The link between the number of healthcare providers who are members of minority and underserved communities and improved health outcomes for those communities is well established. Studies addressing racial, ethnic, and sexual minority communities provide clear evidence that when the demographics of healthcare providers reflect the demographics of the general population, healthcare and health outcomes are improved. In response, pipeline programs have been developed over the last couple of decades to promote the entry of underrepresented minorities and women into healthcare fields. Regrettably, these efforts to increase healthcare provider diversity have omitted a critically underserved population.
People with disabilities comprise the largest minority in the United States — nearly one in five Americans (56.7 million) identify as having a disability. With a large aging population, we can expect that number to increase significantly in the coming years. Mirroring other minority groups, people with disabilities have greater unmet healthcare needs than those without disabilities. Despite seeking more healthcare than non-disabled people, those with disabilities experience significant financial, programmatic, and systemic barriers to healthcare access. These obstacles are evidenced by harrowing personal accounts of medical errors resulting from inaccessible diagnostic medical equipment; health practitioners’ over-focus on the disability to the exclusion of other health issues, leading to misdiagnoses and the omission of general preventative care; and a lack of access to reproductive and sexual healthcare due to faulty assumptions about disability and sexuality.
Underpinning these barriers is a pervasive lack of understanding among health practitioners about the reality of the day-to-day lives of people with disabilities. As with other minority groups, the disability community benefits from health practitioners whose worldview is informed by their lived experience of having a disability. These healthcare providers often bring with them a history of fighting for access, a holistic view of patient care beyond the scope of a disability, an understanding of the “hidden work” that having a disability requires of individuals, and experience with ableism and microaggressions — all of which contribute to a deeper understanding of the health issues faced by patients with disabilities.
When describing why she chose a primary care physician (PCP) with a disability, researcher Alice Wong explained, “I did not choose my PCP because of my disability or in spite of his disability. I chose him for his excellence as a doctor who listens well and actually gets it when I communicate my access-and disability-related needs. My PCP may do these things well as a result of his training, his education, and his lived experiences as a person with a disability — one cannot separate these elements. And this is why diversity is so valuable.”
Despite the overwhelming need for medical practitioners with a personal understanding of disability, the number of graduate health science students with disabilities continues to significantly lag behind that of the general population. Although 11.1 percent of all U.S. undergraduates report having a disability, at the graduate level only 5.4 percent of those obtaining doctorate degrees in science and engineering report having a disability, and the mean number of U.S. medical students with disabilities is only 3 percent.
Students with disabilities have historically been excluded from healthcare education, but that has changed over time. In 1979, the U.S. Supreme Court ruled that a community college did not have to admit a nursing student with significant hearing loss; yet that same student went on to complete her degree at a nearby school — one that would admit her — and had a successful nursing career. Since then, the passage of the Americans with Disabilities Act and improvements in technology that better enable disability access, as well as societal evolution regarding acceptance of individuals with disabilities, have largely done away with the baseline assumption that students with disabilities cannot become competent, safe medical professionals. Courts recently ruled that a deaf man must be admitted to a medical school and that a student with limited vision must be permitted to complete a chiropractic degree.
Schools can and must do more to recruit and retain health science students with all types of disabilities. To increase the number of healthcare providers with disabilities in order to address national health disparities, schools must do the following:
● Actively seek applicants with disabilities. Colleges must tap into existing pipeline efforts for students with disabilities at the high school and undergraduate levels and include institutional resources of interest to applicants with disabilities in application and website materials.
● Encourage students to disclose disabilities and seek appropriate accommodations. Written procedures for how to obtain accommodations should be made available on a school’s website and in class syllabi both to provide students with information and to normalize disability for the rest of the university community.
● Include disability competency as part of the core cultural competency curriculum. Essential to this component is training health science students on the kinds of barriers people with disabilities regularly encounter when seeking healthcare and providing opportunities for these students to interact with people with disabilities in ways that do not focus exclusively on their disability. These efforts must include individuals with disabilities.
● Create an environment where disabilities are acknowledged and respected. This means ensuring that faculty and staff are educated on the value of including students with disabilities and the best practices for working with, supporting, and communicating with students about disability-related issues. Training regarding faculty and school obligations under disability laws is also useful.
● Exchange ideas and knowledge with peer institutions. Resource groups like the Coalition for Disability Access in Health Science and Medical Education (housed within the University of California, San Francisco School of Medicine) and the Association of American Medical Colleges are working together to provide resources and guidance regarding students with disabilities.
Making these kinds of efforts to create a more diverse student body also results in immediate benefits for schools themselves. The National Institutes of Health has begun predicating its approval and renewal of research grants on schools’ efforts to recruit and retain students with disabilities. Increased disability diversity also has pedagogical benefits; working alongside their peers with disabilities in classrooms and clinics typically helps non-disabled students form a more nuanced understanding of and respect for people with disabilities, which informs future practice.
And if health science educators are not interested in doing the right things for the right reason, the courts are deciding that they need to do them anyway; as previously mentioned, schools that deny students with disabilities equal opportunities are having to defend those decisions to the Office for Civil Rights or in the courts, which are increasingly saying that students with disabilities have the right to be in the health science classroom.
Institutional benefits aside, the most important result of the inclusion of students with disabilities in health science education is the improvement of health outcomes for people with disabilities on a national scale. Health science administrators need to actively recruit and work to retain — not just tolerate — students with disabilities. Schools are currently working toward doing this for students of color, in part, because positive results on health outcomes have been demonstrated. It’s time that schools start including students with disabilities in this same effort; they’ve been ignored for far too long, with negative effects not only on their civil rights, but also with serious societal health consequences.●
Elisa Laird-Metke, JD, is the director of the Disability Resource Center at Samuel Merritt University in Oakland, Calif. Neera R. Jain, CRC, is a disability consultant at the University of California, San Francisco (UCSF). Lisa M. Meeks, PhD, is the director of Medical Student Disability Services at UCSF School of Medicine.