糖心vlog

Although the Americans with Disabilities Act (ADA) has been in effect for over 3 decades, challenges persist for professionals with disabilities, including lower employment rates than their peers,¹ and those with disabilities who are employed experience underemployment, part-time or contingent employment, and lower mean salaries.^1,2 These data suggest that people with disabilities likely experience workplaces differently from those who do not have disabilities.³ People with disabilities are also underrepresented in academic medical centers, as only 5% of faculty identify as having disabilities,⁴ compared with 14% of medical students,⁵ indicating a loss of trainees along the career path. To better understand the experiences of health care professionals with disabilities, we asked students and employees at a major US academic medical center whether they feel respected and are treated equitably at their institution.

This cross-sectional study was conducted at Stanford Medicine from November 1 to December 5, 2020. Faculty, students or trainees, and staff were invited to participate in an anonymous online survey. Survey elements included disability identity (no disability, ADA-defined disability and self-identify as disabled, or ADA-defined disability but did not self-identify as disabled; eAppendix in Supplement 1), demographics (gender, race and ethnicity, and sexual orientation; see Table 1 for full list of demographic responses), and 5 climate statements regarding feelings toward the institution, rated on a 5-point Likert scale (Table 2). This study was deemed exempt and consent was waived by the Stanford University School of Medicine鈥檚 institutional review board because the data were deidentified and collected anonymously as part of a needs assessment. No identifying information was collected and surveys were answered completely anonymously via survey link distributed through listservs. This study followed the reporting guideline.

Statistical analysis was performed from January 9 to June 30, 2023. Associations between disability identity and agreement with each statement (鈥渁gree鈥� and 鈥渟trongly agree鈥� combined) were evaluated using logistic regression models adjusted for participant demographics. Odds ratios (ORs) and 95% CIs are reported here. All tests were 2-sided, with P鈥�<鈥�.05 considered statistically significant. Analyses were performed in SAS, version 9.4.

Of 3311 participants discussed in a prior publication,⁴ 2912 completed at least 1 climate question and were included in this analysis (Table 1). Participants who self-identified as being disabled and had an ADA-defined disability showed significantly lower odds of agreeing with every climate statement compared with individuals with no reported disability (question 1: OR, 0.57 [95% CI, 0.40-0.82]; question 2: OR, 0.52 [95% CI, 0.35-0.77]; question 3: OR, 0.66 [95% CI, 0.46-0.95]; question 4: OR, 0.62 [95% CI, 0.44-0.89]; question 5: OR, 0.71 [95% CI, 0.50-0.99]) (Table 2). Participants with an ADA-defined disability who did not self-identify as disabled also had significantly lower odds of agreeing with the first 3 statements (question 1: OR, 0.77 [95% CI, 0.59-0.99]; question 2: OR, 0.62 [95% CI, 0.47-0.82]; question 3: OR, 0.75 [95% CI, 0.60-0.95].

To our knowledge, this is the first major study of disabilities and equity across a major health center in the US. Respondents who self-identified as having a disability and had an ADA-defined disability consistently showed lower odds of agreeing with positive institutional statements, in line with prior research.⁶ These findings highlight a significant gap between the inclusivity goals of institutions and how those with disabilities perceive and experience work at these institutions.

This study is limited by its cross-sectional design, and an accurate response rate cannot be calculated because the survey was distributed through anonymous listservs. These data serve as a call to action for health care institutions to evaluate their internal policies and to foster an environment that not only communicates values of equity and inclusion but ensures these values are felt and experienced by all members. Ensuring that all employees, regardless of disability status, gender, race and ethnicity, or any other identity, feel a genuine connection to their institution鈥檚 vision and mission is crucial for creating truly inclusive environments.

Accepted for Publication: June 27, 2024.

Published: August 28, 2024. doi:10.1001/jamanetworkopen.2024.30367

Open Access: This is an open access article distributed under the terms of the CC-BY License. 漏 2024 Altamirano J et al. 糖心vlog Open.

Corresponding Author: Jonathan Altamirano, MS, Office of Faculty Development and Diversity, Stanford University School of Medicine, 291 Campus Dr, 3rd Floor, Room LK3C02, Stanford, CA 94305 (altamira@stanford.edu).

Author Contributions: Mr Altamirano and Dr Fassiotto had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: Fassiotto, Salles, Sutha, Maldonado, Poullos.

Acquisition, analysis, or interpretation of data: Altamirano, Fassiotto, Salles, Maldonado.

Drafting of the manuscript: Altamirano, Fassiotto, Salles, Poullos.

Critical review of the manuscript for important intellectual content: All authors.

Statistical analysis: Altamirano, Fassiotto.

Administrative, technical, or material support: Altamirano, Fassiotto, Salles.

Supervision: Fassiotto, Salles, Sutha, Maldonado, Poullos.

Conflict of Interest Disclosures: Dr Maldonado reported receiving grants from Pfizer outside the submitted work. No other disclosures were reported.

Data Sharing Statement: See Supplement 2.

Additional Contributions: We thank Sarah Kate Selling, PhD, Stanford University School of Medicine; Richie Whitten Sapp, MD, Harvard emergency medicine resident; Steven Losorelli, MD, Stanford School of Medicine otolaryngology head and neck surgery resident; and Claire Rhee, MD, Johns Hopkins pediatrics-anesthesiology resident, for their contributions to the design of the survey used in this study. They were not compensated for their contributions.