Empowering differences: Disability in child neurology training

The article by Roach¹ describes diversity implications in child neurology training, calling for initiatives toward consensus-building and change. In this letter, we call for an initiative to empower disabled physicians and to pursue a workforce that is neurodiverse.

Schor has underscored the value of developing a workforce that reflects those we serve.² A child neurology workforce, then, should include disabled physicians, including those who identify as neurodivergent with insight regarding neurological differences that compose the human spectrum.

In the United States, disabled persons comprise nearly a quarter of adults, but only 3.1% of practicing physicians report having a disability.³ This may be an underestimate because disclosure comes with risk. Myriad obstacles prevent disabled physicians from disclosing their disability, including cultural expectations, disability stigma, and penalties that come with disclosure. This leads many to hide their disability and discourages disabled students from pursuing medical careers altogether. Likewise, neurodivergent traits are seen generally as problems in medical training despite increasing literature regarding disabled medical trainees and autistic students in higher education.^{4, 5} While affirmative practices may accommodate marginalized racial, gender, ethnic, and socioeconomic identities, neurodivergent traits may be seen as simply disqualifying. Neurodivergent individuals may not disclose their diagnosis during training and may believe that conforming—camouflaging or “masking” their traits and ignoring their needs—is the only path forward.⁶

When our culture and our health care and economic systems view disabled and neurodivergent persons via a lens of alterity—le regard médical, medicalization of behavioral traits, empirical reductionism, and valuation of persons by their economic productivity—disabled physicians meet an unmet need. Disabled physicians are not token individuals but empowered individuals who embody belonging in an equitable society. They teach us to adapt, to consider lived experience, intersectionality, and identity, which are integral to consensus-building, shared decision-making, and goal-directed care. When physicians and patients share common identities, our partnerships can be strengthened, trust engendered, and outcomes improved.

The fact may be that we have always had disabled and neurodivergent physicians among us. What we may need above all is the courage to ask ourselves whether recognizing—and empowering—our differences would better reflect the needs of our patients, making medicine good and integral to our shared humanity. If we as a professional community are pursuing equity and justice rather than token diversity and inclusion, we need to raise up disabled physicians. What must change in our system of training and our culture so that our differences can be empowered?

Young-Min Kim: Conceptualization; writing—original draft; writing—review and editing. Diana M. Cejas: Conceptualization; writing—review and editing.

Young-Min Kim is a member of the ACNS editorial board. Dr. Diana M. Cejas was the site principal investigator for a trial funded by Zynerba Pharmaceuticals in 2021 and participated in another study for UCB Pharmaceuticals in 2022. The remaining author declares no conflict of interest. [Correction added on 22 September 2023, after first online publication: The Conflicts of Interest were revised to include ACNS editorial board membership.]