ACP: Health care is failing physicians, medical students with disabilities

Physician practices, hospitals, medical schools, residency programs and licensing boards, must dismantle the institutional barriers that push qualified physicians with disabilities out of medicine, according to a new position paper by the American College of Physicians (ACP).

It’s a problem that harms not only those physicians but also the patients they would otherwise serve, according to "Fostering Support and Inclusion for Physicians, Postgraduate Trainees, and Medical Students With Disabilities: A Position Paper From the American College of Physicians," published in Annals of Internal Medicine. ACP also released a companion paper calling for improvements to disparities that patients with disabilities face in U.S. health care.

Although 13% of the civilian U.S. population report having a disability, only 4.6% of medical students and 7.5% of residents report having one. Among practicing physicians, that percentage drops to 3.1%, and all the figures are lower than the general population. ACP frames the figures not as a reflection of what physicians with disabilities can do, but as evidence of what the system is doing to them.

There are laws on the books to protect the rights of people with disabilities, in health care and across all business sectors. Technological advances and reasonable accommodations allow physicians with a wide range of mobility, hearing, vision, chronic health, and mental health disabilities to practice safely and provide high-quality care. The problem is that institutions are not keeping pace with that reality, according to ACP.

A climate of stigma and silence

Research cited by ACP shows that many medical students with disabilities do not disclose because of fear of judgment, bias, and a skewed perception of their abilities by supervisors and peers, according to research cited by ACP. Even among students who do disclose, stigma often prevents them from requesting accommodations: A 2022 assessment found only half of second-year medical students who self-identified a disability actually requested accommodations from their institution.

Residents did not fare better. According to data cited in the paper, 50.6% of first-year residents with disabilities who needed accommodations did not request them, with fear of stigma cited most often as the reason. A review of graduate medical education (GME) handbooks from the 50 largest U.S. programs found only 68% included any disability policy, and only 38% included language that encouraged disability disclosure or expressed that disability was a valued aspect of diversity. More than half of programs required trainees to disclose directly to a supervisor — identified in the literature as a known deterrent to disclosure, since the same supervisor typically influences a trainee’s career trajectory.

Despite federal laws, the system may not be primed for improvement. As of April last year, President Donald J. Trump signed an executive order that restricted higher education standards relating to diversity, equity and inclusion, arguing those create unlawful discrimination, the paper said.

The consequences for those who do stay in medicine are significant. In an adjusted analysis of employed physicians, annual earned income was 20.8% lower and hourly earned income was 13.3% lower among physicians with disabilities compared with nondisabled peers. Physicians with disabilities also report higher rates of daily depersonalization, greater incidence of threats of physical harm from co-workers and patients, and higher instances of actually experiencing such harm. The paper notes that mistreatment of physicians is linked to higher burnout and suicidal ideation.

Barriers built into the system

ACP identifies three structural barriers that operate well before a physician ever enters practice.

Technical standards: These are the physical, cognitive, and behavioral criteria that medical schools use to determine admission, continuation, and graduation. The paper states they have changed little in 50 years. A 2016 study found only 33% of medical schools’ technical standards specifically expressed a willingness to provide accommodations as required by the Americans with Disabilities Act of 1990 (ADA). Disability advocates and the Association of American Medical Colleges (AAMC) have called for a shift from “organic technical standards” — which specify demonstration of physical, cognitive, and sensory abilities in person — to “functional technical standards” that focus on outcomes and allow for accommodations and assistive technology.

Licensing examination accommodations: In the 2018-2019 academic year, 52% of students who disclosed a disability and registered for the United States Medical Licensing Examination (USMLE) Step 1 examination were denied their requested accommodations. Of those denied, 51% delayed entry to the next phase of their curriculum, 32% took the examination without accommodations and failed, and 3% withdrew or were dismissed from their programs. Some students waited up to three months just to learn whether their accommodation requests had been granted.

Disability service providers: Disability service providers (DSPs) are the institutional staff responsible for determining a student’s disability-related needs and recommending appropriate accommodations. The paper notes that some institutions share a DSP across undergraduate and graduate programs who may not be familiar with the specific demands of medical training. Medical students with disabilities report receiving incorrect information from DSPs due to their lack of familiarity with medical school culture, particularly around what accommodations work in a clinical context. Students with hearing loss have reported spending an average of 1.9 hours per week arranging their own accommodations as a result.

Recommendations

The paper’s 13 recommendations span three areas:

• Ensuring a fair and inclusive environment for all physicians.
• Reforming medical schools and GME programs.
• Supporting a diverse workforce.

For practices and health systems: ACP urges physician practices to evaluate the physical accessibility of their facilities and provide effective, context-appropriate disability accommodations — not only for patients, but for all medical staff and trainees. Practices should maintain clearly defined, transparent, and readily available policies for requesting disability-related accommodations. The paper emphasizes that legal compliance does not always equate to meaningful access, and that policies must be implemented in good faith.

For medical schools and residency programs: ACP calls for a review and revision of unnecessarily exclusionary technical standards, transparent and confidential accommodation processes that do not require disclosure to evaluating supervisors, investment in DSPs who are specifically trained in medical education contexts, and professional development for faculty and administrators on disability and the law. ACP also urges licensing boards — including the National Board of Medical Examiners, the boards of the American Board of Medical Specialties, and the American Osteopathic Association — to streamline and align their accommodation request processes to reduce the financial and emotional burden on applicants.

For professional organizations: ACP urges medical societies to ensure their conferences, digital resources, and publications are accessible in formats compliant with legal standards and to develop resources that help physicians with disabilities advocate for themselves in clinical workplaces. The paper notes that physician-led groups such as the Docs with Disabilities Initiative have led much of this advocacy to date, while major medical associations have only recently begun to engage.

The patient care argument

ACP makes a clear case that supporting physicians with disabilities is inseparable from improving care for patients with disabilities. The paper notes that a physician who has lived experience with disability carries a form of expertise that translates into more culturally appropriate care. Research also suggests that equal-status relationships between nondisabled and disabled physicians can shift attitudes and reduce the stereotyping that contributes to poorer care for patients with disabilities.

ACP also calls for greater data collection on the needs of physicians with disabilities and on the effectiveness of clinical accommodations, noting that the evidence base remains limited — particularly for physicians who develop a disability during their careers, whose experiences and needs may differ substantially from those whose disability shaped their training from the outset.