That concern underscores the experience and expectations of disabled medical faculty as they persevere in their careers with "a silent and lonely tenacity," according to findings of a paper to be published in the December 25 issue of the Journal of the American Medical Association (JAMA).
"Anecdotal reports suggest that many medical faculty members with disabilities decide against making their condition known because they fear reprisals, particularly the loss of professional opportunities such as tenured positions," said Annie G. Steinberg, MD, of the Department of Psychiatry at the University of Pennsylvania School of Medicine. Steinberg co-authored the study with Lisa I. Iezzoni, MD, MSc, of the Department of Medicine at Beth Israel Deaconess Medical Center and Harvard Medical School in Boston, Mass.
"Faculty members with disabilities bring a wealth of personal insight and experience to medical teaching, but they must be made to feel as welcome, comfortable and secure as their able-bodied colleagues. They are neither super-heroes nor more vulnerable than their peers, but only require legally-mandated accommodations to succeed, " Steinberg added. "Through the daily example of their lives, they may remind students, residents and attending colleagues that medicine is about more than diagnosis, treatment and cure -- it requires an understanding of chronic illnesses that affect 100 million Americans."
The research paper, which is being published as a "special communication" in JAMA, is an outgrowth of the Penn Initiative 2000 project to examine quality of life issues for the university's faculty. Steinberg, Iezzoni, and their colleagues broadened their original work to encompass seven medical schools throughout the country.
The findings raise questions of access and convenience for academic medical professionals with disabilities as they function within a political and social context that the authors describe as increasingly challenging. The 1990 Americans with Disabilities Act, for example, offers no specific accommodation standards but instead mandates "reasonable" efforts by employers that will cause them no "undue hardship," thus leaving room for various legal interpretations.
For the nation's medical schools, the resulting legal ambiguity is translated into a wide range of responses -- from supportive teaching environments to professional isolation. Often, disabled faculty face huge challenges that escape the notice even of sympathetic colleagues. One faculty member who uses a wheelchair told researchers she had to refrain from eating or drinking at a reception where she was the honoree because the auditorium where the function was held had no wheelchair-accessible restroom. Another said the head of her department will not offer her a tenure-track position out of concern that it would be too stressful, leaving her faced with a year-to-year contract.
According to the survey, disabled medical faculty want their institutions to move past those sorts of oversights and misplaced, sterotype-based concerns. They believe they could compete for promotions more successfully with limited changes in academic criteria, such as extended timelines for professional promotions and promotion criteria that de-emphasize extensive travel. They also believe they could benefit in their work from improvements in physical access to teaching, research and clinical sites, and the opportunity to modify their clinical and teaching schedules.
"Now that we recognize these needs, academic medicine's response to them will be a true indication of the values and empathy we offer as members of the healing profession," Steinberg said. "It will also be part of the legacy of example we will leave for those who come after us, and one real measure of how we, ourselves, can expect to be treated by medical professionals in the future."
Penn faculty also participating as researchers for the survey were Alicia Conill, MD, of the Department of Medicine, and Margaret Stineman, MD, FACRM, of the Department of Rehabilitation Medicine. The study was conducted through volunteer time and efforts.
Journal
JAMA