"Reasonable Accommodations" in Surgical Residencies

[PatentForamenOvale]

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** Edited 2/9 for clarity

I have a sleep disorder (narcolepsy w/o cataplexy), so if I don't have a fairly consistent sleep schedule, I start having "sleep attacks" where I physically can't keep myself awake and need a nap to be functional again. I don’t fall asleep when I’m active, movement/adrenaline helps me stay awake. The “sleep attacks” have (so far) only happened while sitting, so I'm not as concerned about having these during active patient care, but more about my overall fatigue and then potential "sleep attacks" during downtime (ie charting at the computer).

My issue is, I'm REALLY interested in surgery (particularly urology and obgyn, but also enjoyed other subspecialties), which I know has demanding and inconsistent hours.

Do you think programs would be willing to work around this? What would be considered "reasonable" accommodations-wise? Or should I just resign myself to a less demanding specialty? One day of bad/inconsistent sleep within a week of good sleep tends to be ok, the issue is more regular inconsistency (ie switching shifts from day to night weekly would be bad, but monthly would be fine) and then 24h calls without time to recover after.

This hasn't affected me so far in med school (I’m an MS2 currently doing rotations) and I was able to get accommodations for no overnights and a protected 8hrs each night, but I know that won't necessarily be the case for residency. I know that doing OBGYN is probably unrealistic, but this post is more to see what would be considered a “reasonable accommodation” so I can gauge what options are available to me.

 

[EthylMethylMan]

I have a sleep disorder, so if I don't get 8 hours of sleep at around the same start/end times basically every night, I start having "sleep attacks" where I physically can't keep myself awake and need a nap to be functional again. My issue is, I'm REALLY interested in surgery (particularly urology and obgyn, but also enjoyed other subspecialties).

Do you think programs would be willing to work around this? Would no overnight shifts be considered a "reasonable" accommodation? (I would be more than willing to make up the hours with extra day shifts, but I'm not sure how realistic/possible that is) Or should I just resign myself to a less demanding specialty?

I don’t think there’s any chance a program will match someone who will make them permanently down one resident for night coverage. I also don’t think anyone would consider that “reasonable accommodations”. Also, I can’t think of a surgical or medical specialty that wouldn’t require nights at some point, except maybe for occupational/preventive med. You should talk to your advisor about this.

 

[RockClimberMed]

Did you not have any nights during your clerkships? How did u manage those?

 

[DrMetal]

I have a sleep disorder, so if I don't get 8 hours of sleep at around the same start/end times basically every night, I start having "sleep attacks" where I physically can't keep myself awake and need a nap to be functional again.

Such diagnoses are very rare. Unfortunately many doctors frivolously make them, to give you a label and make you feel better.

Make sure your symptoms aren't a psychosomatic manifestation of something else (underlying mental health issues). And if they are, get the real problem treated.

 

[eyeeye_captain]

If I stretch really really hard, and a program runs a strict night float (urology is oftentimes busy home call), and is the crunchiest granola of resident wellness, it’s still a no for the program dawg. There’s no night float as a senior btw - you go do the cases.

I guess if you matched without telling them, then they’d have to figure something out under the ADA, but be prepared to have beyond rock solid documentation of said “sleep disorder”, and also be prepared to have every other resident ready to sabotage you because you’re playing by easier rules. I can only imagine what would go down in an OBGYN residency.

Both fields will generally require overnight call when you’re an attending, even if you’ve curated a day job practice. Bare minimum you’re covering the pager, and much more than me, there’s a chance you have to go in overnight. If you try to negotiate zero call, especially as a new grad, you will be shown the door at warp speed.

I’m not saying it’s fair, but it is what it is.

 

[gutonc]

Every credentialing application in the country includes something to the effect of "I certify that I do not currently have any physical, psychological or substance abuse issues that would affect my ability to practice my specialty as outlined in these privileges".

So even if you manage to make it past the application and training stage (which seems wildly unlikely), you're never getting hired as an attending.

 

[RangerBob]

Every credentialing application in the country includes something to the effect of "I certify that I do not currently have any physical, psychological or substance abuse issues that would affect my ability to practice my specialty as outlined in these privileges".

So even if you manage to make it past the application and training stage (which seems wildly unlikely), you're never getting hired as an attending.

OP would need to find a job where they can answer "no" to that question.

Seems like psych, outpt specialties (OP could volunteer to cover more vacation time in return for not taking night call) would work well. I do inpatient PM&R and while I do cover call on my own patients overnight, I only get woken up once or twice a month. And if I sleep poorly then I just come in late the next day...

OP, if your medical situation is as serious as you say it is, I agree with others you really need to think long-term about what specialties you can reasonably practice. I don't see a realistic path to surgery without being able to cover nights (often) in residency, and in practice it is typically hard for surgeons to avoid nights as well, though there are some surgeons who have a nice gig set up. But those same surgeons still had to wade through the same muck for 5-7 years in residency.

Psych, occupational/preventative medicine, and PM&R probably have the most "sleep-friendly" residencies possible. There could be some others--I'm not an advisor, but those are the ones that come to mind. But they also still require an intern year. TY years are going to be the most accommodating for your sleep needs. I did a TY and only had 3 months IM/ICU, which included one week of nights each. No overnight call on any of my other rotations that year (it was nice...).

My PM&R residency was "average difficulty" for PM&R residencies, and we did a week of night call per month the first year (and I would get called, but I never had to come in overnight). I need my sleep as well, so what I would do is call the units I covered before going to bed and see if RNs had any burning questions, and then I'd go to bed an hour or two early so if I got woken up in the middle of the night/had a lot to take care of, I could still get close to 8hrs sleep total.

 

[emergentmd]

So how did you even get through clinicals? I know hour restrictions are better than in past times, but don't interns still take call?

Even if you somehow get this accommodation, you would really be putting your fellow residents in a bad spot.

 

[CopaceticOne]

Consider non-patient facing specialities. Pathology comes to mind

 

[dozitgetchahi]

From what I understand of sleep disorders, if you’re having “sleep attacks” it would sound as though you have narcolepsy (although I’m sure there’s other possibilities too).

If this is the case, then I don’t think anything surgical would be a great idea. Too much call, too many situations where you’d have to go in after hours, etc etc. You’re not going to be able to get around this in training - “reasonable accommodations” are just that, reasonable ways of accommodating someone with a disability doing the job in question. If the accommodations start cutting into the actual tasks expected from someone doing the job, they’re no longer reasonable accommodations. I’m not sure how you’d be able to get around this as an attending either…i don’t think you’d be able to ditch call altogether in urology. In OBGYN, maybe the only way to do so would be to have a 100% OP GYN only clinic practice. But you’d still have to get through the training, and I can’t imagine how that would work out. OB residencies aren’t for the faint of heart to begin with, and I suspect your OB co residents would eat you alive if you were somehow excused from call.

If you like surgery and you need a chill OP only schedule, dermatology is probably a reasonable specialty to go for. But you’d still have to do an intern year…maybe you could get accommodations to shuffle through a cush TY or something. Occ med and prev med would be options, and I also think path could line up with a consistent sleep schedule.

Within IM subspecalties, rheumatology, allergy, palliative, endo etc would all be good options, and of course most PCPs have a decent consistent OP schedule too. But you’d have to get through IM (or for a PCP, possibly also FM) residency, both of which aren’t going to be friendly for this in the slightest.

Since you have a sleep disorder, maybe sleep medicine would be a good fit. That would accommodate your sleep schedule, and you’d be able to relate to the patients very well.

 

[Smurfette]

I have a sleep disorder, so if I don't get 8 hours of sleep at around the same start/end times basically every night, I start having "sleep attacks" where I physically can't keep myself awake and need a nap to be functional again. My issue is, I'm REALLY interested in surgery (particularly urology and obgyn, but also enjoyed other subspecialties).

Do you think programs would be willing to work around this? Would no overnight shifts be considered a "reasonable" accommodation? (I would be more than willing to make up the hours with extra day shifts, but I'm not sure how realistic/possible that is) Or should I just resign myself to a less demanding specialty?

Both those fields are going to require nights during training as well as after (while urologists aren't often in the OR in the middle of the night, a septic pt, testicular torsion and other things will still make them come in. Plus the ER will call throughout the night with consults and patients to see in the AM even if they don't have to go in. OB Gyn has ovarian torsions and ectopic pregnancies that happen even if not covering L&D). Programs usually look at nights as a crucial part of training in order to get exposed to the various emergencies and get adequate volumes of cases, so they can reject an accommodation for no nights. It looks like you are likely a 2nd year med student, so you may still find something on rotations that seems to be a better fit with your ADA needs.

 

[NotAProgDirector]

Let's make sure you understand what "reasonable accommodations" means.

Each job needs to define the "essential functions" of the position. Once these are defined, then employers are required to make "reasonable accommodations" - i.e. alterations to your position / supports such that you can complete the essential functions adequately. Most residency programs are going to define working both day and night shifts as an essential function. Therefore, they will be required to make accommodations to allow you to do so. Not working nights is unlikely to be considered an accommodation as it's an essential function.

Now that narcolepsy is better understood and can be tested for, we're seeing an increased number of people diagnosed with it. I had a theoretical discussion with our disability office about what accommodations for people with narcolepsy might look like. Not working night shifts isn't an option, since that's essential. They recommended devices which may help alert you to the fact that you might be nodding off. We might spread out the night shifts more broadly over time (i.e. shorter runs of nights), or might actually make longer runs so that you would have less transitions. More "time off" after nights might be a possibility -- but that will just be rearranging time off that you'd otherwise have.

But, this is all a moving target and there's innumerable state laws, so the rules in different states might vary.

 

[PatentForamenOvale]

Did you not have any nights during your clerkships? How did u manage those?

So how did you even get through clinicals? I know hour restrictions are better than in past times, but don't interns still take call?

Even if you somehow get this accommodation, you would really be putting your fellow residents in a bad spot.

No nights during clerkship! They aren't required for our school and I was able to get accommodations so that I had the same 8 hours protected each night-- surgery definitely pushed it the most, so part of that 8 hours was going home/eating dinner, but I was able to have a fairly consistent sleep schedule, which was super helpful.

Such diagnoses are very rare. Unfortunately many doctors frivolously make them, to give you a label and make you feel better.

Make sure your symptoms aren't a psychosomatic manifestation of something else (underlying mental health issues). And if they are, get the real problem treated.

As a few others have pointed out, it's narcolepsy (without cataplexy luckily). It's well managed with a consistent sleep schedule and medication, has been for years, but more than a day or two off of my sleep schedule and I start having sleep attacks.

Let's make sure you understand what "reasonable accommodations" means.

Each job needs to define the "essential functions" of the position. Once these are defined, then employers are required to make "reasonable accommodations" - i.e. alterations to your position / supports such that you can complete the essential functions adequately. Most residency programs are going to define working both day and night shifts as an essential function. Therefore, they will be required to make accommodations to allow you to do so. Not working nights is unlikely to be considered an accommodation as it's an essential function.

Now that narcolepsy is better understood and can be tested for, we're seeing an increased number of people diagnosed with it. I had a theoretical discussion with our disability office about what accommodations for people with narcolepsy might look like. Not working night shifts isn't an option, since that's essential. They recommended devices which may help alert you to the fact that you might be nodding off. We might spread out the night shifts more broadly over time (i.e. shorter runs of nights), or might actually make longer runs so that you would have less transitions. More "time off" after nights might be a possibility -- but that will just be rearranging time off that you'd otherwise have.

But, this is all a moving target and there's innumerable state laws, so the rules in different states might vary.

This is super helpful, thank you! This is exactly what I was looking for-- I know that the no nights thing isn't realistic, but I was wondering what options there would be that WOULD be reasonable. Having the longer runs of nights at a time actually would probably work, the big thing for me seems to be consistency, so my body actually sleeps during the hours its supposed to, so I think I could do nights if it wasn't just a random week at a time. The device is also an interesting point, I'll have to look into that!

 

[NotAProgDirector]

Although I'm glad you found that helpful, I don't think I communicated well how difficult this will be for you.

The ACGME limits how many nights in a row you're allowed to do, so they may not be able to accommodate this. Or they might, it depends on their assessment of the situation. If you have sleep attacks when your sleep schedule is disrupted, I think you'll find most surgical specialties almost impossible to manage. Non surgical specialties may be less demanding and more flexible with scheduling. Specialties with no/minimal overnight work might be best.

If you have a single sleep attack in the OR, that will likely be the end of your career. You will be deemed unsafe in the OR, and that will be that.

Residency is difficult in the best of cases. You should try to find something that you're more likely to be successful in.

 

[I'dPitThat]

No nights during clerkship! They aren't required for our school and I was able to get accommodations so that I had the same 8 hours protected each night-- surgery definitely pushed it the most, so part of that 8 hours was going home/eating dinner, but I was able to have a fairly consistent sleep schedule, which was super helpful.


As a few others have pointed out, it's narcolepsy (without cataplexy luckily). It's well managed with a consistent sleep schedule and medication, has been for years, but more than a day or two off of my sleep schedule and I start having sleep attacks.


This is super helpful, thank you! This is exactly what I was looking for-- I know that the no nights thing isn't realistic, but I was wondering what options there would be that WOULD be reasonable. Having the longer runs of nights at a time actually would probably work, the big thing for me seems to be consistency, so my body actually sleeps during the hours its supposed to, so I think I could do nights if it wasn't just a random week at a time. The device is also an interesting point, I'll have to look into that!

I'm an OB resident. I just got done a block of nights. We do 4 weeks of night float at a time here. The only time we are doing just a random week or two is around holidays when someone has to cover. However, every program has call. You just can't get away from that. You will be taking 24 hour call as a resident, and it will be just sprinkled around throughout the year. There are call shifts where I am able to get a couple hours of sleep, but there are plenty where I am up the whole night. You can't be falling asleep in the middle of a stat section at 3am.

Even after residency, it will be very hard for you to find a job that doesn't have a call requirement.

OBGYN residency is quite tiring in general as most programs seem to have the minimum number of residents to cover the various services and call, and we don't have outpatient only blocks. It is not unusual on a gyn or onc block to be operating past signout and not leave the hospital until 6:30-8 at night only to have to be back in the morning to round. Overall, I'd say our hours are better than general surgery, but they are still surgery hours.

OB blocks are a little more predictable as there are clear turnover times. However, you still have to come in early to round on postpartum as an intern, and it isn't unusual to have to stay a little late to finish notes especially as a junior.

I think you would have a really hard time matching into ob with this condition. I know that probably isn't what you want to hear, but I don't think you'd be doing yourself any favors in ob, and I'd be concerned about you putting patients at risk. The last call shift I had before this nights block, I had to take someone to the OR for a ruptured ectopic, stat someone off the deck, and had a couple vaginal deliveries I had to chief. I didn't sleep that shift. I went home the next morning and crashed out, then I had to work the next day. That just doesn't sound sustainable for you.

 

[anonperson]

I have a sleep disorder, so if I don't get 8 hours of sleep at around the same start/end times basically every night, I start having "sleep attacks" where I physically can't keep myself awake and need a nap to be functional again. My issue is, I'm REALLY interested in surgery (particularly urology and obgyn, but also enjoyed other subspecialties).

Do you think programs would be willing to work around this? Would no overnight shifts be considered a "reasonable" accommodation? (I would be more than willing to make up the hours with extra day shifts, but I'm not sure how realistic/possible that is) Or should I just resign myself to a less demanding specialty?

You shouldn't do OB in general. Even if you could get these accomodations (which I don't think is realistic), numerous jobs want labor and delivery coverage which usually is a full 24 shift or home call.

Even if you manage a full gyn OR practice, what happens if you run cases late or your cases get delayed etc because you got bumped. You're going to cancel your case or pass out?

 

[operaman]

You’re in a very tough spot. Disclose to programs and most programs will likely not even interview you. The only possible match would be your home program if they really liked you.

If you keep it under wraps until you match, you’ve got a catch 22. You’re caught by having to portray your need for reasonable accommodations as serious enough to qualify as a disability. But then You not only become subject to the very subjective definition of “reasonable,” but also involvement by hospital legal and risk management staff who may frame your severe sleep attacks as a threat to patient safety. So if you disclose, you’re at the mercy of the powers that be - make it serious enough to require accommodations, but not so serious that you’re a threat to patient safety. Not easy to do.

Your best bet might be to find programs that already have schedules conducive to your needs. Look for in house call as a tern so you get a post call day, night float blocks for pgy2/3 nights, and then not sure what to do for the senior years. It will be a function of how busy your program is and how amenable your PD and co residents are to working with your needs. But I trained at a very busy program and senior backup call was pretty chill and was only q10-14 so long stretches of sleep between. I feel like you could have done well where I trained, plus if you had a bad night I as chief could have easily subbed a junior to cover your cases the next day without much pushback.

So there may be programs that would work for you, but it won’t be easy and your options will be limited. This may be one of those “if you can find something else you like, do that” situations.

 

[comp1]

So I have had to accommodate something like this for both attendings and residents in psychiatry as a manager and site director. It's doable and indeed much more commonly diagnosed now for whatever reason. Of course, we've had blind psychiatrists, most things are doable in psych. That said, no matter what you are in, you are universally going to be asking other people to do more work to cover for you. Life isn't fair, so people do it, and it's usually better than nothing, but there's no realistic way for you to really make it up to the other people fully. We gave up on trying long ago as then you're just creating more work for the scheduler with different categories of people and it often leads to scheduling errors (that the manager or attending ends up having to emergently cover). We just don't put people who can't take calls at night into the call pool at all. There's no ACGME requirement for "call" and you can adjust attending salaries. Now could this be done with surgery? I don't think so. I think narcolepsy really honestly makes you a global liability in surgery. Sometimes you're going to have to stay late even if you aren't "on call" and your sleep schedule is going to get disrupted. If you're falling asleep in a psych interview, you're just going to hurt feelings. If you're doing it in surgery, you're going to kill people. It's just not reasonable in surgery.

 

[emergentmd]

Did you have this issue when you applied to medical school? I do not think it is wise for anyone with this condition to think of being a doctor. You have people's lives in your hands and one sleep attack during a procedure would get you right in front of MEC. On top of this, you are doing the patient an injustice if it requires your full attention.

 

[comp1]

Did you have this issue when you applied to medical school? I do not think it is wise for anyone with this condition to think of being a doctor. You have people's lives in your hands and one sleep attack during a procedure would get you right in front of MEC. On top of this, you are doing the patient an injustice if it requires your full attention.

They are a MS3 as far as I can tell, so it's a bit late for that train of thought. Just find a non (or minimally) procedural field and it'll work out somehow. We all have to assess every day whether we're physically and mentally capable of going in to do our job. The OP just happens to be on more of a razor's edge than the average person. Theoretically they are going to know if they can't work. It's just about finding a specialty that is less likely to put them in a situation where they can't on a regular basis and where the risk is relatively low if they misjudge their sleep situation. Patients face a lot of injustice at baseline. I'd certainly rather have a psychiatrist or PCP with managed narcolepsy than no clinician at all.

 

[I'dPitThat]

You’re in a very tough spot. Disclose to programs and most programs will likely not even interview you. The only possible match would be your home program if they really liked you.

If you keep it under wraps until you match, you’ve got a catch 22. You’re caught by having to portray your need for reasonable accommodations as serious enough to qualify as a disability. But then You not only become subject to the very subjective definition of “reasonable,” but also involvement by hospital legal and risk management staff who may frame your severe sleep attacks as a threat to patient safety. So if you disclose, you’re at the mercy of the powers that be - make it serious enough to require accommodations, but not so serious that you’re a threat to patient safety. Not easy to do.

Your best bet might be to find programs that already have schedules conducive to your needs. Look for in house call as a tern so you get a post call day, night float blocks for pgy2/3 nights, and then not sure what to do for the senior years. It will be a function of how busy your program is and how amenable your PD and co residents are to working with your needs. But I trained at a very busy program and senior backup call was pretty chill and was only q10-14 so long stretches of sleep between. I feel like you could have done well where I trained, plus if you had a bad night I as chief could have easily subbed a junior to cover your cases the next day without much pushback.

So there may be programs that would work for you, but it won’t be easy and your options will be limited. This may be one of those “if you can find something else you like, do that” situations.

OB is just not a good fit for someone with this kind of condition unfortunately. The kind of job that they will need to find after residency is going to be hard to find.

Call in ob during residency isn't really an in-house and senior backup call situation. Call is in-house all 4 years. We refer to it as call, but really you're just working the weekend or holiday. You are covering the labor deck and then holding the gyn and/or subspecialty pager. Some places have the same team cover onc and others have a separate onc call person taking home call. So there isn't really any chill home call where you rarely get called in. I'm an senior resident, and we were very busy my last call shift to the point where I didn't sleep at all.

Any accommodations this person will need to make residency possible will unfortunately be very likely to put a burden on the rest of the residents. It's not reasonable to ask the rest of the program to take more nights, more call, more late stay, etc.

 

[PatentForamenOvale]

Although I'm glad you found that helpful, I don't think I communicated well how difficult this will be for you.

The ACGME limits how many nights in a row you're allowed to do, so they may not be able to accommodate this. Or they might, it depends on their assessment of the situation. If you have sleep attacks when your sleep schedule is disrupted, I think you'll find most surgical specialties almost impossible to manage. Non surgical specialties may be less demanding and more flexible with scheduling. Specialties with no/minimal overnight work might be best.

If you have a single sleep attack in the OR, that will likely be the end of your career. You will be deemed unsafe in the OR, and that will be that.

Residency is difficult in the best of cases. You should try to find something that you're more likely to be successful in.

I understand the concern and appreciate the insight— I’m lucky that when I’m in a more stressful situation, I’m able to keep myself awake (my sleep attacks have only ever happened while sitting so far), but I will probably be looking more into non-surgical specialties just to be safe.

I think you would have a really hard time matching into ob with this condition. I know that probably isn't what you want to hear, but I don't think you'd be doing yourself any favors in ob, and I'd be concerned about you putting patients at risk. The last call shift I had before this nights block, I had to take someone to the OR for a ruptured ectopic, stat someone off the deck, and had a couple vaginal deliveries I had to chief. I didn't sleep that shift. I went home the next morning and crashed out, then I had to work the next day. That just doesn't sound sustainable for you.

Thanks for the info! The one thing that keeps me awake is doing things— so if I’m active, I won’t be falling asleep luckily! The issue would be working the next day and most likely having a sleep attack during any downtime when I’m sitting. I do plan to look into other specialties though, and really do appreciate the perspective.

You shouldn't do OB in general. Even if you could get these accomodations (which I don't think is realistic), numerous jobs want labor and delivery coverage which usually is a full 24 shift or home call.

Even if you manage a full gyn OR practice, what happens if you run cases late or your cases get delayed etc because you got bumped. You're going to cancel your case or pass out?

My goal would be gyn only, so the OB issue would hopefully just be during residency. As for the second part, it’s more about inconsistency for me, so if I have one late day but a week of consistent nights, I’m fine. Also, napping helps! So if my case gets bumped, theoretically on accommodation could be napping so I could bank some sleep. I do hear you though, the point of this post was to get an idea of what WAS reasonable to ask for so I could figure out whether or not this was something I should give up on, so I do plan to look into other specialties based on these responses.

Did you have this issue when you applied to medical school? I do not think it is wise for anyone with this condition to think of being a doctor. You have people's lives in your hands and one sleep attack during a procedure would get you right in front of MEC. On top of this, you are doing the patient an injustice if it requires your full attention.

Nope! And I was able to get accommodations pretty easily. I don’t tend to fall asleep when I’m actively doing something, so the worry is more my ability to stay awake when I’m sitting and charting or something, not with a patient!

 

[NITRAS]

Consider non-patient facing specialities. Pathology comes to mind

My wife has a friend who is a path resident. She does get calls and occasional has to come in. It isn’t common, but it does happen.

Yall think the OP is trolling? Urology and GYN get nigh calls ALL the time.

 

[PatentForamenOvale]

My wife has a friend who is a path resident. She does get calls and occasional has to come in. It isn’t common, but it does happen.

Yall think the OP is trolling? Urology and GYN get nigh calls ALL the time.

Not trolling and just updated my post to clear things up— I get that nights happen all the time on those specialties. I’m just wondering what would be considered “reasonable” with ADA accommodations, if not “no nights”, how about all of the nights at once so my sleep schedule isn’t constantly changing? Or a day off/afternoon start after 24h shifts and then making up that time later? I don’t know what program directors can offer, which is why I posted

 

[ThoracicGuy]

Not trolling and just updated my post to clear things up— I get that nights happen all the time on those specialties. I’m just wondering what would be considered “reasonable” with ADA accommodations, if not “no nights”, how about all of the nights at once so my sleep schedule isn’t constantly changing? Or a day off/afternoon start after 24h shifts and then making up that time later? I don’t know what program directors can offer, which is why I posted

I just don't see those as being reasonable accommodations for most programs. Plus, when you finish its not like you can avoid night call in urology or gyn. Going with derm, path, pm&r, or something along those lines will probably give you your best chances for success.

 

[comp1]

I definitely second above that this goes well beyond what you can get an ACGME regulated program to ultimately agree to, although I also believe that will be a problem. Attending employers are not going to have nearly the level of oversight that training programs do and I think they'd have a super easy legal case saying that they can't meet your needs reasonably under the ADA.

 

[Apollyon]

I'm just thinking here of "reasonable" accommodations, versus "unreasonable". It's a very difficult conversation to have about unreasonable when the person requesting is calm and affable. If the requestor is loud and combative, then it's a comfortable decision to say "no" to them.

 

[comp1]

Most of these sort of requests, in my fairly extensive experience, are handled without a 1:1 verbal discussion between the supervisor/academic director and employee/trainee. Instead, they are handled through HR officers via written correspondence. There's far too much legal danger in verbal discussion of this topic. Now if you're rude to the HR officer, indeed, nothing is happening.

 

[PatentForamenOvale]

I'm just thinking here of "reasonable" accommodations, versus "unreasonable". It's a very difficult conversation to have about unreasonable when the person requesting is calm and affable. If the requestor is loud and combative, then it's a comfortable decision to say "no" to them.

I’m sorry if I came off as combative. I do genuinely appreciate the feedback I've gotten here and learning more about what “reasonable” means for ADA accommodations in residency, although I have been a bit frustrated with some responses that have been less constructive, like people telling me I shouldn’t have gone into medicine. I also think I failed to explain the nuances of my condition in my original post, so when I responded with more info to try and clarify, it put me on the defensive (and I tend to overuse exclamation marks).

 

[I'dPitThat]

I understand the concern and appreciate the insight— I’m lucky that when I’m in a more stressful situation, I’m able to keep myself awake (my sleep attacks have only ever happened while sitting so far), but I will probably be looking more into non-surgical specialties just to be safe.


Thanks for the info! The one thing that keeps me awake is doing things— so if I’m active, I won’t be falling asleep luckily! The issue would be working the next day and most likely having a sleep attack during any downtime when I’m sitting. I do plan to look into other specialties though, and really do appreciate the perspective.


My goal would be gyn only, so the OB issue would hopefully just be during residency. As for the second part, it’s more about inconsistency for me, so if I have one late day but a week of consistent nights, I’m fine. Also, napping helps! So if my case gets bumped, theoretically on accommodation could be napping so I could bank some sleep. I do hear you though, the point of this post was to get an idea of what WAS reasonable to ask for so I could figure out whether or not this was something I should give up on, so I do plan to look into other specialties based on these responses.

Nope! And I was able to get accommodations pretty easily. I don’t tend to fall asleep when I’m actively doing something, so the worry is more my ability to stay awake when I’m sitting and charting or something, not with a patient!

It is not reasonable to expect to be napping between cases. Serious question. If you're on a call shift and fall asleep while charting, what are you like when you get woken up? Things can go from quiet to insane very quickly and then back down again.

I just don't see an ob residency being feasible for you. Unless you are very unlikely to fall asleep during patient care, would have no problem working long days, taking call, and doing night float, it just won't work. Those things are all part and parcel of obgyn training. It's only a 4 year program, and you need to be at work to see things.

As for doing gyn only, it is possible; however, the job opportunities for that kind of a practice are not numerous. Most practices will have some ob component. Even if you can find a gyn only practice, if you want to operate at a hospital you will likely have to take call there. Gyn calls in the middle of the night are very common. Over my last night block, there were maybe 3-4 nights the whole month where we didn't get an ed page. Not all of them require you to come in, but some do.

You could always do an AI in obgyn to see what it would be like for you, but my AI was pretty robust and the jump to intern year was still huge workload and hours wise. I would strongly recommend not trying to hide this if you end up applying for ob. If you hide it and then match and THEN try to force the accommodations, your coresidents are going to hate you (and justifiably so imo if you're adding to their workload).

 

[PatentForamenOvale]

It is not reasonable to expect to be napping between cases. Serious question. If you're on a call shift and fall asleep while charting, what are you like when you get woken up? Things can go from quiet to insane very quickly and then back down again.

I just don't see an ob residency being feasible for you. Unless you are very unlikely to fall asleep during patient care, would have no problem working long days, taking call, and doing night float, it just won't work. Those things are all part and parcel of obgyn training. It's only a 4 year program, and you need to be at work to see things.

I can snap out of a nap almost instantly with adrenaline (even as small as a phone notification sometimes lol), the worst part about the sleep attack is when I'm fighting it, but if I manage to nap, even for a few minutes, I feel a lot better. I know ObGyn at baseline would be really hard for me with this condition, so I would be getting ADA accommodations if I ended up doing it. After reading everyone's posts, I'm now thinking more of accommodations like a nap during downtime (if there's no downtime, that's also fine, as long as I'm actively doing something to keep me energized), trying to group night shifts so I have less switches in sleep schedule, and maybe spacing out call so that any inconsistent sleep days are sandwiched in a week of more consistent days. If I were able to get some of those accommodations, I actually think it would be doable for me (but I also realize those might not be reasonable either, so I'm keeping my hopes low and my mind open to other specialties as I continue my rotations).

 

[Apollyon]

I’m sorry if I came off as combative.

No, no, not at all. I was speaking in total generalities. That was definitely not my intent. I haven't seen anything I consider mean or illogical or oppositional from what you've written.

 

[PatentForamenOvale]

No, no, not at all. I was speaking in total generalities. That was definitely not my intent. I haven't seen anything I consider mean or illogical or oppositional from what you've written.

Whew! Glad to hear it! And I agree with the intent-- much easier to say "no" when the person isn't a saint!

 

[ThoracicGuy]

I can snap out of a nap almost instantly with adrenaline (even as small as a phone notification sometimes lol), the worst part about the sleep attack is when I'm fighting it, but if I manage to nap, even for a few minutes, I feel a lot better. I know ObGyn at baseline would be really hard for me with this condition, so I would be getting ADA accommodations if I ended up doing it. After reading everyone's posts, I'm now thinking more of accommodations like a nap during downtime (if there's no downtime, that's also fine, as long as I'm actively doing something to keep me energized), trying to group night shifts so I have less switches in sleep schedule, and maybe spacing out call so that any inconsistent sleep days are sandwiched in a week of more consistent days. If I were able to get some of those accommodations, I actually think it would be doable for me (but I also realize those might not be reasonable either, so I'm keeping my hopes low and my mind open to other specialties as I continue my rotations).

You don't always have downtime between cases or anything to just take a nap. In between cases you might be rounding, checking on things from earlier in the day, seeing new consults, etc. I'm sorry, but I think procedural based specialties are going to be outside what can be reasonably done in your situation based on what you have written. I realize its not what you want to hear, but even if you find that diamond in the rough program that could accommodate you, the chances of finding a job that could also do so is exponentially hard to do.