Securing reasonable adjustments when always moving on

This anonymised account reflects the views of an individual, and not the General Medical Council.

A post-Foundation year 2 doctor who is taking a year out to work as a Clinical Fellow, talks about their experiences of moving through education, dealing with how disability is viewed, and securing reasonable adjustments.

Always on the move

I wanted to become a doctor since as far back as I could remember. At school, I found human biology fascinating. I also enjoyed talking to people and thought medicine would be the perfect fit. That was until I developed a significant physical health problem in my third year of medical school.

I plan to apply for public health training. My choice of specialty is certainly more compatible with my current health status but is not the reason I chose it.

I feel having a disability has added challenges to my path in terms of logistics, attitudes and the mental toll, which is compounded by being a doctor in training. When seeking adaptations, I was acutely aware I was far from being an irreplaceable, long valued team member. Also, I would be moving again in a short time.

In five years, I had 13 main posts across four base hospitals and one community setting. This made any adaptation to physical environments very challenging, especially when considering the time spent off base, working nights and covering admission units.

Getting reasonable adjustments right

During my time in medical school, I was referred to the disability service which help secure equipment, funding and extra time in exams. The medical school arranged on-campus adaptations such as moving lectures to accessible venues. However, support for placements was more mixed. I could secure placements near to my home but it was my responsibility to identify who my supervisor would be and contact them to explain my disability and needs.

Another issue was that I almost never knew my timetable until days before the start of each block. As someone who required at least twice weekly rheumatology appointments this was very challenging. Every 6-8 weeks I would miss appointments until I could figure out when I would be free to attend again.

I’ve received support for my training by working part-time, being exempted from some duties, such as carrying an arrest page, and being supported to find adaptive equipment, such as a mobility scooter. All these measures were vital in enabling me to work in a way that was safe for me and my patients.

I was also given voice activated software. This unfortunately was not that useful, as I rarely had a quiet enough space for it to function adequately.

Feeling like a nuisance

Working part-time was difficult to arrange and required annual renegotiation. At times this resulted in months of uncertainty or even worse, a half unfilled rota. Colleagues resented being asked to cover the shifts left unfilled.

I’ve faced challenging attitudes, such as when a supervisor wrote in my end of placement report that I ‘felt I was better able to relate to patients because of my disability’. This was their opinion and not a sentiment I share. I was also confused with another physically disabled staff member during a meeting about my health needs and accommodations by my training support committee.

I’ve also been asked deeply personal questions about my health countless times by fellow trainees, consultants, trainers, nurses and allied health professionals without any relevance to the job at hand. This is often followed by an unsolicited opinion on my coping, treatment or ability to be a doctor.

Ultimately, I believe my training was substantially more stressful than that of my able-bodied friends (an opinion they agree with). I didn’t feel particularly supported as a trainee and, whilst not meeting hostility, I felt I was a ‘nuisance’ or ‘inconvenience’ to others.

What I would change…

  • Improve communication. It would have helped if I’d been given a list of my supervisors and their contact details at the beginning of the term, rather than spends hours calling various wards and secretaries to track them down.
  • Have a dedicated contact at postgraduate training organisations with a special interest in disability.
  • For the trainee, this person could be a liaison point for advance planning of placements, job share arrangements, etc. They could take an active advocacy role in areas like annual leave requests, which can be crucially important to healthy pacing for those with chronic conditions.
  • For hospital staff and trainers, this person could be a point of contact for questions, including how to assess the progress of a part-time trainee relative to a full-time peer.
  • Greater flexibility. Remove the restriction to working either 50% or 100% at foundation level. Similarly, if there were concerns about excessive absences, have an option to increase hours at a later point to make up the deficit.
  • Have someone who supports disabled doctors to identify and access the supports available when undertaking clinical work. Many of my challenges were due to ignorance of the options, for example supernumerary training, undertaking modified CPR, allowable absences and portfolio requirements.