Friday, 29 June 2012

Residency Applicants with Disability or Health Condition

Those who are healthy take their health and the ease that comes with it for granted at times. Some applicants are not so lucky and end up facing tough health situations that decide if they can or cannot pursue the dream of residency. I have come across questions from potential applicants regarding if a particular health condition they have may preclude them from being selected for interviews for residency.


The Americans with Disabilities Act [1] was enforced to help protect the rights of those with mental or physical disabilities. The law states that employment discrimination is prohibited against "qualified individuals with disabilities." An individual is considered to have a "disability" if s/he has a physical or mental impairment that substantially limits one or more major life activities, has a record of such impairment, or is regarded as having such impairment. This is good for employment in the strictest sense of a job, however residency training lies on the cusp of education and employment. In fact, this grey zone is the reason why some institutions are willing to sponsor H1b (employment based) while all others are ok with J1 (visiting scholar – training). This borderline issue thus also spreads into the question, what is the outlook for an applicant who suffers from physical disability or physical condition?

I researched the World Wide Web, to look for policies over many institutions across US regarding applicants with disabilities. The over arching theme across all the policies that were studied was that the house staff must remain fit for duty at all times. They must be able to perform their duties in a safe, appropriate, and effective manner. The ultimate rule here is “will you be able to perform your duties as a physician and take care of your patients” if you answer yes to this then, you should not have issues with residency programs.

However, in the real world, things may not always go as described on paper. Programs require the house staff to be fit to endure the rigors of residency. They also require strength of mind and resolve to persist in tough life and death situations and awkward working hours. Thus if there is an obvious disability that the PD may think will preclude you from performing your duties, you may not be invited for interview or if you are interviewed you may not make it to the rank order list. Thus, while a potential resident that has disabilities cannot be discriminated against, they may face bigger hurdles in the quest for residency.

Some institutions like northwestern university [2] or Indiana University were very clear about their policies and the “technical standards” that the applicant must meet. They talk about observation, communication, motor skills, intellectual abilities and behavioral skills [3], which an applicant needs to have to fulfill his or her duty as a resident physician. Others were not explicit but the consensus is that there are mechanisms in place to evaluate and assess each applicant on a case per case basis to see if they are able to discharge their duties as a physician. A fitness-for-duty evaluation may be recommended for the applicant who is to begin residency which may include a comprehensive medical and psychological assessment in addition to the universally mandated drug and alcohol screening.

So, are there programs that have residents with disabilities? Takakuwa et al [4] did a survey of the program directors in emergency medicine representing about 4600 residents. They found that 1.3% of all EM residents reported as having a documented disability. Furthermore, 52% of the program directors suspected a resident might have an undiagnosed disability a vast majority of them (85%) recommended testing or referral. Thus this data can be used to extrapolate to the majority of residents in other specialties, hard evidence is lacking regarding the actual numbers of residents with impairment.

ACGME (Accreditation Council for Graduate Medical Education), the agency that oversees all residency training has issued institutional requirements for all residency programs. Per law, applicants cannot be barred because of discrimination from disability. Ultimately, the decision to accept a resident with disabilities is made by individual programs on a case-by-case basis and falls back on the singular rule: Will you be able to perform your duties as a physician. If you like this site and wish to be in touch and get the latest posts and updates, join me on Facebook or follow me on Twitter.


References: 
  1. Americans with Disability Act (ADA): Guide to disability, http://www.ada.gov/publicat.htm#Anchor-14210
  2. http://www.gme.northwestern.edu/programdirectors/housestaff_manual/policies-procedures/
  3. http://medicine.iu.edu/residents/gme-house-staff-handbook/
  4. Takakuwa KM, Ernst AA, Weiss SJ. Residents with disabilities: a national survey of directors of emergency medicine residency programs. South Med J. 2002 Apr;95(4):436-40.

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