QUOTED: Physical Disability and Residency

[NotAProgDirector]

Posted anonymously per request.

I am currently on a leave of absence from school (approved medical leave). I will be returning to school this summer to start my 3rd year; however, I have some questions regarding my injury/disability.

I completed the first two years of medical school with an "A" average. Toward the end of my second year I had some health issues that required me to take a medical leave (exacerbation of a preexisting injury). My medical issues might advance to a stage where I require a wheel chair at some point in my career. I never envisioned this as a possibility in my life, but I did know being pain-free again in my life was a stretch.

Anyway, choosing a speciality that will also "save" my physical health has now crossed my mind. At this point, I have an interest in many different specialties in medicine. However, I'm not sure my body could endure "endless" hours of rounding, etc. required of some specialities. Thus, I have started thinking about specialities based on physical demand and perceived difficulty during residency and beyond.

The specialities I'm now entertaining are: (without doing any rotations as of yet) radiology, a subspeciality of anesthesia, PM&R, neurology, etc. I've never thought about these specialties as a career per se, but my interest in them has increased with my physical disability.

A couple of questions:

1) Are there resources besides "on-the-job" rotating and FREIDA that will help paint a clear picture of a given speciality for me? Are there specialities that are known to be more accommodating for those with physical limitations and challenges? I hope the idea I'm trying to convey makes sense. I do know I'm not interested in specialties like psychiatry.

2) Will I run into problems with Program Directors when I am applying for residencies due to my medical leave of absence? I know there are non-discriminatory policies in place, but I'm sure that certain applications are overlooked based on a leave taken. My Steps will have an asterisk next to them for special seating accommodations--the asterisk indicates special accommodations for my board exams, but a PD would have to call the NBME in order to find out what my specific accommodations were. I've heard this also puts an applicant in the "special" pile. It just seems like another reason to overlook my application.

3) Should I make my attendings aware of my physical disability during rotations? I have heard that I should and also that I shouldn't regarding this. I just don't want to be painted as "Student Doctor Physical Limitation," but rather as Student Doctor (my name)-- and have my grade based on my capability as a physician one-day and not on my disability. (FYI If I didn't inform the attending that I have a physical disability, most of them would have absolutely no clue, as I look "normal.")

4) I will be medicated on opioids and other drugs during my rotations. I'm on a low dose of opioids where I am able to function without physical/mental impairment. My only concern is random drug screenings and malpractice insurance. I am going to notify Graduate Medical Education at each site know my situation and the medications I'm taking. I just want to avoid explaining every excruciating detail to my attending on the very first day.

Thank you for your time and help.

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[NotAProgDirector]

1. Shadowing physicians whom work in certain fields, or doing rotations, is probably the best way to get a sense of what various fields are like. Remember that working in a non-academic setting can be very different, so you might need to rotate (or shadow) outside of your medical school. I would recommend that you do some shadowing during this LOA.

2. The answer is probably yes. This will make your application look different than everyone else's, and will raise some concerns. The basic issue will be simple: PD's will want to know whether the cause for the LOA will likely affect your training, or if you might require another LOA during residency. You really have two choices: you can simply say you had a medical LOA and leave it vague like that, or you can explain your medical problem. Legally, you do not need to explain the reason for your medical leave. It's unclear, from your description, whether explaining the cause for the leave will help or hurt you. If you leave it vague, some PD's will assume the worst -- an ongoing problem that is likely to be recurrent and chronic. If you describe it in more detail, PD's may be worried about further leaves, your medication use, and perhaps accomodation needs under the ADA. Some of the answer here depends on the other issues below.

3. The answer is probably no. Either your injury/disability requires special accomodations during your clinical rotations, or it doesn't. If it doesn't, then no one should know and you should simply be evaluated compared with everyone else. Standards shouldn't be altered. If it does require accomodations, then really the clerkshi director should review that with faculty, whatever they may be. If you do require accomodations during your clerkships, then that will probably need to be spelled out in your evaluation.

4. This is always a tough question. Can my patient on chronic narcotics drive a car? What about a truck? What about a school bus? What about my child's school bus? Similarly, one could ask whether a physician can use chronic narcotics. We can rationalize this by saying that low dose narcotics do not impair functioning -- but this is obviously not true. It's pretty clear that there is a dose response curve, and that low dose narcotics (or benzos, or whatever) will have some effect on your reaction times / attention / etc. Another way to word it (that perhaps sound a bit better) is this: the impairment caused by narcotics will be much less than the impairment caused by uncontrolled pain.

Many programs will have a drug screening process. You will test positive, but will have a medical reason for doing so. Programs should allow you to be credentialed, but this may be a problem. Some may have a "no narcotics" policy, even if legally prescribed. You will also always be at some increased risk of losing a medmal case, since your narcotic use could (theoretically) be used as a stick. However, many docs practice on controlled medications.

Again, you should not have to explain this to individual attendings, either as a student or as a resident. Once you are credentialled, you will be treated like everyone else.

 

[michaelrack]

Psychiatry is one of the least physically demanding of the specialties

 

[dragonfly99]

I don't know the nature of your physical limitations, but if you can't be lifting patients, intubating patients (which actually can require a fair amount of strength) and run to "stat"/"code" type situations, anesthesia would be a very bad choice. It's actually pretty physically demanding.

I have seen wheelchair-bound neurology residents. A resident like that would require special accommodations and some programs would probably be willing while others would not.

Psych and radiology or pathology would seem like they would be good choices for someone with significant physical limitations.

Yikes on the chronic narcotics...not sure what the policy will be at the various hospitals where you'll rotate. I think it could be more of a problem for later hospital credentialing and licensure as an attending, vs. when you are a student.