By Julie G. Madorsky, MD, and Barry Corbet
For doctors with disabilities, overcoming obstacles is part of the job.
In 1973, a class of medical students slipped on their white coats, grabbed their clipboards and readied themselves for what they thought would be just another routine lecture. Instead, they got a different eye-opening lesson.
They watched as a patient was wheeled into an examining room. He had cerebral palsy, dysarthria and ataxia. After taking a history and doing a physical examination, the class was asked to appraise his capacity for learning and employment.
The collective opinion was that, at most, he might end up selling pencils on the street.
Minutes later, the "patient" returned to the classroom. This time he was introduced as Dr. Thomas Strax, then the assistant medical director at Philadelphia's Moss Rehabilitation Hospital.
That was twenty six years ago, and some people in the medical community have come a long way since those days of gross misperceptions and wild assumptions. But many qualified applicants with a disability still have an uphill fight to gain access to medical schools. While 13.7 percent of the U.S. population has a significant disability, a 1988 survey found that nationwide, people with disabilities constitute only 2.6 percent of physicians and .25 percent of medical students.1 And in 1993, an AMA report confirmed that applicants who have disabilities still face stiff barriers gaining entrance to medical schools.2
It's not an easy road for people with disabilities who want to become doctors. Take the case of Jim Post, MD, who has quadriplegia. He had to overcome four years of rejection by 10 medical schools before Albert Einstein College of Medicine in New York gave him a chance. He earned his MD with honors in 1997.
Medicine has long harbored an unwritten code of perfection, and physicians are often seen in unrealistically heroic terms. "This idea of the perfect healer, the godlike person, just simply is unrealistic," says Selma Calmes, MD, who has post-polio syndrome and is chief of anesthesiology at Olive View/UCLA Medical Center in Los Angeles. "The attitude of many physicians toward colleagues with a disability is blatantly discriminatory. The whole culture of medicine would improve if it was possible to consider the whole person, to capitalize on strengths, not weaknesses."
In the 1988 survey, physicians were subdivided into two groups according to different life circumstances: those who had a disability before medical school, and those who acquired their disabilities later in life.1 Of the two categories, the former confronted more attitudinal and financial barriers, but their disabilities required less adjustment during adulthood. The latter had better economic and professional resources, but had greater accommodations to make to the radical changes that accompany the late onset of disability.
Although there is a tendency to type-cast doctors with disabilities for certain fields such as psychiatry, clinicians with disabilities are functioning successfully in various specialties, including physical medicine and rehabilitation, neurology, pathology, anesthesiology, general surgery, urology, orthopedics, obstetrics and gynecology, plastic and reconstructive surgery, internal medicine, family medicine, radiology and pediatrics.3 People with late onset disabilities tend to stay in their original specialties, and adjust the workload and the workplace to accommodate new needs.
Adaptations to compensate for a disability add to the culture of change. Talking thermometers, vibrating beepers, optical-tactile converters, Braille sphygmomanometers and Braille transcription services are just a few technology options to help physicians to do their jobs.
But not all adaptations require high technology, just ingenuity. For instance, Serena Young, MD, an orthopedic surgeon who had polio as a child, developed her own protocol for scrubbing and gowning with crutches and braces.
Frank Jirka, MD, a urologist and past president of the American Medical Association, has a double below-the-knee amputation; he modified the cut and burn pedals of a cutting and coagulating machine. David Rogers, MD, who has high-level quadriplegia and is clinical geneticist with Genzyme Genetics in Orange, Calif., uses a voice-activated computer to access information. An assistant helps answer telephone calls, transport records, file papers, stamp signatures and turn pages of documents.
While physicians can change and adapt work environments, attitudes aren't so easily altered. Discrimination is a fact of life for all people with disabilities, and physicians are no different. For many clinicians, past experiences have hardened their resolve and form the bedrock of their perseverance.
During childhood, Sharon Kawai, MD, who has spina bifida, was first treated as someone expected to die soon, then later as a mentally handicapped child. She was initially turned down at every educational level from kindergarten to college to medical school. Yet she persevered and is now a physiatrist and medical director of rehabilitation at Saint Jude Medical Center in Fullerton, Calif. But she still encounters prejudice. "Even today, people think that because you're in a wheelchair, you don't think as well as others," she says.
Dr. Strax, professor and chair of the department of physical medicine and rehabilitation at the University of Medicine and Dentistry in New Jersey and medical director of the JFK/Johnson Rehabilitation Institute, lived through a time when children with disabilities were considered shameful. Dr. Strax was mainstreamed because of his parents' persistence in court, but not before he was exposed to bus drivers who didn't want him on the bus and teachers who felt he couldn't be educated. He had to continually prove himself, a quality that carried over to his drive to join the medical profession.
While society still struggles to come to grips with disability rights, it's not the only source of discrimination facing physicians with disabilities. Ironically, the strongest resistance to bringing people with disabilities into the profession comes from within medical circles. Just getting into medical school is a huge hurdle.
Applicants run into by-the-book "technical standards," which effectively bar all people with disabilities. For example, of 127 medical schools in the United States, 28 rely on technical standards, demanding that candidates for an MD degree must have "somatic sensation and functional use of the senses of vision and hearing, coordination of gross and fine muscular movement, equilibrium and functional use of touch and vision." Only two report a policy of disregarding disability in the admissions process.1
Judith Pachciarz, PhD, MD, spent 17 years trying to get into medical school and found that schools didn't bother to hide that she was being rejected because she was deaf. It's easy to wonder how physicians with disabilities can do specific tasks, and it's even easier to assume they cannot. "I would explain technical advances.
I would bring pictures of my instruments, and I would explain how to do it," says Dr. Pachciarz. "Even after I answered their questions, they felt uncomfortable. They didn't want to say 'Yes,' but they had a hard time saying 'Why not?'" Today, Dr. Pachciarz is transfusion service director at Martin Luther King Jr. and Drew Medical Center in Los Angeles.
Margaret Stineman, MD, who has multiple congenital malformations of the musculoskeletal system, remembers her struggles. "Some schools interviewed me because they were curious, because I was different. And some schools flatly rejected me. Either they had filled their 'quota' of disabled people, or they just thought I couldn't do it," says Dr. Stineman, associate professor of physical medicine and rehabilitation at the University of Pennsylvania in Philadelphia.
David Hartman, MD, a psychiatrist practicing in Salem, Va., who has been blind since age 8, encountered similar resistance. "At first, there was some ambivalence in the field of medicine as to whether I could do a full evaluation or not. I didn't feel the people saw me as someone who would take responsibility," he says.
Stanley Wainapel, MD, who has a progressive visual impairment and is clinical director of rehabilitation medicine at Montefiore Medical Center in the Bronx, N.Y., believes these problems stem less from prejudice and more from ignorance. "There's a great deal of unawareness from physicians, in admissions committees and in many levels of the medical community, about what a person with a disability can accomplish.
I don't think it's occurred to many of them that the white coat is a symbol that does not have to be worn standing up, or that a physician does not have to be taller than the patient."
These barriers can even extend to the workplace. Stanley Yarnell, MD, medical director of rehabilitation medicine services at Saint Mary's Hospital in San Francisco, has recurrent optic neuritis and is legally blind. He had been medical director at another facility for three years, but things changed abruptly when his blindness advanced and forced him to use a cane. The hospital viewed his visual impairment as a medical-legal liability and asked him to step down as medical director, says Dr. Yarnell.
"I was numb. I couldn't believe that somebody wouldn't want to make an accommodation for me." Dr. Yarnell shifted his primary focus to an already established private practice.
Adjusting was simple. He handed off procedures, such as EMGs and nerve blocks, to his partners and kept a sighted resident at his side when he saw patients. Although the hospital was eventually supportive, scars remained. "I have a lot of self-confidence, but I was rocked to the core by institutional prejudice even more than adjusting to personal changes," he says. "I thought that was the beginning of the end."
Despite these difficulties, one area, surprisingly, doesn't create much of a problem: patient acceptance. It's a concern that weighs heavily, but only briefly, on most fledgling doctors with disabilities. "If anything, I am much more effective dealing with disabled people," says Dr. Yarnell. "People look at me and know I know what I'm talking about. And I think I'm a little more empathetic too, as all disabled people are with other disabled people."
Dr. Wainapel uses his disability to his advantage. "I'm capable of taking the metaphor of vision loss and applying it to other disabilities. I can't tell someone who [has] paraplegia that I know what it's like to [have] paraplegia, but I can say that I know what it's like to be stigmatized."
As a physiatrist who was disabled by polio while he was in medical school, Glenn Reynolds, MD, agrees that "disabled people's empathy in dealing with other people who are disabled is a great asset, especially in an environment where everything has been reduced to a procedure. There are so few people who get a chance to have someone sit down and listen to them and help them work out a problem. Any disabled person who's in medicine can do that. It's worth more than any kind of dexterity of arms or legs."
In addition, says Dr. Strax, doctors with disabilities are perceived as being warm, humanistic, understanding, caring and confident. Today, physicians with disabilities are still pioneers. But they are more than just educated survivors.
They're making it possible for others to accept the challenge of practicing medicine with a disability.
- Ring, J.J. (1988). Handicapped Medical Students. Report to the AMA Board of Trustees (I-88).
- McCormick, B. (1993, January). Disabled still face stiff barriers to medicine. American Medical News, 1.
- Wainapel, S. F. (1987). Physical disability among physicians: An analysis of 259 cases. International Disability Studies, 9, 138-140.
Julie Madorsky, MD, is clinical professor of physical medicine and rehabilitation at the University of California, Irvine, and the Western University of Health Sciences in Pomona, Calif. She is a polio survivor. Barry Corbet is a writer, filmmaker and the editor of New Mobility magazine. He sustained paraplegia after a helicopter crash.