Anesthesia Professionals With Disabilities
A diverse workforce is more productive and more representative of the American population.1 Factors such as race, ethnicity, gender, sexual orientation and religion are frequently considered aspects of diversity, while disability is largely ignored.2 Indeed, only 15 percent of top-ranked companies include disability in their definitions of diversity.3 Lack of awareness of the various forms of disability can contribute to conflict and mistrust between employees.4 It is unlawful to discriminate against an employee for having a disability,5 yet employees with disabilities often face prejudice.6 Though the literature on physician disability is limited, health professionals of all types—ranging from clinical psychologists7 to nurses8—may face disability throughout their lives.9 While some guidelines exist surrounding disability-related recruitment and retention among medical students,10 health professionals may also develop a disability later in life.9 In order to reduce discrimination against and provide adequate resources for practitioners with disabilities, anesthesia providers should become familiar with definitions of disability, stigma associated with various conditions and disability in anesthesiology in particular.
According to the Centers for Disease Control and Prevention (CDC), a disability is any condition of the body or mind that makes it more difficult for a person to do certain activities and interact with the world.11 A disability is marked by impairment, such as loss of a limb, blindness or memory loss; activity limitation, such as difficulty reading, hearing, walking or problem solving; and participation restrictions, such as working, engaging in social and recreational activities and obtaining health care services.12 Specifically, work-related disabilities may result in employment problems because the individual is unable to perform a work role in a manner that is considered “normal.”13 A health care professional with a disability is one who is unable to practice medicine or nursing with reasonable skill and safety because of a physical or psychiatric condition.13 These vague, subjective definitions lead to a spectrum of interpretations and implementations, often causing stigma against workers with disabilities.8 Indeed, one study found that prejudice surrounding certain types of disabilities—such as AIDS, cerebral palsy and stroke—contributed to lower acceptance of the worker.6 The complexity of disability in client-facing roles, including the health professions, can have profound personal, professional and societal ramifications.13
Disability in anesthesia providers can manifest in a number of ways, and can arise from before medical school to later in life.9 For example, disability in anesthesiology includes a practitioner who has suffered an injury or illness and wants to return to practice; a provider with an established impairment who is seeking support or hoping to receive disability insurance benefits; and colleagues who are questioning whether an anesthesia provider with a particular limitation should be allowed to continue practicing.9 These issues almost always subjective and ethically challenging, and they are made more complex by the fact that a condition may be disabling in one context, but merely inconvenient in another.13 A case study by Fitzsimons et al. found that cognitive disabilities, such as attention deficit/hyperactivity disorder (ADHD), may go undiagnosed among anesthesiology trainees and contribute to the trainee’s struggles throughout residency.14 Meanwhile, a review by Katz shows that substance use disorder is one of the most common disabilities among resident and attending anesthesiologists.15 Other disabilities include physical issues, major psychiatric disorders like clinical depression, burnout and age-related dementia.15 Management of these disabilities among anesthesia providers can be complicated, given prejudices and potential impairment attached to the conditions.15
Though some degree of impairment will occur in one-third of anesthesiologists during their careers, there are few studies on the role of stigma and work difficulties for anesthesia providers with disabilities.15 Some general approaches to workplace disability can include diversity management services,4 improved definitions of disability in anesthesiology8 and individualized programs for anesthesiology trainees or attendings who may require special accommodations.14 Anesthesia professionals should embrace the diversity that providers with disabilities bring to the workforce4 while simultaneously preserving their mission to “do no harm” to patients.8
1. Selden SC, Selden F. Rethinking Diversity in Public Organizations for the 21st Century: Moving toward a Multicultural Model. Administration & Society. 2001;33(3):303–329.
2. Diversity includes Disability. Accessibility Information 2019; https://accessibility.cornell.edu/diversity-includes-disability/.
3. Ball P, Monaco G, Schmeling J, Schartz H, Blanck P. Disability as diversity in Fortune 100 companies. Behavioral Sciences & the Law. 2005;23(1):97–121.
4. Muyia Nafukho F, Roessler RT, Kacirek K. Disability as a Diversity Factor: Implications for Human Resource Practices. Advances in Developing Human Resources. 2010;12(4):395–406.
5. The ADA: Your Employment Rights as an Individual With a Disability. Washington, D.C.: U.S. Equal Employment Opportunity Commission; 2008.
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7. Olkin R. Could you hold the door for me? Including disability in diversity. Cultural Diversity and Ethnic Minority Psychology. 2002;8(2):130–137.
8. Sin CH, Fong J. ‘Do no harm’? Professional regulation of disabled nursing students and nurses in Great Britain. Journal of Advanced Nursing. 2008;62(6):642–652.
9. Dangler LA, del Carmen Forrest M. A Diverse Perioperative Physician Workforce Includes Those With Disabilities. ASA Newsletter. 2019;83(6):20–22.
10. Meeks LM, Jain NR, Moreland C, Taylor N, Brookman JC, Fitzsimons M. Realizing a Diverse and Inclusive Workforce: Equal Access for Residents With Disabilities. Journal of Graduate Medical Education. 2019;11(5):498–503.
11. National Center on Birth Defects and Developmental Disabilities. Disability and Health Overview. September 4, 2019; https://www.cdc.gov/ncbddd/disabilityandhealth/disability.html.
12. International Classification of Functioning, Disability and Health (ICF). Classifications March 2, 2018; https://www.who.int/classifications/icf/en/.
13. Katz JD. The Disabled Anesthesiologist. ASA Newsletter. 2007;71(5):17-21.
14. Fitzsimons MG, Brookman JC, Arnholz SH, Baker K. Attention-Deficit/Hyperactivity Disorder and Successful Completion of Anesthesia Residency: A Case Report. Academic Medicine. 2016;91(2):210–214.
15. Katz JD. The impaired and/or disabled anesthesiologist. Current Opinion in Anaesthesiology. 2017;30(2):217–222.