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How BIG is the Problem of Disability Amongst Physicians?
From a presentation to the Federation of Medical Licensing Authorities of Canada, St. John's, Nfld June 2001.
Canadian data in the public domain on this question approach nil. A PubMed search 1990 – 2001 revealed several anecdotal articles, but nothing directly applicable. Neither were there websites addressing the issue.
Statistics Canada does provide some online statistics on disability, but these were not directly applicable to the physician population. However Target Group Profiles can be commissioned to perform custom requests on a particular group such as physicians, creating a profile based on the 1996 census, by categories such as GP/specialist, age, sex, ethnicity, income, geography, and so on.
An "Update on the Survey on Persons with Disabilities", an HRDC project with Statistics Canada should have results available in 2003.
Revenue Canada may be a potential source of information. For a cost of approximately $500 they can provide the number of physicians claiming the Disability Tax Credit on their tax return by province or territory. However, it is clear that many physicians may be disabled without qualifying for the strict criteria of the Disability Tax Credit.
Statistics from physicians groups are less available. In response to a short questionnaire sent out by this organization in May 2001 to the provincial and territorial Colleges of Physicians and Surgeons, approximately 65,100 physicians in June 2001 were identified as having active licenses. Another 322 were identified as having inactive licenses due to disability. But 7 provinces and territories do not have a licensure category for this group at all. Alberta knows of 6 disabled physicians but doesn't formally track this group. 316 physicians with inactive licensure due to disability were identified in 4 provinces: British Columbia, Saskatchewan, Quebec, and Newfoundland/Labrador, for a prevalence rate of 1.11% in those provinces. Those with active licensure and disability were not identified, nor were those physicians with disabilities who had simply allowed their licenses to lapse. So the estimate of 1.11% is undoubtedly an underestimate.
The American data are somewhat more plentiful, but largely indirect in their implications for physicians. Lewis (in Callan: The Physician: A Professional Under Stress, 1983.) suggested a prevalence of physician disability of approximately 4%. The original reference was unavailable at the time of writing.
American literature on the many facets of disability blossomed in the early '90's largely in response to the Americans with Disabilities Act passed in 1990. Much was focused on the legal implications of the ADA. Physician impairment, when addressed, was generally restricted to psychiatric disorders and drug and alcohol abuse. The issue of medical schools admitting students with disabilities and managing the occurrence of disability in their students figured prominently. Two studies approximately a decade apart suggested a prevalence rate of disability among medical students of approximately 0.2%. Wu (Wu et al, Am. J. of Physical Medicine and Rehabilitation) surveyed 67 medical schools in the US and Puerto Rico in his 1996 article.
American disability statistics are readily available online. There is a registry of disability web pages which provides data at a multitude of level. The National Institute on Disability and Rehabilitation Research home page (affiliated with University of West Virginia) and the Disability Statistics Centre home page (run by the University of California, San Francisco) were particularly useful. Others require further investigation.
Results vary somewhat, depending on methodology and definitions used. In one study by the Disability Statistics Centre 9% of working age people in the United States have some work disability, defined as a limitation in work due to chronic illness or impairment. 5% of civilians aged 16-64 have severe work limitation, defined by the US Bureau of the Census as not working at all or receiving Medicare or Supplemental Security Income. Keep in mind that the proportion of people with work disability increases greatly with age, from 1.8% of people aged 16-24 who are limited in the kind or amount of work they can do, to 7.9% of people aged 55-64. Similarly, the proportion of people with severe work disability rises from 1.9% to 14%. The rate of disability also decreases with increasing education. Based upon the same population survey 2.9% of college graduates are limited in the amount or kind of work they can do.
So, where does this leave physicians?
Physicians as a group are probably not representative of the general population with respect to disabilities, thereby limiting the applicability of statistics in the general population. If we assume --- as a place to start ---that the rate of disability in our medical student population is 0.2%, then that is approximately 1/20th the rate of disability in the general population for young college age adults i.e.. 1/20 of (1.8 + 1.9). What subsequent trends there are in the physician population with regards to aging and disability, premature deaths, patterns of practice and so on are at this stage unknown and presumably, till now, uninvestigated. Perhaps it's time to start asking those questions.
But why should we ask those questions? After all, it's only a small proportion of our physician population. 2%. Maybe 4%. Maybe more. The point is, we don't know. And where there is ignorance, there is discomfort and fear. It's easy to say, "It's not a big problem." "It's not my problem." The problem is easy to ignore --- out of sight, out of mind.
But these are your colleagues. They deserve the respect you give to your other colleagues. They deserve to hear the questions, What CAN you do? What can we do to help? How can we keep you involved? The worst disrespect of all is the ignoring, the dismissal, of the person. It could be you in those shoes tomorrow.
At the most basic unemotional, economic, and ethical level we owe it to our public to know and understand this problem. They have a tremendous – at its most crass – number of dollars invested in each of us. It's up to us as a profession to make sure they get value for each dollar spent.
Dr. U. D. Nielsen,
Canadian Association of Physicians with Disabilities
June 2001