糖心vlog

As described by Altamirano and colleagues,¹ in late 2020鈥攎ore than 30 years after the July 1990 signing of the Americans with Disabilities Act (ADA)鈥攔esearchers conducted an online anonymous survey of all 28鈥�000 faculty, staff, students, and trainees across Stanford University School of Medicine, Stanford Health Care, and Stanford Children鈥檚 Hospital. They aimed to explore perceptions of institutional justice, equity, and workplace climate, including whether participants perceived that the institutions had achieved their stated goals relating to fairness, respect, antidiscrimination, and compensation equity. Their primary research question was whether and how these perceptions varied by disability status. Therefore, in addition to gathering information about other historically marginalized demographic traits, their survey captured 2 measures of disability: meeting the ADA definition of having a disability and whether an individual self-identified as disabled. The researchers analyzed findings from 2912 responses. After accounting for participants鈥� demographic characteristics, they found that compared with participants without disabilities, individuals who both had an ADA-defined disability and self-identified as disabled were significantly less likely to agree with positive assertions about institutional achievements relating to vision or mission, workplace respect, compensation equity, fairness, and discrimination. Those who had an ADA-defined disability but did not self-identify as disabled were significantly less likely than participants without disabilities to agree with positive assertions about vision or mission, respect, and compensation equity.

Altamirano and colleagues¹ conclude that gaps exist 鈥渂etween the inclusivity goals of institutions and how those with disabilities perceive and experience work at these institutions.鈥� These results suggest perceptions of ableism (discrimination based on disability) and structural ableism (discriminatory social, environmental, and policy factors that impede full participation by people with disabilities) among survey participants with disabilities. Although this research involves a single institution, disability discrimination is well recognized in professional workplaces across the US and other countries.

A systematic review of the international literature explored discrimination, social exclusion, and marginalization of faculty with disabilities within academia.² Studies from 6 nations, including the US, documented widespread barriers to full participation of faculty with disabilities in their workplaces; faculty members with disabilities often did not receive accommodations or supports available to students with disabilities.² In late 2019 through early 2020, the British Medical Association conducted an online survey of disabled physicians and medical students about their professional experiences.³ (British survey participants explicitly preferred 鈥渋dentity-first鈥� language [ie, 鈥渄isabled person鈥漖 rather than the 鈥減erson-first鈥� language [ie, 鈥減erson with a disability鈥漖 often used in the US; this language is used only to describe the results of this survey.) Although some participants reported thriving at work, many disabled physicians鈥攅specially those at senior levels鈥攄escribed bullying or harassment relating to their disability. Compared with White disabled physicians and medical students, disabled physicians and medical students of other races and ethnicities reported significantly less supportive workplaces.

Title I of the ADA prohibits disability discrimination in the workplace and employment applications. Discrimination occurs when employers do 鈥渘ot [make] reasonable accommodations to the known physical or mental limitations of an otherwise qualified individual with a disability鈥�; reasonable accommodations involve 鈥渕odifications or adjustments鈥� that enable a qualified individual with a disability to perform the essential [job] functions鈥� or鈥� enjoy equal benefits and privileges of employment.鈥�^4(p25) To be considered a 鈥渜ualified鈥� individual, employees (or applicants) must demonstrate 鈥渁n ability to perform essential functions of a given position with or without reasonable accommodations.鈥�⁴ Hiring or employment in health care prioritizes patient safety as an essential job function, according to courts that have adjudicated disability employment discrimination claims in health care settings.⁴ Altamirano and colleagues¹ surveyed individuals employed or training at their institutions, but they did not address whether participants had requested and/or received reasonable disability accommodations.

Lack of or inadequate accommodations could explain some of the findings by Altamirano and colleagues,¹ especially negative perceptions of fairness, respect, and discrimination. Faculty and trainees with disabilities frequently fail to receive appropriate accommodations in their workplaces, both in the US and abroad.^2,3 Without accommodations, faculty members across disability types confront barriers to effectively performing their jobs and thus succeeding in their professional roles.² The British Medical Association survey found that only 55% of disabled physicians and medical students who needed workplace accommodations (called 鈥渁djustments鈥� in Great Britain) had received them.³ Explanations included unresponsive employers and medical schools, lengthy and convoluted procedures for obtaining adjustments, perceived high costs, perceived negative effects on others, and fears about negative career consequences for requesting adjustments. Interestingly, 57% of adjustment requests involved more flexible work or study schedules; only 11% requested changes to buildings or premises, and 34% involved assistive technology. In a 2022 US survey of first-year resident physicians, among residents who reported disabilities and a need for accommodations, 50.6% did not request them.⁵ The most common reason for not seeking accommodations was fear of stigma or bias (59.5%), followed by absence of clear institutional processes for making accommodation requests (23.8%).⁵

An intriguing finding from the survey by Altamirano and colleagues¹ is the differences in responses between the participants who both reported an ADA disability and self-identified as disabled and the participants who reported an ADA disability but did not self-identify as disabled.¹ The former reported more negative perceptions of institutional justice, equity, and workplace climate than those reporting only ADA disabilities but did not self-identify as disabled. Previously published results from this survey found that only 28.4% of participants who reported an ADA disability also self-identified as disabled.⁶ One possibility is that individuals with a disability who profess a disability identity have stronger expectations about being treated fairly and a heightened awareness of disability discrimination than those without this identity.

The study by Altamirano and colleagues¹ did not analyze the types of disabilities. However, disabilities are diverse, and many are not apparent. The fear of stigmatization and ableism may affect whether some people with nonapparent disabilities self-identify as disabled or disclose their disability. For faculty with nonapparent disabilities, factors that affect willingness to disclose include worries about job security, fear of being disrespected or marginalized, unrealistically high productivity expectations, and being disadvantaged in hypercompetitive or toxic work environments.² In the British Medical Association survey, disabled physicians and medical students with nonapparent disabilities hesitated to reveal their disability and worried about exclusion in their workplace; 77% indicated that they feared being treated unfavorably if they disclosed their disability or chronic health condition, and among those who had disclosed, only 46% described their colleagues as supportive after disclosure.³

Finally, the prevalence of an ADA-defined disability (27%) in the study by Altamirano and colleagues¹ is similar to that among the broader US adult population.⁶ This finding alone does not prove that Stanford University does not discriminate against applicants with diabilities in hiring or trainee acceptance decisions, but it is encouraging. Altamirano and colleagues¹ speculate that having strong disability representation within health care settings is essential given the nature of the services and training they provide.⁶ Health care workers with lived experiences of disability could improve care of the growing population of patients with disabilities and enhance disability-related training of future physicians. Indeed, employees with disabilities offer important benefits, including fostering an inclusive workplace culture, attracting loyal and diverse customers, and bolstering economic performance (eg, through high retention, reliability, productive work ethic, and enhanced safety).⁷ Improving the employment and educational experiences of workers and trainees with disabilities will be difficult; disability discrimination in professional workplaces exists worldwide. Nevertheless, addressing concerns such as those highlighted by Altamirano and coauthors¹ could attract and maintain more health care professionals and trainees with disabilities, which could ultimately benefit patients and enhance health care delivery and training environments.

Published: August 28, 2024. doi:10.1001/jamanetworkopen.2024.30315

Open Access: This is an open access article distributed under the terms of the CC-BY License. 漏 2024 Iezzoni LI. 糖心vlog Open.

Corresponding Author: Lisa I. Iezzoni, MD, MSc, Health Policy Research Center, Mongan Institute, Massachusetts General Hospital, 100 Cambridge St, Ste 1600, Boston, MA 02114 (liezzoni@mgh.harvard.edu).

Conflict of Interest Disclosures: None reported.