Career development for doctors with a disabilityBMJ 1998; 317 doi: http://dx.doi.org/10.1136/bmj.317.7154.2 (Published 01 August 1998) Cite this as: BMJ 1998;317:S2-7154
Doctors with disability can face discrimination and hostility from their colleagues, though they are more likely to be better employees. Stuart Mercer, general practitioner and amputee, discusses
- Stewart Mercer, general practitioner
Although there has been much publicity about doctors suffering from stress and associated problems, there has, until recently, been little attention paid to the problems faced by doctors with disabilities.(1)(2) In 1996 the BMA set up a working party, of which I was a member, to examine the issues facing doctors and medical students with disabilities, and its findings were published at the end of last year.(3) What follows is a summary of the findings and recommendations, together with a few personal views and reflections on the subject.
Before this report the issues of being disabled and a doctor had not been explored in Britain. There were no figures of the numbers of doctors with a disability, nor on the sorts of problems they might encounter. Similarly, the number of disabled applicants or potential applicants to medical school was not known, nor was there any information on the career progress of doctors who entered medicine with a disability or gained a disability during their training.
The working party answered some but by no means all of the questions, and the report should be viewed as an important first step in assessing the needs of disabled doctors rather than a definitive statement. Indeed, one of the main recommendations of the report was the need for more research into whether and how disabled doctors' needs are being met in employment and education.
The working party consisted of 10 members, some of whom were drawn from other BMA Committees (Occupational Health Committee, Career Progress of Doctors Committee, Junior Doctors Committee, and Medical Students Committee). A few members (including myself) were not linked to other BMA work, and included a disability consultant (medically qualified) and a nurse from the Association of Disabled Professionals. About half of the members had a disability themselves. The remit of the party (as defined by BMA council in 1995) was to “investigate and identify the difficulties encountered by disabled doctors and doctors with long-term ill-health.” Issues considered included the definition of disability, legislation, prevalence, problems encountered, best practice in other professions, and best practice in other countries.
Disability and discrimination
A major achievement of the disability movement - in addition to the campaigns that resulted in the introduction of anti-discrimination legislation in 1995(4) - has been to challenge the common notion that disabled people are intrinsically ill or weak (and therefore unable to work) and to replace it with a more positive and realistic view of disability.(5) Indeed, studies of the work records of disabled employees in the United States have consistently found lower rates of sick leave, absenteeism, and work related accidents compared with the general work force, together with equal or better levels of productivity. Despite this, disabled people in the United Kingdom are generally six times more likely to be turned down for a given job than non-disabled applicants with identical qualifications and experience, suggesting that lack of equal opportunities and discrimination in the workplace is widespread. It was political acceptance of this that led to the passing of the Disability Discrimination Act by parliament in 1995.(4)
Typical responses from disabled doctors and medical students
“The worst thing about being disabled is the lack of experience which the medical profession has as a whole in dealing with people in my position”
“The medical profession is apparently unable to care for its own”
“I was a fourth year medical student when I had an accident which meant I had to use a wheelchair. Access, or lack of it, necessarily affected my choice of clinical career. I was obliged to work in the wheelchair friendly USA.”
There was considerable debate among the members of the working part on a suitable definition of disability. Increasingly, disability is being defined in its social rather than strictly medical dimensions. Disability is not synonymous with illness, and to view disabled doctors as such simply reinforces the “tragedy model” of disability that campaigners have fought to change.5 These findings were discussed in the light of the Disability Discrimination Act and with regard to best practices in industry, commerce, and other professions.
The working party agreed on a definition that would encompass both the medical and social dimensions of disability and ill health (as it was their remit to attempt to do both) and that could be specifically applied to doctors and medical students. It should be emphasised, however, that the members of the working party understood the clear distinctions that can exist between disability and ill health and that the issues are not always the same for both.
The agreed definition was: “Disability is the end result of either physical, mental or sensory impairments (and people can be healthy with such impairments) or long term ill health (which can limit functional ability). Either case may result in loss or limitation of opportunities.” The target population was defined as people “with a chronic physical, mental or sensory impairment or with long term ill health resulting in the loss or limitation of opportunities to take part in medical education and the practice of medicine on an equal level with others.”
Main findings of the working party
Attempts were made to gather information about and make contact with disabled doctors through deans, postgraduate deans, associate deans, and regional advisors in general practice throughout the United Kingdom. They were also asked about the services and advice they offered to disabled doctors or medical students. Information was also gathered directly from almost 50 identified disabled doctors and medical students by letter and questionnaire. The response rate from the deans and postgraduate deans and associate postgraduate deans was generally poor, and the information gathered too varied to draw firm conclusions. Only four deans of the nine who replied (out of 32 contacted) said that they provided access for disabled medical students, and only two said they would provide equipment and careers advice. On the positive side, one medical school commented: “On the whole, it is our experience that such disabilities strengthen both the individual and the groups of students with whom they work.” All 22 of the regional advisers in general practice who were contacted responded, but only one had heard of a disabled doctor in training in general practice. Their willingness to help disabled doctors with advice, access, or facilities seemed somewhat limited. Responses from the disabled doctors and medical students, who had wide range of disabilities, revealed both negative and positive experiences. More than half felt that they had experienced discrimination and lack of equal opportunities and reported hostile or unhelpful attitudes and behaviour by colleagues. A general finding was lack of help, advice, and support within the profession (see box).
The way forward
The working party discussed the possible solutions to the problems facing disabled doctors and medical students and made some specific recommendations. These included:
The need for accurate, up to date information about disabled doctors including a BMA database to offer a “signposting service” and to put disabled doctors in touch with each other
The availability of appropriate careers advice, guidance, and counselling from people with a real understanding of the issues
A comprehensive occupational health service for all doctors, including general practitioners
Addressing problems of access and facilities
Changing attitudes within the profession through a variety of mechanisms, including disability awareness training and disability equality training within the undergraduate curriculum and in postgraduate centre programmes.
The working party further emphasised the need for further quantitative and qualitative research in order to gain reliable and unbiased information on which to base future policy.
The information gathered by the working party was limited and may therefore not be representative of disabled doctors in general. Nonetheless, it raises concerns that disabled doctors may be facing a burden of lack of equal opportunities and possibly discrimination in the same way that disabled people in Britain generally face.
Creativity and flexibility are required within the medical profession to encourage and value diversity and life experience rather than perpetuating the myth of the “perfect being in the white coat.” Doctors with personal experience of coping with a disability are in a uniquely useful position and should be viewed as a resource and not as “square pegs in round holes.” They need help, advice, and support, but most of all they need a level playing field.
Stewart Mercer, general practitioner with experience in rehabilitation medicine, has been an amputee since before starting medicine.