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July 17, 2017

1 in 5 people has a disability—but only 1 in 50 doctors. Is that a problem?

Daily Briefing

    Editor's note: This story was updated on July 18, 2017

    Medicine often falls short when it comes to caring for the nearly 57 million Americans with disabilities—but boosting the representation of individuals with disabilities in medicine could help address the issue.

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    Overall, more than 20 percent of the U.S. population has a disability—including 10 percent of non-elderly adults and 8 percent of children, Dhruv Khullar, a physician at NewYork-Presbyterian Hospital, writes for the New York Times' "The Upshot." But according to Khullar, only about 2 percent of practicing physicians have a disability—and most of those physicians acquire the disability after they are trained.

    Barriers to bringing individuals with disabilities into the field

    Writing for Slate, Nathan Kohrman reports that for individuals with disabilities who are interested in pursuing a career in medicine, "The struggle for representation in medicine starts with who gets to go to medical school in the first place."

    When it comes to medical school admission, the "technical standards" can complicate the admissions process for individuals with disabilities. To be admitted, students must demonstrate that they can meet those standards, which include communication, conceptual and quantitative analysis, motor function, observation, and social skills—standards that medical schools have long defended as necessary for patient safety and academic consistency.

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    Enhancing hospital diversity

    Under the Americans With Disabilities Act, individuals with disabilities who attend schools that receive federal funding cannot be "excluded, denied services, segregated, or otherwise treated differently than other individuals because of the absence of auxiliary aids and services," unless the school can show that accommodations would "fundamentally alter" the education they offer or present "an undue burden."

    But the law has resulted in only a modest increase in the number of students with disabilities graduating from medical school, Kohrman writes. He explains that medical schools largely seem to comply with the law in a manner meant to avoid lawsuits rather than encourage inclusion, with many schools placing the burden of proof with technical standard compliance on students.

    A 2016 paper from the University of Michigan's Philip Zazove found that many schools' technical standards are hard to find. Further, the research showed that schools do not offer accommodations or intermediaries—and some schools even require the student to make his or her own accommodations. This fosters a "self-selecting application process," Kohrman writes, in which individuals with disabilities apply only to certain, more accommodating medical schools.

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    For its part, the Association of American Medical Colleges (AAMC) is working with a consultant on a report about disability inclusion in medicine, Kohrman reports. According to consultant and disability expert Lisa Meeks of University of California, San Francisco, all of AAMC's top executives have been supportive and enthusiastic.

    Some schools already are mulling whether the technical standards need to be interpreted so strictly for all students as a practical matter. While most schools require their graduates to complete a range of rotations, some are easing their technical standards with the understanding that students ultimately will select one specialty for their residency and career. So for example, Kohrman writes that a medical student with limited arm function might not have to complete an intense surgical rotation to train for, and become, an "excellent oncologist." 

    How doctors with disabilities make a difference in the field

    While doctors with disabilities are still relatively uncommon, these individuals "are changing the profession," Khullar writes. He reports that patients tend to be more comfortable with doctors who are similar to them in background—including individuals with disabilities.

    According to Khullar, "[W]hile the medical profession is devoted to caring for the ill, often it doesn't do enough to meet the needs of the disabled." Individuals with disabilities are less likely to undergo routine medical care, such as cancer screening, flu vaccination, and vision and dental exams. At the same time, individuals with disabilities have higher rates of unaddressed cardiovascular risk factors such as obesity and hypertension, according to Khullar.

    Gregory Snyder, a physician at Brigham and Women's Hospital who has paralysis in the legs and uses a wheelchair, said his disability has made him more relatable to his patients. He said that were it not for an accident that occurred while he was in medical school, he "would have been this six-foot-tall, blond-haired, blue-eyed Caucasian doctor standing at the foot of the bed in a white coat." He reflected, "Now I'm a guy in a wheelchair sitting right next to my patients. They know I've been in that bed just like they have. And I think that means something."

    Separately, C. Lee Cohen, a resident at Massachusetts General Hospital, shared how his hearing loss enables him to better communicate with patients sharing a similar disability. "From my experience, I know that when you can't hear well, your brain parses words and syllables in a certain way. Instead of asking people to repeat themselves, I ask them to rephrase themselves," he explained. "So when my patients are hard of hearing, I know which sounds they'll have trouble with. I rephrase so they can understand."

    And in addition to the benefits doctors with disabilities can bring to their care and the overall profession, recent research quells common concerns about medical students with disabilities.

    The researchers said patient risk concerns typically overestimate the responsibility of medical students with disabilities and underestimate their capacity. "Not a single legal case known to the authors has been filed in which patient harm resulted from an accommodation provided to (a student with disabilities)," the researchers said (Khullar, "The Upshot," New York Times, 7/11; Kohrman, Slate, 7/5; Kuhrt, FierceHealthcare, 7/5; Rege, Becker's Hospital Review, 7/11).

    Why you're in danger of building the wrong workforce

    To succeed in the future, health care organizations will need to provide care in the lowest-cost, most appropriate setting—and to accomplish this, they’ll need a different complement of staff than in the past.

    But if today's leaders don't revise their workforce planning strategy, they're in danger of building the wrong workforce, a mistake that will be costly in the long run and could take 10 to 12 years to correct.

    Find out what you need to do to revise your approach—starting from the "outside-in."

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