Individuals living with disabilities are underrepresented in the physician workforce, despite the known benefits of disability inclusion. As noted by former American Medical Association (AMA) president, Barbara McAneny:
“One requirement to advance health equity is to promote greater diversity among medical school applicants and enrollees.”
Yet both ableism in medical schools’ admissions processes and expectations set by technical standards for the physician workforce can perpetuate historical patterns of exclusion in health care settings, as argued in this recent article in the AMA Journal of Ethics. Patients with disabilities receive substandard health care and have unequal access to health care services and barriers for persons with disabilities to enter the medical profession will undermine commendable disability awareness efforts for clinicians.
For example, it is known that patient-physician racial concordance leads to greater patient satisfaction and use of health care by patients from racial minority backgrounds. By extension, concordance in disability status might similarly foster greater use of health care and satisfaction in the patient-physician relationship, especially as it relates to clinician understanding of disabled patients’ needs for accessible care and/or clinician understanding of their legal obligations towards patients with disabilities. Indeed, surveys of physicians reveal negative perceptions about persons with disabilities’ quality of life.
Still, students with disabilities remain underrepresented in US medical schools: in 2019, only 4.6% of students in US allopathic medical schools reported disabilities. Students interviewed for this article cite “alarming ableist tendencies in admissions processes” that confirm other reports. One medical student with disability described a conversation with an admissions officer as follows:
“He highly recommended that if I receive any interview invitations, if at all possible, I should wear the prosthesis rather than come in the wheelchair.”
Further, attitudinal barriers faced by applicants with disabilities can sometimes be masked by schools’ purported compliance with “neutral” technical standards, which outline outdated expectations for abilities and skills required for admission to medical school. For example, as illustrated by the case McCulley v. University of Kansas School of Medicine, a medical school applicant may be denied admission because of her inability to meet a program’s motor technical standard of performing cardiopulmonary resuscitation (CPR) chest compressions without accommodations even though there are a number of medical specialties in which CPR is not a principal duty, and reasonable accommodations, such as an assistant for physical maneuvers, would allow for adequate care.
Thus, the authors urge disability implicit bias training for admissions officers and reviews of technical standards that may discriminate on the basis of disability.
HPOD’s Executive Director Professor Michael Ashley Stein co-authored this piece with HPOD fellow Dorothy W. Tolchin, an Instructor in Physical Medicine and Rehabilitation at the Harvard Medical School, and Nicole D. Agaronnik and Shahin A. Saberi, both Harvard Medical School students. The AMA Journal of Ethics also interviewed Dr. Tolchin for this article as part of its ongoing Ethics Talk series, available here.