Resources for physician residents with disabilities

[DrJosephKim]

Over the past few years, I have had the opportunity to connect with a number of residents and practicing physicians who have developed physical disabilities. As such, some have left clinical practice while others have continued to practice medicine.

Disability can strike anyone, anywhere. I think that we often forget to think about the frailty of our human bodies.

What types of disability resources, support tools, or organizations are you aware of? Does your program/hospital offer such resources for physicians who have disabilities?

I am now in the process of forming some online resources for healthcare professionals with disabilities.

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[Eat Oatmeal]

I do not have any resources but I would like to highlight an issue I have encountered numerous times. I feel like physicians who have disabilities that are not visually apparent have difficulty notifying individuals for the fear of appearing "weak" to colleagues and superiors. I was told that this is a real fear and not a misconception as there can be repercussions to disclosing the disability. I have encountered two residents so far in my fourth year of medical school who had issues. One was during a rotation I had where a diabetic resident held off at least an hour during rounds to get a snack when her blood sugar was in the 60's. She said that it was not a big deal because she can feel when she gets really low. The fact of the matter is she does not need to do that (she took a risk, regardless of whether it was big or small). The other instance (this was told to me by another resident) was a resident who was diagnosed with bipolar disorder. She ended up having "anger issues" that caused her to get terminated. To make a long story short, she only told one person in the residency and didn't want to tell anyone in the program about it, even when she got terminated.

I don't know how big of an issue this is but it is something that I have noticed this year. It may be worthwhile to look into.

 

[DrJosephKim]

I don't think most people would consider diabetes to be a "disability." Mental illness can be an entirely different story, but I'm focusing my question around physical disability and less on mental disability. I know many physicians who have developed heart conditions, rheumatoid diseases, and cancer. They now have a physical disability.

 

[Samoa]

I'm not aware of any resources beyond what is available to the general public.

One thing that I think makes a huge difference in residency, as opposed to medical school, is that residents are provided employee-level insurance (or often even better coverage). Whereas students only have access to their university's student health plan, which often provides only catastrophic coverage (totally inadequate for anyone with any serious health issue). It may not be that way at all schools, but it was certainly true at mine. The result is that the cost of chronic care may require additional loans to cover. The good thing is that financial aid will usually approve an increased cost of education to cover it.

I have more comments, but I'll have to post them later.

 

[DrJosephKim]

I won't go into great detail about my personal situation but needless to say I suffered a significant medical set back that drastically changed my life and my ability to work for a long time. The greatest resource for me was having a hosptial GME department and residency program that were understanding of my situation and let me focus on me when I needed to. I wasn't held to a different standard then my colleagues but accomodations were made that allowed me to continue in my residency. Had I been at a lot of other institutions I think I may have been let go.

I hope that you'll find the same type of support when it comes time to find a job. I've spoken with a number of physicians who have lost their ability to work in the hospital setting. It's been a real challenge for them to find a new position.

 

[turquoiseblue]

dr. kim, i think u should also try to get involved with mental disability, because there is a lot of prejudice in this. it is just like any other physical illness, as it is a chemical imbalance, cured by medication, and shouldn't be overlooked. any disability, whether physical or mental, should have help in the work place.

 

[Gastrapathy]

This isn't so simple though, is it? If one's disability hurts his technical skill or intellectual capacity, it can hurt patients.

I'm totally 100% in favor of adaptive technology or other accommodations when the end product is still good enough. But, sometimes it can't be and then it has to be about the patients. Its tragic but you can't let the physician with mild dementia continue to practice.

 

[turquoiseblue]

This isn't so simple though, is it? If one's disability hurts his technical skill or intellectual capacity, it can hurt patients.

I'm totally 100% in favor of adaptive technology or other accommodations when the end product is still good enough. But, sometimes it can't be and then it has to be about the patients. Its tragic but you can't let the physician with mild dementia continue to practice.

things like dementia should be an exception. as long as their intellectual ability isn't incapacitated they should be allowed to work. also a situation where its a surgeon and their hand or arm or eyes are somehow injured, that should be exception, but maybe they should be given alternative jobs they can do, so they're not completely jobless, like maybe allow them to work as a gp if their hand doesn't work. not to mention, they can get disability checks in the mail from the government to help them out financially if they can't work. but maybe a little more should be done for them if they're not completely incapacitated, like help them find another job doing something else they can do.

 

[Smurfette]

things like dementia should be an exception. as long as their intellectual ability isn't incapacitated they should be allowed to work. also a situation where its a surgeon and their hand or arm or eyes are somehow injured, that should be exception, but maybe they should be given alternative jobs they can do, so they're not completely jobless, like maybe allow them to work as a gp if their hand doesn't work. not to mention, they can get disability checks in the mail from the government to help them out financially if they can't work. but maybe a little more should be done for them if they're not completely incapacitated, like help them find another job doing something else they can do.

These type of things (dementia, hand injuries, etc.) are what disability insurance should help out with. Especially for procedural specialties---you can get a disability insurance option that is specialty specific, meaning that if you can no longer perform the duties within your specialty, you can collect your disability payments (and potentially find another job, and still collect both disability and a salary for your new position---depends how you set up the policy and if you are willing and able to work outside of your specialty and/or medicine itself).

 

[Eat Oatmeal]

I don't think most people would consider diabetes to be a "disability." Mental illness can be an entirely different story, but I'm focusing my question around physical disability and less on mental disability. I know many physicians who have developed heart conditions, rheumatoid diseases, and cancer. They now have a physical disability.

Type 1 diabetes is considered a disability and patients who have T1DM qualify for appropriate accommodations per federal mandate.

I also feel that you are missing my point. Irrespective of the disability, there is a huge stigma on disclosure of needs (whether it is a rheumatoid disease, diabetes, or a mental illness).

 

[oreosandsake]

http://www.cdihp.org/

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WesternU established the Center for Disability and Health Policy (CDHP) in 1998 in response to the concerns of the disabled community, which is emerging as one of the nation's fastest growing and least understood minority groups. The Center goals include but are not limited to: improving the capabilities of health care providers to meet the growing needs of people with disabilities, increasing the number of qualified individuals with disabilities who pursue careers in the health professions, and empowering people with disabilities to become more vocal and active participants in their health care.

this is a great place to start. Brenda Premo has been a huge advocate for people with disabilities and helping physicians with disabilities gain residency and employment

 

[DocDanny]

I am a have Type I Osteogenesis Imperfecta, and I am almost done with my Clerkships. I guess I could share that with you guys.

I went into the year concerned about if I could physically handle it. People have always assumed that I was too weak physically (and also not intellligent enough) to be a doctor. But I made it through the first two years fine while some classmates fell by the wayside, and I have passed every clerkship and every shelf.

Though I usually do much better on resident and attending evaluations than on any test. But I suppose that is a good thing, yes?

The rounding in IM took getting used to, because one of my legs is slightly bowed and I have bad knees. But I handled it. Sometimes the teams I was rounding with would take the elevators with me, other times I'd walk the stairs. I was BEAT at the end of the day, but I was always writing my notes, presenting, doing my presentations, and answering questions if I got pimped.

Surgery was hard. The surgeries were long, and very boring. Standing still for so long was harder on me, and I needed a stool since I am kind of a short guy. No other 'limitations'. I worked through the LONG calls and got through it fine.

So so far, I've done everything I needed to do, and get good evaluations. But I do worry about next year. I am doing a couple of Sub-Is, plus working in a MICU and ER. I assume that I will be doing more procedures than I have done this year. I worry if I can get through those ok.

I tell people what I have, though they can usually tell something because I'm only 5'1, which is short for a guy, and have a limp, and they are smart. I've never asked for special treatment. I've never felt I needed it, and I THINK I am doing ok. But I do worry if I can hack it when it gets harder.

 

[Samoa]

I've run across a resident with OI in PM&R. He seemed as capable as any of the others.

With the exception of cognitive and psychiatric problems, the person with the disability is the best judge of their own limitations. People--even people who should know better--assume that procedures (both bedside and OR) require a great deal more physical functionality than they really do. For example, I have RA. But it actually adds to the stability of my wrists, significantly dampening any physiologic tremor. Which is far more helpful than range-of-motion in fields like ENT, vascular, cardiac and neurological surgery (with the exception of spine). But it's entirely counterintuitive, and people just don't believe it. Hell, I didn't even believe it myself until I had a whole class of fellow surgical interns to use as a comparison. So now I am diligent about tracking my own involvement and outcomes in various cases and bedside procedures. It's hard to argue with data.

Instead people just ignore data that makes them uncomfortable. I don't know the solution for that.

Cognitive deficits are a completely different issue, though, and one which I think cannot be lumped in with physical problems

 

[turquoiseblue]

i think that psych problems should be included in physical disability....because they can be treated with medications, which makes them essentially normal. that is physical as it is a chemical imbalance. if it is an incurable severely disabling case where they can't work anymore--that is another story.

cognitive defects like Alzheimer's and parkinsons, etc should be included but only to an extent, maybe mild cases where they haven't completely lost themselves.

 

[Samoa]

i think that psych problems should be included in physical disability....because they can be treated with medications, which makes them essentially normal. that is physical as it is a chemical imbalance. if it is an incurable severely disabling case where they can't work anymore--that is another story.

cognitive defects like Alzheimer's and parkinsons, etc should be included but only to an extent, maybe mild cases where they haven't completely lost themselves.

There's a fundamental difference between cognitive/psychiatric diseases and physical disabilities. Yes, they can all be treated with medications, but the similarity ends there. The big difference is that part of the disease process of mental and cognitive illness is a loss of insight , which interferes with the sufferer's ability to identify and monitor their own impairment.

 

[turquoiseblue]

There's a fundamental difference between cognitive/psychiatric diseases and physical disabilities. Yes, they can all be treated with medications, but the similarity ends there. The big difference is that part of the disease process of mental and cognitive illness is a loss of insight , which interferes with the sufferer's ability to identify and monitor their own impairment.

i've seen plenty of bipolar people that are doctors who are on medications function just fine. There should be no discrimination in mental illness if they are controlled on medications where they can function normally. if there is, should they not disclose their psych illness to anyone? i don't see that as fair to them. loss of insight is on a per individual basis, and on a degree basis, because not everyone loses insight, they may just have a mild case.

 

[Samoa]

i've seen plenty of bipolar people that are doctors who are on medications function just fine. There should be no discrimination in mental illness if they are controlled on medications where they can function normally. if there is, should they not disclose their psych illness to anyone? i don't see that as fair to them. loss of insight is on a per individual basis, and on a degree basis, because not everyone loses insight, they may just have a mild case.

No disagreement here. Mental illness should not, in itself, be a reason to bar someone from practicing medicine.

My point is that the nature of the disease means that the affected person may not be the best judge of their own ability to practice safely. In contrast, someone with with a physical disability is probably a much better judge of their disease affects their ability to practice than anyone else. This is a critical difference that raises very different questions about someone's ability to practice medicine. One is a potential impairment of technical skill, and the other is a potential impairment of judgment and critical thinking.