Diversity among doctors: Students with disabilities are finding their place in medical schools—and beyond

Diversity among doctors: Students with disabilities are finding their place in medical schools—and beyond

Cathy Gulli

September 25, 2015

For Jessica Dunkley, getting into medical school was no ordinary childhood dream. Deaf since the day she was born, Dunkley aspired to become a doctor when, at age 10, her aunt gave her a plastic human anatomy model with removable organs.

She didn’t think it was possible until, in her mid-20s, she happened to read about deaf doctors practising in the United States. “I realized the opportunity was out there,” and she became “determined to do medicine.” Dunkley applied to numerous medical schools and, in 2010, completed the undergraduate program at the University of Ottawa, where a sign language interpreter accompanied her to class and clinical sessions. Today, Dunkley is finishing her second year of residency in public health and family medicine at the University of Alberta—making her one of the first deaf doctors in Canada.

Dunkley’s accomplishment represents the latest diversification of medicine, which was first practised mostly by white male doctors, and has since flourished with the inclusion of women and people of different races and ethnicities. Now the profession is set to expand again, as students with disabilities—including limited mobility or dexterity, hearing or vision loss, learning or developmental disorders, and psychological or mental health issues—are increasingly being accepted and supported at medical schools.

Like Dunkley, a handful of other young Canadians are making history by becoming doctors with disabilities: Megan Jack, who is also deaf, graduated from the University of Manitoba in 2013, and is now a family physician. Janel Nadeau had a stroke at 19, which partially paralyzed her and has affected her memory; she is finishing her training as a neurologist at the University of Calgary. Steven Daniel was paralyzed from the waist down during a paratrooping accident while serving in the military; although he is in a wheelchair, Daniel is training to be a family doctor at the Northern Ontario School of Medicine.

Part of what makes Dunkley’s experience so remarkable is the legal precedent she’s established along the way. In late June, she won a human-rights case against the University of British Columbia, which failed to provide her with a sign language interpreter in 2010, when Dunkley was supposed to start her residency. (She was later accepted at the University of Alberta, which provides interpreters.) Dunkley says the discrimination “came as a shock,” but she was not deterred. This ruling means others won’t be, either. “I just knew I didn’t want the next person to go through this,” says Dunkley. “I’m pleased it [will] improve accessibility.”

While disabled doctors have always practiced—in 2011, there were approximately 9,000 working, according to Statistics Canada—most of them became disabled after their education and training. What’s different “is the entry point,” says Melanie Lewis, associate dean of learner wellness and advocacy at the University of Alberta’s faculty of medicine and dentistry. “You have medical students presenting with disability.”

Over the last five years, there has been “a big tipping point” at medical schools toward “embracing the possibility of accommodation and looking at what we can do [for disabled students], rather than dismissing that it’s a possibility,” says Lewis, whose office supports students such as Dunkley with a range of conditions, including sleep disorders, depression, epilepsy and multiple sclerosis. “We’re recognizing that medicine needs to attract people [who] represent the diversity in society in order to provide good care.”

That’s forced universities and students to get creative. Dunkley has had to invent sign language for medical terms. She uses a digital stethoscope or portable ultrasound machine to check a patient’s heart. In the operating room, colleagues wear clear surgical hoods rather than paper face masks so she can lip-read. Daniel has used a “stand up” wheelchair, which allows him to be positioned upright at a patient’s bedside during surgery or in the emergency room. He gets help “scrubbing in,” and his colleagues position his wheelchair at the operating table.

Universities must identify the needs of students and residents, figure out how to meet their needs on campus and inside hospitals, then determine “who is going to pay,” says Geneviève Moineau, who was undergraduate dean at the University of Ottawa when Dunkley was a student. Since then, accommodation is “a topic that has become more important within our faculties,” says Moineau, now president of the Association of Faculties of Medicine of Canada.

Part of the conversation is about how impairment can actually facilitate better doctor-patient relationships: A disabled doctor may empathize more with patients, who, in turn, may relate to or trust a disabled doctor more because they feel understood. Dunkley has experienced this first-hand. “People come in and they are frustrated or going through a painful experience, and they feel they are the only one,” she says, “and then they [see] me and it just [gives] them a better perspective.”

What’s more, disabled doctors have all been patients, so they understand personally how a doctor’s disposition and bedside manner can affect someone. While Nadeau was recovering from her stroke, she saw “the whole spectrum of doctors,” and that’s partly what motivated her to pursue medicine. “I was determined to add to the good ones.”

While disabled doctors may be better equipped to bond with patients, it can also alienate them from other physicians. “You can sense this uncertainty or questioning about how you are going to be able to do it,” says Dunkley. This can be especially challenging during medical training, when students and residents move between different hospitals and clinics for brief rotations. “The most problematic people are usually [those] who do not work with me directly, and they have assumptions.”

That medical students and residents face stigma because of a health condition is ironic—but not so surprising. “There’s some deep psychological theory around how doctors in general may not necessarily accept their mortality,” says Vera Krejcik, president of the Canadian Association of Physicians with Disabilities. “A lot of people have noticed a certain discomfort; colleagues don’t know how to negotiate being with somebody with a difference.”

Krejcik had a stroke while studying medicine at the University of Calgary. With limited use of one arm, she switched her focus from internal medicine to psychiatry. It was a matter of being “realistic,” says Krejcik. “I don’t worry about hobbling around or needing to suture.”

Before anyone can become a doctor, there are technical standards they must meet, both physical and cognitive, says Lewis, who helped Dunkley establish herself as a resident at the University of Alberta. But there are intangibles to consider, too. Dunkley and others are proving that. As Lewis puts it, “Any candidate who comes from an extraordinary background with a unique perspective, they often do make extraordinary physicians.”

The Voice of Disability in Nursing

The Voice of Disability in Nursing
by Holly Clayton, RN, MSN
New Hampshire Nursing News
www.NHNurses.org

Recently, I represented NHNA in a monthly American Nurses Association’s Nursing Practice & Work Environment (NP&WE) conference call. With the goal of “promoting the health, safety, and wellness of the nurse and the nursing profession,” this call served to educate and disseminate information of interest to nurses. ANA members included Marie Barry, MSN, Senior Policy Analyst; Holly Carpenter, Senior Staff Specialist; Jaime Dawson, MPH, Senior Policy Analyst and Ruth Francis, MPH, MCHES, Sr. Administrative Assistant. Current projects of the ANA NP&WE include HealthyNurseTM, Safe Patient Handling and Mobility, Fatigue, Safe Staffing and Care Coordination.

A portion of this monthly conference call focuses on current issues with this meeting highlighting the National Organization of Nurses with Disabilities (NOND). Guest speakers included Karen McCulloh, RN, BS, Founder, NOND and Beth Marks, RN, PhD, President, NOND.

I learned the majority of members of the nurse board of NOND, a volunteer organization, have a variety of disabilities. The organization has a mission of “being the voice of disability in nursing.” According to NOND, of those nurses that have disclosed their disability, three per cent of the workforce have disabilities. There are challenges and employment gaps, but there are new expectations with legal and social changes.

Student standards were discussed. Standards must be achievable by students with reasonable accommodations. The presenters discussed students achieving a standard centered on “what,” not “how.” The example provided was “able to gather vitals” rather than “hear the heart murmur through a stethoscope.”

The presenters cited a study demonstrating the aging workforce, with increased incidence of chronic health conditions and disabilities in nurses. They emphasized nurses need to become more knowledgeable, increase their awareness of possible accommodations and be prepared to advocate for themselves.

Following this meeting, I phoned NOND co-founder Karen McCulloh, RN, BS to learn more. She stated NOND is “here for nurses with chronic health conditions and disability.” She discussed strategies for nurses to collaborate with other nurses practicing with disabilities and advised that nurses should not assume they can’t do something based on a disability. Advances in technology and a changing paradigm enable nurses to be nurses, not “patients.” McCulloh provided an example of a nurse who sustained permanent injuries but completed her nursing program with a personal assistant. According to McCulloh, doors can be opened, but nurses need to increase their understanding of how to navigate.

The NOND website www.NOND.org, emphasizes that NOND is the voice for nurses with disabilities. New members are encouraged to join.

Holly Clayton RN, MSN is an active NHNA member and Associate Editor of the NHNursing News.

Moving From Disability to Possibility

When I was in the first grade, an astute teacher noticed that I had trouble seeing the blackboard. This finding was quickly confirmed by a vision test. Formal evaluation by an ophthalmologist revealed that I had a rare degenerative retinal disease. Worse than that diagnosis was the ophthalmologist’s devastating prognosis for my life: attending college would be very challenging, sports and certain activities would be difficult or impossible, and it was unlikely that I would ever have a professional career.

Think College

ThinkCollege.net

Think College is a national organization dedicated to developing, expanding, and improving inclusive higher education options for people with intellectual disability. With a commitment to equity and excellence, Think College supports evidence-based and student centered research and practice by generating and sharing knowledge, guiding institutional change, informing public policy, and engaging with students, professionals and families. Click to learn more about our various grant projects.

Americans with disabilities may be the best workers no one’s hiring

Americans with disabilities may be the best workers no one’s hiring

Walgreens actually prefers disabled employees because they’re more efficient workers, explains a new report

BY THE MONITOR’S EDITORIAL BOARD

Walgreens and now a report by the National Governors Association show businesses can benefit by seeing disabled workers not as charity cases but employees with uncommon qualities that can enhance profits.

Few people noticed, but last week marked the 23rd anniversary of the 1990 passage of the Americans with Disabilities Act. That landmark law is best known for mandating such conveniences as designated parking for people with disabilities, wheelchair ramps, and Braille on elevators. A whole generation has now benefited from it. But one thing has not changed very much for America’s 54 million disabled people: landing a job.

That may change with a report last week by the National Governors Association. It is called “A Better Bottom Line: Employing People with Disabilities.” Note the words “bottom line.” The report aims to help states support a trend in American business led by Walgreens. Since 2007, the drugstore chain has hired those with disabilities not out of magnanimous charity but for the competitive advantage in employing disabled workers.

Studies of Walgreens’s experience at a few distribution centers show disabled workers are more efficient and loyal than nondisabled workers. Absenteeism has gone down, turnover is less, and safety statistics are up. And the cost of accommodating such workers with new technologies and education is minimal.

More than 100 executives of major companies have toured Walgreens distribution centers where at least a third of workers are physically or mentally disabled. And last year, the US Chamber of Commerce committed to increasing the employment of people with disabilities by 1 million by 2015.

“Walgreens has shown that people with these disabilities can work alongside people without disabilities,” says Sen. Tom Harkin (D) of Iowa. “You can’t tell who is who and which is which.”

This isn’t just a business trend but a societal change in attitude. Delaware Gov. Jack Markell, the recent head of the governors association and the leader behind the report, says employers must focus on a person’s ability rather than disability – or even on how a disability enhances a person’s employability. Many disabled workers are so grateful for a job that they work harder. Some industries, such as software and data testing, prefer workers with certain disabilities, such as autism, because of a person’s intense focus on detail.

Still, business needs a partner in government to make this shift. The report cites successes in several states in linking up disabled people with employers and tracking the benefits of hiring such workers. Teens who are disabled need help, beginning in middle school, to assess their skills and the industries that need them. The report advises states to approach businesses with a proposition on the value that disabled workers bring to shareholders, not with “an appeal to their corporate responsibility.”

“Businesses tell states that they do not want to hire a candidate to meet a state’s need,” according to the report. “They want to hire a candidate that meets the business needs.”

Walgreens now plans to have at least a quarter of its workforce consist of people with disabilities. Other companies are following in its path. They have plenty of people to pick from. Only 1 of 3 disabled adults is employed. Finding them is half the battle. State governments are best equipped to help in such recruitment.

The incentive for government to encourage this trend is strong. More than a third of people on income-based assistance are disabled. Studies show employing them raises tax revenue and reduces entitlement spending.  But more than money is at stake. Disabled people simply want to be treated for the best they can offer – which might just be better than what a potential employer presumes.

CareerCast.com Reports Best Jobs for People with Disabilities

The U.S. Equal Employment Opportunity Commission

Introduction

The Americans with Disabilities Act (ADA) is a federal law that prohibits discrimination against individuals with disabilities. Title I of the ADA covers employment by private employers with 15 or more employees as well as state and local government employers of the same size. Section 501 of the Rehabilitation Act provides the same protections for federal employees and applicants for federal employment.

The ADA protects a qualified individual with a disability from disparate treatment or harassment based on disability, and also provides that, absent undue hardship, a qualified individual with a disability is entitled to reasonable accommodation to perform, or apply for, a job or to enjoy the benefits and privileges of employment. The ADA also includes rules regarding when, and to what extent, employers may seek medical information from applicants or employees. The U.S. Equal Employment Opportunity Commission (EEOC) enforces the employment provisions of the ADA. Most states also have their own laws prohibiting employment discrimination on the basis of disability. Some of these laws may apply to smaller employers and provide protections in addition to those available under the ADA.

Health care is the largest industry in the American economy, and has a high incidence of occupational injury and illness.[1] Though they are “committed to promoting health through treatment and care for the sick and injured, health care workers, ironically, confront perhaps a greater range of significant workplace hazards than workers in any other sector.”[2] Health care jobs often involve potential exposure to airborne and bloodborne infectious disease, sharps injuries,[3] and other dangers; many health care jobs can also be physically demanding and mentally stressful.[4] Moreover, health care workers with occupational or non-occupational illness or injury may face unique challenges because of societal misperceptions that qualified health care providers must themselves be free from any physical or mental impairment.[5

Several Million Healthcare Workers Needed by 2020

Several Million Healthcare Workers Needed by 2020

Regardless of the fate of the Affordable Care Act, the United States will need 5.6 million new healthcare workers by 2020, according to a study.

The study, by researchers at Georgetown University’s Center on Education and Workforce, also found that 4.6 million of those new workers will need education beyond high school.

“In healthcare, there are really two labor markets — professional and support,” Anthony P. Carnevale, the report’s lead author and director of the Center on Education and Workforce, said in a news release. “Professional jobs demand postsecondary training and advanced degrees, while support jobs demand high school and some colleges.”

There is “minimal mobility” between the two, Carnevale said, “and the pay gap is enormous — the average professional worker makes 2.5 times as much as the average support worker.”

Among the study’s findings:

  • In 2008, 80% of entry-level RNs had at least an associate’s degree, up from 37% in 1980.
  • Rising degree requirements in nursing may be crowding out disadvantaged minorities, according to the authors: 51% of white nurses under age 40 have bachelor’s degrees, compared with 46% of Hispanic nurses and 44% of African-American nurses.
  • Healthcare has the largest number and proportion of foreign-born and foreign-trained workers of any industry in the U.S. Among healthcare workers, 22% are foreign-born, compared with 13% of all workers nationwide. Most foreign-born nurses come from the Philippines, India and China.
  • Only 20% of healthcare professional and technical occupations earn less than $38,000 a year, and almost 50% earn more than $60,000.
  • More than 70% of healthcare support workers make less than $30,000 per year, but that percentage is still better than most available alternatives for workers of that skill and education level, according to the report.
  • Healthcare successfully competes for science and engineering talent. Because the healthcare, science and technology fields tend to require similar skills, healthcare programs at the associate and bachelor’s level often are appealing alternatives for science and engineering students.
  • One difference between the fields: People in healthcare jobs tend to value forming social bonds, while people who gravitate to science, technology and engineering occupations place a greater emphasis on achievement and independence, the researchers found.

To read a PDF of the executive summary of the report, visit http://bit.ly/MBpzig. To read a PDF of the full report, visit http://bit.ly/N2RUfN.

Additional Federal Attention Needed to Help Protect Access for Students with Disabilities

Charter schools enrolled a lower percentage of students with disabilities than traditional public schools, but little is known about the factors contributing to these differences. In school year 2009-2010, which was the most recent data available at the time of our review, approximately 11 percent of students enrolled in traditional public schools were students with disabilities compared to about 8 percent of students enrolled in charter schools.

Read GAO Report: Additional Federal Attention Needed to Help Protect Access for Students with Disabilities

GAO also found that, relative to traditional public schools, the proportion of charter schools that enrolled high percentages of students with disabilities was lower overall. Specifically, students with disabilities represented 8 to 12 percent of all students at 23 percent of charter schools compared to 34 percent of traditional public schools. However, when compared to traditional public schools, a higher percentage of charter schools enrolled more than 20 percent of students with disabilities. Several factors may help explain why enrollment levels of students with disabilities in charter schools and traditional public schools differ, but the information is anecdotal. For example, charter schools are schools of choice, so enrollment levels may differ because fewer parents of students with disabilities choose to enroll their children in charter schools. In addition, some charter schools may be discouraging students with disabilities from enrolling. Further, in certain instances, traditional public school districts play a role in the placement of students with disabilities in charter schools. In these instances, while charter schools participate in the placement process, they do not always make the final placement decisions for students with disabilities. Finally, charter schools’ resources may be constrained, making it difficult to meet the needs of students with more severe disabilities.