Disability and Reasonable Accommodations for Residents and Fellows

What are “accommodations”? 

Many residents and fellows are living with disabilities and illnesses that require modifications to the standard resident or fellow schedule or environment in order to be able to fulfill their program responsibilities- these modifications are called accommodations. The residency and fellowship programs are required by law to make reasonable accommodations for residents or fellows with a disability. 

Do I have a disability as defined under the Americans with Disabilities Act?

An individual with a disability is defined in the ADA as someone who has “a physical or mental impairment that substantially limits one or more major life activities; has a record of such an impairment; or is regarded as having such an impairment.” 

The Americans with Disabilities Act (ADA) does not set forth an exclusive list of conditions covered by the ADA. 

 

If I have a disability, how do I get accommodations from the Residency or Fellowship Program? 

You may submit a request for the accommodation(s) that you believe are necessary for you to fulfill your responsibilities in the Residency or Fellowship Program.

Each request for reasonable accommodations is considered on an individual basis. Residents and fellows who are found to be eligible for reasonable accommodations are given the accommodations that are most appropriate for their individual needs and that allow performance of the essential functions of the residency and fellowship program requirements. 

 

To whom do I submit a request for accommodation? 

Your request for accommodation may be submitted in writing to the: 

• Disability Management Services (DMS) DMS is housed within Human Resources and can be reached at (415) 476-2621.  

• Residency Program Director or

• Fellowship Program Director  

You do not need to include your diagnosis or any personal health information with this request. 

If your request is submitted to the Residency or Fellowship Director, the Program Director, the Director will coordinate with DMS to initiate the interactive process. 

 

Do I need to provide documentation from a physician to request an accommodation? 

Medical documentation from a qualified healthcare professional will be requested as part of this process.  A qualified healthcare professional is one who treats the area of disability or impairment for which you are seeking accommodations. 

Please note that qualified healthcare professionals should be independent (i.e., not your relative, even if otherwise qualified) and should have personally evaluated you. 

There will be no request for disclosure of PHI, the documentation solely needs to outline the functional limitations imposed by the health condition(s). 

 

How will my specific accomodation be determined?

DMS will review with you what disability or impairment is involved and its impacts on your responsibilities in the Residency or Fellowship Program, in order to determine what accommodations would be appropriate.

You may also request a specific accommodation. Each request will be reviewed on an individualized basis and if alternate accommodations are available, these may be offered to you.

The determination of accommodations will occur via an interactive dialog during which DMS will seek your input and the Program Director's input. The Program Director has the discretion to grant or deny the requested accommodation based upon the need for the delivery of safe patient care, adverse impact on other trainees, essential functions of the job, and program/licensure/board requirements. 

 

What are some examples of accommodations residents have received?

**Individual needs are evaluated to determine which accommodation may apply.**

• Optimizing sleep
  What can be done: minimization of 28-hour call, some rotations with no overnight call, or reduced call requirements
   
• Minimizing day-to-night transitioning
  What can be done: splitting your float block into two months and request consecutive night shifts
   
• Accessibility to computers
  What can be done: Dragon software, ergonomic equipment, Zoom Text, globally increasing font size
   
• Medical care
  What can be done: Time off for medical treatment

 

What are some examples of accommodations for mental health or learning disabilities (depression, ADHD, autism, dyslexia)?

**Individual needs are evaluated to determine which accommodation may apply.**

• Memory Loss/Learning Disability
  What can be done: 
  • Reminders or training refreshers
  • In lieu of attending lectures, allow written review of training materials and subsequent review of content with faculty.
  • Extra time for tests
  • Speech recognition or screen reading software
     
• Attentiveness/Concentration/Executive Functioning Deficits/Managing Time/Noise Sensitivity/Stress Intolerance
  What can be done: 
  • Modification of supervisor communication style or methods
  • Screen magnification and screen readers
  • Regular meetings with the Supervisor/Program Manager to discuss expectations
  • Remote work, where viable
  • Noise-cancelling headphones or white noise apps
  • Concentration/organization/time-management apps
  • Time off for medical treatment

 

Will my request for accommodation be documented in any of my files maintained by the Residency or Fellowship program?

Yes. Your accommodation will be maintained in the DMS and Residency or Fellowship Program files. These files are confidential. 

 

If I am granted an accommodation during the Residency or Fellowship Program, is that accommodation reported to the ACGME and/or my potential future employer?

The Residency and Fellowship Program supports your wellbeing and will not report the accommodation(s) you received during the program to the ACGME or your potential future employer, unless specifically requested or necessary. Instances in which the disclosure of an accommodation is necessary include, but are not limited to: 

• if disclosure is required by law and
• a failure to meet the requirements of the Residency or Fellowship Program

We are required to respond to inquiries when government or state agencies ask as part of their investigations. This could include, for example, an investigation by the Medical Board of CA, or a criminal investigation by law enforcement. Absent a court subpoena, it would not include a civil case such as malpractice. The Program will make the determination whether disclosure is necessary on a case-by-case basis and is not required to notify you in the event such a disclosure was made. 

 

If I am granted an accommodation during the Residency or Fellowship Program, do I have to report it on my licensing application?

In California, no. The applicable questions about "Practice Impairment or Limitations" on the CA license form read: 

1. Do you currently have any condition (including, but not limited to, emotional, mental neurological, or other physical, addictive or behavioral disorder) that impairs your ability to practice medicine safely?
2. Do you currently have any other condition that impairs or limits your ability to practice medicine safely?

As long as you can practice medicine safely with your reasonable accommodation(s), you may answer "no" to these questions. 

Each state has a different licensing process. If you have questions about how to fill in the forms, you may contact Risk Management for assistance.