At some point in their lives, one in four people in the US will be considered disabled. From congenital or acquired conditions that require use of a wheelchair or cane, to intellectual disabilities, to spinal cord injuries, to stroke—the causes of disability are as varied as the people who live with them.
“When you have met one person with a disability, you have met one person with a disability,” said panelist Oluwaferanmi Okanlami, MD, MS, the director of student accessibility and accommodation services at the University of Michigan.
Dr. Okanlami was one of three panelists in the 2024 ACGME Annual Educational Conference’s Featured Plenary, “Closing the Gaps in the Care of the Disabled: The Role of Graduate Medical Education.” The session’s panelists, two of whom have lived experience with disabilities, discussed the gap in education and training of physicians to address their implicit bias in meeting the needs of the disabled population, as well as the ACGME’s commitment to closing that gap. The panel was moderated by ACGME Chief of Communications and Public Policy John R. Combes, MD.
The perception physicians have of disabled patients is a barrier to improved care, said Michael Stillman, MD, an internist and clinical associate professor at Sidney Kimmel Medical College in Philadelphia, Pennsylvania. “I think the medical community is biased against people who are disabled. It is uncomfortable to sit here in front of you and say that. I hope it’s uncomfortable for you to sit here and hear that,” he said to a room with plenty of open seats, a troubling visual that underscored his perception.
Dr. Stillman’s assertion is backed by studies; only 40 percent of physicians feel comfortable caring for patients with disabilities. Worse, more than 80 percent believe people with disabilities have a poorer quality of life.
“I invite you to imagine the type of biases that introduces into the care of people with disabilities,” Dr. Stillman said.
That bias, however, does not at all reflect the lived experience.
“I have an immensely rich quality of life,” said National Council on Disability member Emily Voorde, MEd, MPP. Ms. Voorde identifies as disabled and uses a wheelchair.
But for many patients with disabilities, that rich quality of life can become compromised, and not because of a disability itself, but because the medical establishment isn’t equipped with the knowledge or even the physical environment to administer high-quality care, she said.
Studies show those with disabilities are less likely to receive treatments such as diagnostic testing, cancer screenings, dental care, and more. “Assumptions are made about how well I could be,” Voorde said.
Dr. Okanlami had a spinal cord injury during his third year of residency and experienced this weakness in the medical system first-hand. “I have been a Black man my entire life,” he said. “I did not truly feel what discrimination was until I entered the world on what I call ‘the other side of the stethoscope.’”
So, what is the solution?
Dr. Stillman, partnering with his institution’s physical medicine and rehabilitation program, helped create an elective for second- and third-year internal medicine residents focusing improving learners’ skill and comfort in working with people with disabilities. His institution also offers an online Disability Care Lecture Series, to begin building clinician knowledge in disability-focused care.
Ms. Voorde encouraged attendees to reframe the conversation about incorporating care for disabled patients into the curriculum. “Inclusion in education is a competitive advantage. It’s not only the right thing to do, but it allows you to stand out.”
Dr. Okanlami said he has felt frustrated at the lack of movement in educating physicians to care for disabled patients. Next year, he hopes the ACGME’s conference session on disabilities and medical education “isn’t about what we could do, but… about what we have done,” he said. The ACGME will host a symposium on disabilities and GME in the spring of 2025.
Additionally, the ACGME’s Common Program Requirements will undergo their regular periodic reviews in 2025, Dr. Combes said. The revision of these Requirements, which are written by the GME community for the GME community and apply to all programs regardless of specialty or subspecialty, opens an opportunity to weigh in about if and how care of patients with disabilities should be incorporated, he said, encouraging attendees to participate in the review process.
Physicians cannot abdicate responsibility for understanding this topic simply because they do not have lived experience, nor do they have to wait for a requirement forcing them to address it, Dr. Okanlami said. “We create programs before the ACGME mandates that we create them because we think they’re important,” he said, adding that the community has an opportunity to not just say but demonstrate that care of people with disabilities is important.
“If today’s presentation has made you squirm in your seat or be defensive of your programs, with all due respect, I’m glad for that,” he said. “That discomfort is where the growth will happen, and improvements will occur.”