The commitment


By Tushar Garg, MBBS, Eric J. Keller, MD, MA, and Pete Poullos, MD


Creating opportunities for IRs with disabilities


D


r. P spent the last decade at a small, busy community practice in Colorado. After years of wearing lead


protection and unfavorable ergonomics, her neck and back pain became increasingly difficult to ignore during IR procedures. Furthermore, she developed numbness in her dominant hand and worried she might lose the tactile feedback needed to do her job. She underwent a routine operation to manage her numbness, but woke up with worsening of her condition. The surgeon said her numbness would improve with time, but it didn’t. She did her best to keep working by doing a few small cases while battling to collect disability. Her practice was supportive at first, but she ultimately felt unable to continue her work—”you either have it, or you don’t.”


Dr. R is faculty at a prominent medical center in New York with metastatic lung cancer. He attended faculty meetings, published, did cases and taught fellows and residents all while undergoing a debilitating chemotherapy regimen. He is still nowhere near 100% but believes that even at 50%, IRs are more productive than others.


These are two of multiple stories of IRs with disabilities (details changed for anonymity). Disability and impairment among physicians are generally considered taboo topics,1


specialties like IR that praise technical ability as a key virtue.2


Nevertheless,


IRs and those entering the field are not immune to impairment and, in some respects, they are more vulnerable. Physicians have similar impairment rates as the general population1,3


but


tend to be driven perfectionists, which can cause them to delay seeking help.4 There is often a connotation in medical


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While there are functions one must be able to perform to practice IR, there is also a range of disabilities that may simply require accommodations.


culture that one either has what it takes to make it in a field or does not.5


Impairment in IRs can develop


mid-career due to increased rates of musculoskeletal problems, cataracts and possibly cancer among image- guided interventionalists, creating another unique challenge.5,6


can also be a normal part of aging.


The language here is critical. “Disability” and “impairment” are generally considered to be related but are not synonymous.3,7


“Impairment” tends to


describe a deviation from a physiologic norm, while “disability” refers to a limitation of activity. For example, the numbness and weakness in Dr. P.’s hand is an impairment, while her


inability to thread a wire with that hand is a disability. There are also additional types of disability and impairment beyond physical, including cognitive and psychological disabilities, which can be even more stigmatizing.


“Impairment” tends to have pathologic connotation—something that should be fixed or corrected if possible. For example, substance use disorder is considered a common type of physician impairment with roughly the same rates as the general population. “Disability” has historically also been considered pathologic, but it can also be a positive and central part of one’s identity.8


It may motivate someone Impairment


to become a physician in the first place and help them better connect with patients and improve their care. Thus, it can be offensive to assume someone’s disability is something that needs to be fixed or corrected merely because it is different.


There are currently limited specialty- specific resources to support members of our IR community with an impairment or disability. Some, even those with a disability, may feel these resources unnecessary and view their disability as a challenge to overcome


particularly in


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