases might not allow for an "extra" resident, and it would be near impossible for them to create an opening for her.

2. The second case is a psych resident who was treated for a malignant renal tumor. This case we clearly don't have all of the facts. If they just fired her for this, that's wrong. But the only description in the article is that she "missed time and did not respond to calls when it was aware she was attending appointments relevant to her cancer treatment" It's clear (to me) that there is much more to the story, and we can't say anything meaningful without the whole story. I will point out that the image is somewhat ridiculous -- I have no idea why this psych resident's picture is in some sort of full protective gear including a bouffant hat.

3. The third case is a very interesting problem. A student with a history of a resected brain tumor goes to medical school and has a recurrence requiring surgery, and develops some increased symptoms and problems. They graduate from medical school and enter a peds residency, and then run into problems and ask for a decreased work schedule to accommodate their illness. Specifically, she requested decreased hours and no night shifts.

This case raises some very interesting questions:

A. Is it reasonable to decrease the total hours per week, and increase the total length of training? Unfortunately, some of the rotations we have are 60+ hours per week, and it would be difficult to make them have less hours without compromising patient continuity. It would be possible (perhaps) to be on an inpatient service for a week, then off for a week, and repeat -- and increase the length of training. This would have some effect on the other residents in the program, and would wreck havoc with the GME cap for the program, although if the program is big enough this won't be a huge problem. But that's not what she's requesting (I think). And if we did this, the resident would need to understand that they would only get 1/2 a salary (since they are only working every other week). Alternatively I guess they could do 1 week on service and then 1 week of outpatient/elective, if I was willing / considered it reasonable to pay a resident for increased elective time because of their illness.

B. Is it reasonable to not have the resident work night shifts? I personally do not feel this is a reasonable accommodation. Night shifts are part of the educational curriculum, as night medicine is different from day medicine. We would not allow a resident to pay other people to cover their night shifts, nor would we allow one spouse of a married couple to take the night shifts of the other. The resident might argue that based on their planned career working nights will not be an issue, but we have residents do many tasks/services that are not 100% germane to whatever they think their career is. Perhaps this is a fault of the system, but it is what it is. An essential function of the job is working night shifts -- you can't accommodate it away. Others may disagree.

Note that just because her doc wrote her a note that she can't work night shifts, that doesn't mean that I have to accommodate it. I have seen this create a Catch-22 for the resident. Resident sees physician who writes note saying resident can't do XYZ. Program decides that XYZ is a critical part of the program, and therefore resident not longer qualifies for position and is let go. Resident says "wait, I'll do XYZ". Program says "Sorry, you can't, a physician has said it's impossible." This is why it's critical to work with your program when trying to decide these things, and come up with a mutually acceptable plan.

 

[deleted367183]

Hi! I am a mere medical student, but I just wanted to comment a bit. Others have spoken about residency and clinical rotations. I had a thought about the preclinical years.

My program has a newly remodeled systems-based curriculum (first GI, then MSK, etc.). Now, no med school would WANT to do this, but there's a way it could work. You would have to show up to all in-person encounters just like any other student in your class. Discussion groups, clinical skills, anatomy lab, etc. There is a lot more of this than you'd think, believe me. But THEN you would need to get permission to take the recorded/lecture-based content + exams at a slower pace. As in, you finished all the dissection and ancillary content for GI, but you still have three weeks of lecture, plus weekly tests and final exam, to complete. Your program is not going to want to hear it, but in the era of recorded lectures, this is definitely doable. At the end of M2, you would have a certain amount of lectures and tests to finish before you could take the USMLE and be promoted.

A friend of mine sought to do something like this when she got pregnant. She wanted to listen to last year's lectures on her own time and take weekly tests and exams EARLIER
than scheduled to clear the decks for her baby's arrival. This was turned down without discussion...and this was an excellent student in one of our admittedly easier blocks. This is also a school--I speak from personal experience--that routinely accommodates disabilities. (Pregnancy is not a disability, but still.) (You can look in my history for more of my story.)

I wonder if this wouldn't work better in the Caribbean's trimester system? 3 entering classes per year, so 2 chances per year to pick up a missing lecture? Just a thought.

 

[ThoracicGuy]

Hi! I am a mere medical student, but I just wanted to comment a bit. Others have spoken about residency and clinical rotations. I had a thought about the preclinical years.

My program has a newly remodeled systems-based curriculum (first GI, then MSK, etc.). Now, no med school would WANT to do this, but there's a way it could work. You would have to show up to all in-person encounters just like any other student in your class. Discussion groups, clinical skills, anatomy lab, etc. There is a lot more of this than you'd think, believe me. But THEN you would need to get permission to take the recorded/lecture-based content + exams at a slower pace. As in, you finished all the dissection and ancillary content for GI, but you still have three weeks of lecture, plus weekly tests and final exam, to complete. Your program is not going to want to hear it, but in the era of recorded lectures, this is definitely doable. At the end of M2, you would have a certain amount of lectures and tests to finish before you could take the USMLE and be promoted.

A friend of mine sought to do something like this when she got pregnant. She wanted to listen to last year's lectures on her own time and take weekly tests and exams EARLIER
than scheduled to clear the decks for her baby's arrival. This was turned down without discussion...and this was an excellent student in one of our admittedly easier blocks. This is also a school--I speak from personal experience--that routinely accommodates disabilities. (Pregnancy is not a disability, but still.) (You can look in my history for more of my story.)

I wonder if this wouldn't work better in the Caribbean's trimester system? 3 entering classes per year, so 2 chances per year to pick up a missing lecture? Just a thought.

No. US med schools are not the diploma mills of the Caribbean and don't need a trimester system.

 

[deleted367183]

> No. US med schools are not the diploma mills of the Caribbean and don't need a trimester system.

Understood. I meant that maybe OP would have better luck stretching out a program if s/he were in a trimester school. Like I said, just a thought.

 

[npappasan]

I had read your "maybe one class less per term" as "maybe one class per term." That was where I initially got the sense that you were not being realistic.

This...

 

[Promethean]

> No. US med schools are not the diploma mills of the Caribbean and don't need a trimester system.

Understood. I meant that maybe OP would have better luck stretching out a program if s/he were in a trimester school. Like I said, just a thought.

Whether semester or trimester, the US system doesn't do multiple starts per year. It isn't a la carte like undergrad.

 

[Instatewaiter]

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

While it seems everyone is treating you with kid gloves, I am here to be harsh. It is my job. There are so many red flags in your posts in this thread that I have to wonder if you are a troll or just clueless.

First, you seem more entitled than you realize. This will likely come off in your interviews. Realize that unlike law school or your MBA program, medical schools have an affirmative obligation to prevent people who will be dangerous physicians from becoming physicians. You seem unable to perform the requirements of medicine, much less medical school/residency and are requesting accomodations with fundamentally change the jobs required in medical school, residency and beyond.

Next, the accommodations you are looking for are very unlikely to happen. Furthermore, were they to happen, your colleagues are going to be exceptionally resentful. This even, more than getting the accomodations, is going to be one of your bigger hurdles (your biggest actually surviving training). I have seen residents essentially force out a co-resident who wasn't carrying her load and taking extra days off. What you are planning/asking for is another level entirely.

Third, medical school is much, much more stressful than law and business. This is not to be self congratulatory but from experience. My wife is a trial lawyer and we have been together through law school, multiple bar exams, multiple firms, and essentially my entire training. She tells me the road I have been through, the hours, the stress and the requirements are so exceptionally above what lawschool and practice entail that it is no comparison. Let's recap, you having an anxiety disorder that is so bad you need special accomodations - you think it is a good idea to enter into arguably the most stressful career? Sounds like a horrible idea. There is a dirty little secret about medical training in that are scores of medical students and residents without mental health problems who commit suicide every year because of the stress... and you already have a poorly controlled anxiety disorder. Is this a joke? WTF are you thinking?

Just because you want something doesn't mean you should have it, especially if you can't fulfill the obligations and requirements.

/thread

 

[Jc2008]

While it seems everyone is treating you with kid gloves, I am here to be harsh. It is my job. There are so many red flags in your posts in this thread that I have to wonder if you are a troll or just clueless.

First, you seem more entitled than you realize. This will likely come off in your interviews. Realize that unlike law school or your MBA program, medical schools have an affirmative obligation to prevent people who will be dangerous physicians from becoming physicians. You seem unable to perform the requirements of medicine, much less medical school/residency and are requesting accomodations with fundamentally change the jobs required in medical school, residency and beyond.

Next, the accommodations you are looking for are very unlikely to happen. Furthermore, were they to happen, your colleagues are going to be exceptionally resentful. This even, more than getting the accomodations, is going to be one of your bigger hurdles (your biggest actually surviving training). I have seen residents essentially force out a co-resident who wasn't carrying her load and taking extra days off. What you are planning/asking for is another level entirely.

Third, medical school is much, much more stressful than law and business. This is not to be self congratulatory but from experience. My wife is a trial lawyer and we have been together through law school, multiple bar exams, multiple firms, and essentially my entire training. She tells me the road I have been through, the hours, the stress and the requirements are so exceptionally above what lawschool and practice entail that it is no comparison. Let's recap, you having an anxiety disorder that is so bad you need special accomodations - you think it is a good idea to enter into arguably the most stressful career? Sounds like a horrible idea. There is a dirty little secret about medical training in that are scores of medical students and residents without mental health problems who commit suicide every year because of the stress... and you already have a poorly controlled anxiety disorder. Is this a joke? WTF are you thinking?

Just because you want something doesn't mean you should have it, especially if you can't fulfill the obligations and requirements.

 

[hello1234!]

You use an example of a lawyer who works 100 hours a week. The difference between a lawyer working that many hours and a resident is that the lawyer has a choice. In medical training, you don't get to choose your hours. Until you are a fully trained physician you have to accept whatever the training requirement are. Reasonable accommodations can be made but as a pre-med there is no way you can know what is a reasonable accommodation and what is not. I just finished residency in internal medicine and frankly I don't even feel qualified yet to say what the training requirements should be to become a fully trained internist. I'll leave that to attendings and program directors who have experience in training residents. If you have a disability that doesn't allow you to complete medical training, then you can't be a doctor. I don't think this is discriminatory. There is an obligation for medical culture to ensure that the residents who graduate are capable of practicing independently.

 

[rokshana]

While it seems everyone is treating you with kid gloves, I am here to be harsh. It is my job. There are so many red flags in your posts in this thread that I have to wonder if you are a troll or just clueless.

First, you seem more entitled than you realize. This will likely come off in your interviews. Realize that unlike law school or your MBA program, medical schools have an affirmative obligation to prevent people who will be dangerous physicians from becoming physicians. You seem unable to perform the requirements of medicine, much less medical school/residency and are requesting accomodations with fundamentally change the jobs required in medical school, residency and beyond.

Next, the accommodations you are looking for are very unlikely to happen. Furthermore, were they to happen, your colleagues are going to be exceptionally resentful. This even, more than getting the accomodations, is going to be one of your bigger hurdles (your biggest actually surviving training). I have seen residents essentially force out a co-resident who wasn't carrying her load and taking extra days off. What you are planning/asking for is another level entirely.

Third, medical school is much, much more stressful than law and business. This is not to be self congratulatory but from experience. My wife is a trial lawyer and we have been together through law school, multiple bar exams, multiple firms, and essentially my entire training. She tells me the road I have been through, the hours, the stress and the requirements are so exceptionally above what lawschool and practice entail that it is no comparison. Let's recap, you having an anxiety disorder that is so bad you need special accomodations - you think it is a good idea to enter into arguably the most stressful career? Sounds like a horrible idea. There is a dirty little secret about medical training in that are scores of medical students and residents without mental health problems who commit suicide every year because of the stress... and you already have a poorly controlled anxiety disorder. Is this a joke? WTF are you thinking?

Just because you want something doesn't mean you should have it, especially if you can't fulfill the obligations and requirements.

/thread

Apologies in advance to those who answered my questions in a polite manner- I appreciate you, but I need to address this, there's just too many ignorant replies pinging me on here.

Instatewaiter-
I don't really think you any idea what you are talking about. I am not entitled, nor do I think you have any insight into my specific diagnosis or pathology that would allow you to decide whether I am able to perform the requirements of medical school or residency. I also don't think you have any understanding of the law behind accommodations, you seem to be parroting back key words you read in other posts. Whether I receive an accommodation or not , will be decided by a disability /accommodations office, and not some anonymous guy on an online forum.

For all I know, you're the troll on here- what mentally stable fellow spends his precious free time writing morally and intellectually dubious replies in an online forum? You've made it, you got through residency, you're a doctor. I'm sure it was hard, I'm sure you were stressed...now move on and get a life.

I don't think you know what you're talking about with the other professions either. You have 0 relevant experience from what I can tell in law or business, certainly not enough experience to make a broad generalization of the sort you are making. My mother is a doctor and she found residency or medical school very do able. Her brother (my uncle) is a lawyer. He works 100 hours a week and is miserable. Let's see, my dad's cousin is director of a large company, he works non-stop. Had a heard attack last year but no risk factors. He's 48. My dad is a doctor, he works part time and travels during his free time. You see, your anecdotal example is useless. There is an ugly trend in every profession and esp in medicine apparently, to want to believe that no one else "works as hard as we do" and "we deserve what we have more than other people for that reason" and "no one should be able to get where I am if he is not able or willing to put in the same effort that I put to get here". That's understandable, yet a pathetic argument intellectually. There are plenty of lawyers, business people, construction workers etc.... who have worked and will work harder than you have and make far less than you and who don't show your entitlement (or should I call it bitching?) when it comes to their profession being the 'hardest' . There are also plenty of other doctors who maybe had a far easier route into medicine than you did, maybe they were smarter and needed to study less, maybe they received some form of accommodation, maybe they just got lucky and their medical school and residency wasn't as demanding. You're a doctor, not a God. I know you may have been brainwashed to believe differently but that's highly entitled of you not to see that.

Let's recap, you're an a**hole, who is so bitter about having potentially lost his youth working so many hours in medical training, that you now, as a fellow, spend your time passively aggressively answering questions of people with disabilities in online forums, in an attempt to create some sort of 'one size fits all' conformity to what it takes to become a doctor.

What is sad is that this last part also applies to a couple of other posters on this thread (although there were many who were very helpful and I m thankful for their answers).

What those folks need to understand is this and I probably speak for many other disabled people:

I will not be quitting on the basis of a discriminatory medical culture or a few dinguses who feel emboldened enough by an anonymous forum to bully others with their ignorance and bias. You folks should not be doctors. Your lack of a well rounded intellect is frightening in such a position of power. I don't care if it's hard or a bad idea. I've heard the same type of attitudes throughout my life. Had I listened to them I would not have gone to college, law school or done an MBA. Those were all huge risks. Yes, it would have been infinitely easier for me to work at a grocery store or drive a taxi part time, but that's not who I am. I have been blessed enough to meet people on my way who have showed me that becoming a physician is possible even with a disability if one is willing to do the hard work and wants it bad enough. There are no guarantees in life and there is no guarantee that I'll succeed but I take solace in the fact that when I encounter your type of ignorance in my medical education, I won't be surprised. And if I crash and burn in medical school as one does when hitting a wall, like someone on here suggested, at least I'll go down swinging. I don't mind failing and if that's what happens, so be it. I look forward to seeing some of you in the medical profession and butting heads whenever possible with those of you who insist on propagating a backwards and discriminatory medical culture.

so its january...all of this is moot if you haven't gotten interviews and interviewed for medical schools by now...by january you are interviewing for a waitlist at best.

while its nice that you are idealistic enough to think you can overcome the established medical culture, its not an easy one to change...and while you may have friends and family that have been involved in the process, YOU are the one, as a pre-med, that has no idea what internship, residency, and fellowship take...your 1st post here said you posted this in the residents forum because you wanted to hear from actual doctors and not the wannabes in the pre med forum...well instatewaiter fits that bill...what you do with it or take away from it is up to you.

and btw, if it wasn't for the interns, residents, fellows, and attending that do take the time out to give advice and warnings on sdn, then it would be a worthless site...instatewaiter, whether you agree with him or not has a well established history here and frankly, you do not...it is disrespectful for you to personally attack someone when they give you information that you don't like or in a way that you don't like.

 

[AdmiralChz]

Classic SDN thread:

1) OP: "Seeking honest help need advice!"
2) SDN: "Well, maybe not a good idea because of such and such"
3) OP: "Screw you I'm going through it anyway and you are all jerks with no compassion"
4) SDN: *Sigh*

 

[j4pac]

Medicine is where you go to develop chronic fatigue, insomnia, OCD, and an anxiety disorders. It's not something that you should do if you have any of these issues going into the process. I'm going to strongly discourage you from going into medicine...for you own health, and the health of your patients. Find a job out there that is less taxing. I'm sure you are "dedicated" and have "no plan B"...continue to be dedicated and find a plan B. You are going to hate your life if you go into medicine.

 

[Perrotfish]

I've heard the same type of attitudes throughout my life. Had I listened to them I would not have gone to college, law school or done an MBA. Those were all huge risks.

Questions:

1) Why don't you work in either of the two professions you already have professional degrees for?

2) How much student debt do you have right now?

3) How old are you now?

 

[Instatewaiter]

Instatewaiter-
I don't really think you any idea what you are talking about. I am not entitled, nor do I think you have any insight into my specific diagnosis or pathology that would allow you to decide whether I am able to perform the requirements of medical school or residency. I also don't think you have any understanding of the law behind accommodations, you seem to be parroting back key words you read in other posts. Whether I receive an accommodation or not , will be decided by a disability /accommodations office, and not some anonymous guy on an online forum.

For all I know, you're the troll on here- what mentally stable fellow spends his precious free time writing morally and intellectually dubious replies in an online forum? You've made it, you got through residency, you're a doctor. I'm sure it was hard, I'm sure you were stressed...now move on and get a life.

I don't think you know what you're talking about with the other professions either. You have 0 relevant experience from what I can tell in law or business, certainly not enough experience to make a broad generalization of the sort you are making. My mother is a doctor and she found residency or medical school very do able. Her brother (my uncle) is a lawyer. He works 100 hours a week and is miserable. Let's see, my dad's cousin is director of a large company, he works non-stop. Had a heard attack last year but no risk factors. He's 48. My dad is a doctor, he works part time and travels during his free time. You see, your anecdotal example is useless. There is an ugly trend in every profession and esp in medicine apparently, to want to believe that no one else "works as hard as we do" and "we deserve what we have more than other people for that reason" and "no one should be able to get where I am if he is not able or willing to put in the same effort that I put to get here". That's understandable, yet a pathetic argument intellectually. There are plenty of lawyers, business people, construction workers etc.... who have worked and will work harder than you have and make far less than you and who don't show your entitlement (or should I call it bitching?) when it comes to their profession being the 'hardest' . There are also plenty of other doctors who maybe had a far easier route into medicine than you did, maybe they were smarter and needed to study less, maybe they received some form of accommodation, maybe they just got lucky and their medical school and residency wasn't as demanding. You're a doctor, not a God. I know you may have been brainwashed to believe differently but that's highly entitled of you not to see that.

Let's recap, you're an a**hole, who is so bitter about having potentially lost his youth working so many hours in medical training, that you now, as a fellow, spend your time passively aggressively answering questions of people with disabilities in online forums, in an attempt to create some sort of 'one size fits all' conformity to what it takes to become a doctor.

What is sad is that this last part also applies to a couple of other posters on this thread (although there were many who were very helpful and I m thankful for their answers).

What those folks need to understand is this and I probably speak for many other disabled people:

I will not be quitting on the basis of a discriminatory medical culture or a few dinguses who feel emboldened enough by an anonymous forum to bully others with their ignorance and bias. You folks should not be doctors. Your lack of a well rounded intellect is frightening in such a position of power. I don't care if it's hard or a bad idea. I've heard the same type of attitudes throughout my life. Had I listened to them I would not have gone to college, law school or done an MBA. Those were all huge risks. Yes, it would have been infinitely easier for me to work at a grocery store or drive a taxi part time, but that's not who I am. I have been blessed enough to meet people on my way who have showed me that becoming a physician is possible even with a disability if one is willing to do the hard work and wants it bad enough. There are no guarantees in life and there is no guarantee that I'll succeed but I take solace in the fact that when I encounter your type of ignorance in my medical education, I won't be surprised. And if I crash and burn in medical school as one does when hitting a wall, like someone on here suggested, at least I'll go down swinging. I don't mind failing and if that's what happens, so be it. I look forward to seeing some of you in the medical profession and butting heads whenever possible with those of you who insist on propagating a backwards and discriminatory medical culture.

Heh... well good luck with your "disability" despite multiple people telling you it is a bad idea to go into medicine given what you need and what you are asking for.

You're what 34 or 35? Why did you leave law? Was it because you couldn't hack the stress (if this is the case I would strongly recommend you don't go into medicine)? And why not use the MBA?

Why go into medicine? And why didn't you go into medicine in the first place?

 

[npappasan]

Classic SDN thread:

1) OP: "Seeking honest help need advice!"
2) SDN: "Well, maybe not a good idea because of such and such"
3) OP: "Screw you I'm going through it anyway and you are all jerks with no compassion"
4) SDN: *Sigh*

This...