Fostering inclusion of healthcare providers with disabilities: Implications for HealthCareCAN members
Healthcare providers with disabilities are valued members of healthcare institutions in Canada. Unfortunately, systemic and institutional barriers exist that prevent meaningful inclusion. In this brief, we explore some of the research examining the importance of promoting equal opportunities for healthcare providers with disabilities in hospitals and academic health sciences centres.
DEFINITIONS OF DISABILITY
The most widely accepted definition of disability is provided by the World Health Organization (2013):
“Disabilities is an umbrella term, covering impairments, activity limitations, and participation restrictions. An impairment is a problem in body function or structure; an activity limitation is a difficulty encountered by an individual in executing a task or action; while a participation restriction is a problem experienced by an individual in involvement in life situations.”1
The Accessible Canada Act (2019) defines disability as “any impairment, including a physical, mental, intellectual, cognitive, learning, communication or sensory impairment — or a functional limitation — whether permanent, temporary or episodic in nature, or evident or not, that, in interaction with a barrier, hinders a person’s full and equal participation in society”.2
There is no one single working definition of disability because it can be a complex experience and varies case by case.
Under the Canadian Human Rights Commission, employers have a duty to accommodate the needs of people with disabilities to ensure they have equal opportunities. All direct care providers in hospitals and healthcare organizations can face structural barriers related to a lack of policies and procedures, clinical accommodation, and support services. However, physicians face additional barriers as they are not always employees of their respective institutions.
Importance of representation of physicians with disabilities
According to the 2017 Canadian survey on disability, more than 6 million Canadians aged 15 and over self-identify as having a disability.3 Recent survey data from the United States showed that 3.1% of physicians self-identified as having a disability.4 Unfortunately, there is very little data available on the number of physicians with disabilities in Canada.
Much of the literature related to healthcare providers with disabilities and inclusion focuses on physicians. In a 2016 paper published in Medicine and Society, author Dr. Lisa Lezzoni, discusses why increasing the number of physicians with disabilities could improve care for patients with disabilities.5
From a patient standpoint, increasing the representation of providers with disabilities within the medical field has the potential to improve outcomes and clinical experiences. Physicians with disabilities might guide improvements in health care quality for persons with disabilities. Overall, these contributions could result in decreased stigma, more cultural competence or empathetic understanding of disability experiences.
A study published in the AMA Journal of Ethics found data that suggests that persons with physical, cognitive, or sensory disabilities face significant hurdles in entering, continuing, and completing training in health professional fields.6 Furthermore, physicians who develop disabilities after completing their training often have difficulty obtaining appropriate accommodations from their workplace as they are usually not employees of the institution. Without policy support, they are at risk of leaving clinical practice for other non-clinical positions.
The Ottawa Hospital (TOH) recently identified opportunities for additional policies for physicians with disabilities that align with the goals of both the Physician Wellness and the Equity, Diversity and Inclusion (EDI) offices. The TOH’s Medical Advisory Committee unanimously supported and adopted a position statement created for physicians with disabilities (see Appendix A). The statement includes recommendations to promote accommodation and provide physicians with disabilities with equitable opportunities.
With these recommendations, policy development that lays out reasonable accommodations may now be possible to support safe and enhanced practice by physicians with disabilities. Reasonable accommodations can include ensuring physical access, restructuring jobs or work schedules, adjusting training procedures, and acquiring assistive devices (e.g., height-adjustable examination tables).
There are steps that hospitals, healthcare organizations and academic health sciences centres can take as they work toward fostering more diverse and inclusive environments. Such steps include introducing strategies to remove barriers for providers with disabilities and recognizing the challenges faced by providers with disabilities.
Healthcare organizations are advised to have the right supports in place to reduce barriers and navigate difficulties for physicians with disabilities. This includes persons knowledgeable in reasonable accommodations who can help facilitate the process, and mentorship programs.7 Healthcare organizations also must foster a sense of community and raise awareness to support providers with disabilities. More information about hiring persons with disabilities can be accessed through Employment and Social Development Canada campaigns and promotions website.
Data is necessary to plan for future health system needs. Canada does not have basic demographic data on its healthcare workforce, including data on health care providers, including physicians, who self-identify with a disability. This is important to understand the people working in our system, and the policies we need to support the healthcare workforce in their career. HealthCareCAN calls on the federal government to implement a national health workforce planning strategy to gather workforce data to tackle the shortage of health professionals and address the factors hindering recruitment and retention.
HealthCareCAN wishes to get a better sense of this issue from our members’ perspectives. We are working with The Ottawa Hospital to support their work on fostering inclusion of physicians with disabilities. If your organization would be interested in providing us with more information about your work to support healthcare providers and physicians with disabilities, please contact Emily Follwell or Jonathan Mitchell.
HealthCareCAN would like to thank Drs. Kathleen Gartke, Senior Medical officer at The Ottawa Hospital and assistant professor in the Division of Orthopaedic Surgery, Department of Surgery, University of Ottawa, Camille Munro, Director of Equity, Diversity and Inclusion in the Department of Medicine, and assistant professor in the Division of Palliative Medicine, Department of Medicine, University of Ottawa, and Michael Quon, lecturer in the Division of General Internal Medicine, Department of Medicine, University of Ottawa, and, for bringing this important issue forward and for their input.