DocsWithDisabilities Podcast Ep 16: Molly Fausone

Molly Fousone

While applying to residency in internal medicine, Dr. Molly Fausone drew parallels to her medical school application process in many ways. In this episode, Dr. Fausone considers the impact of disability on the transition points in medical education and reflects on her successes at the University of Michigan Medical School.

Episode 16, Transcript 

DocsWithDisabilities Podcast #16

Dr. Molly Fausone

Introduction: Lisa Meeks

Doctors with disabilities exist in small but measurable numbers. How did they navigate their journey? What were the challenges? What are the benefits to patients and to their peers? What can we learn from their experiences? My name is Lisa Meeks, and I am thrilled to bring you the Docs with Disabilities podcast.

Join me as I interview Docs, Nurses, Psychologists, OT’s, PT’s, Pharmacists, Dentists, and the list goes on. I’ll also be interviewing researchers and policy makers that ensure medicine remains an equal opportunity profession.

Kate Panzer:

Welcome back to the DocsWithDisabilities Podcast! My name is Kate Panzer, and I am a MDisability research assistant at the University of Michigan Medical School. In this episode, Dr. Lisa Meeks catches up with one of our very own fourth year medical students here at the University of Michigan, Molly Fausone. Before she heads to Vanderbilt for residency, we asked Molly to reflect on her past four years of medical education, ranging from the application process to mentorship, and more recently her application to residency.

Lisa Meeks:                 

Today, I get to introduce you to one of our fourth year students at the University of Michigan Medical School. Why don't you introduce yourself for our audience?

Molly Fausone:            

Yeah, so I'm Molly. I am a fourth year medical student here at the University of Michigan and I'm applying into internal medicine. I met Lisa four years ago, right after I had started at the University of Michigan. She was at another institution at the time. And now, again, at a big transition point in my timeline of medical education, here we are talking about disability and its impact on the process.

So, I have a C5-C6 spinal cord injury. I have limited use of my fingers and hands, but I use my arms quite well and I'm functional. I use a power wheelchair to get around, but I am independent. I live on my own. I do all my own ADLs. And in terms of medicine, I’m able to do my own physical exams and some smaller procedures, putting in IVs and drawing blood and stuff like that, if I have someone to help with the dexterity stuff like opening packaging.

Lisa Meeks:

So let's start at admission. Briefly walk us through that time of transition coming into medical school.

[TRANSITIONAL BARRIERS]

Molly Fausone:            

I was thinking a bit before the podcast about times at which disability had been a prominent issue in my medical education. And thinking back, I feel like it was a really big topic, both in terms of the amount of time and energy and brain space it was taking for me, but also the amount of questions that people had about my disability and the amount they wanted to talk about it in the admissions process to medical school. I think it's sort of becoming that in the admissions process to residency, similarly, where I'm spending a lot of time and energy thinking about how I want to approach it, how I want to present it.

But in the space between, I feel like it's been sort of a non issue. The first two years of medical school are preclinical education. It's just like learning in a classroom, which we are all very good at by the time we get to medical school. So, it was really a complete non-issue there. And then I think on the wards, a lot of medicine is really an intellectual process.

I found that it was sort of a non issue for faculty that I worked with, patients that I worked with. But then at these gatekeeper type stations, entrance to medical school and entrance to residency, I think people are much more interested in specifics and in my disability than I would expect would be relevant based on my actual experience.

When I went to medical school, the way I was thinking about it was I could either decide where I wanted to go to medical school and pay no particular attention to my disability and then have to spend a lot of time thinking about my disability in medical school and potentially advocating for the types of accommodations that I needed or dealing with faculty who might not have been receptive to having a student with disability. Or my other option was to decide where I was going to go to medical school based almost entirely on my disability and then have to think very little about it during medical school. And I chose the second option. A lot of my decision was based on where I felt the faculty and the administration were happy to have me, where people said, “We don't need to know exactly how everything is going to work right away, but we trust that we're going to be able to figure this out and we're willing to work with you.” And I decided that that type of environment was going to allow me to focus on learning medicine and becoming a good doctor and not being focused specifically on box checking or doing things to prove that I could do them that weren't going to be relevant to my future career, which I thought might be a possibility at some other institutions. I made a decision based on where I felt like I was going to be well received and I was.

Lisa Meeks:                 

Four years ago, you shared with me the phone call that came before you decided to sign on the dotted line if you will and matriculate to Michigan. Can you talk about that?

Molly Fausone:

Yeah. So the process for those who aren't familiar with the medical school application process and disabilities closure, when you apply, you're supposed to be invited to interviews based on your application. So your grades, your test scores, your extracurriculars, just like everybody else. My application did make it clear that I had a spinal cord injury and that I used a wheelchair. After that, you interview and then the schools decide whether or not they're going to offer you admission. After they've offered you admission is when you're meant to have a more detailed conversation about what accommodations you might need specifically and how it would look for you to go to that school. I was accepted to a number of schools and I chose the four that I was most interested in to pursue a conversation with.

Michigan was the only school that called me and said like, “Hey, we want you to come here. Let's talk about how this would look.” And they basically said in that conversation, “We don't know exactly how this is going to work. We don't know exactly what you're going to need. But they said, we're committed to you coming here. We think you're a great fit and we're willing to figure out the details.” And I think they sort of put trust in the fact that I was a good fit for Michigan and trusted in me as a person and the idea that I would be a good physician, and they were willing to not get hung up on specifics of how I would do a pelvic exam or a rectal exam or suture or retract. And those were the types of questions I was getting from other schools. How are you going to percuss? How are you going to palpate? And Michigan sort of said like, “We can figure that stuff out.”

And I think they even went so far as to say, “There are going to be clinical specialties that are a good fit for you. Probably not all of them, but some of them will be, but even if you decide at some point that you aren't going to practice clinically, you can still have a huge impact on the field of medicine. And we're okay with that.” They took a more sort of 50,000 foot view of what a medical education gives you and the types of things that their graduates can give back.

Lisa Meeks:                 

In having those discussions post acceptance but pre matriculation, I imagine that those discussions revolved around the technical standards and whether or not you would meet them.

Molly Fausone:            

They did.

Lisa Meeks:                 

When you were presented with these technical standards from other institutions, what were those conversations like?

Molly Fausone:

I initially read technical standards for a bunch of the institutions I was applying to, thinking that that would be helpful in some way to guide what types of schools would be more or less interested in having me as a student. I quickly found that wasn't helpful at all. It didn't correlate in any way with institutions that I knew had had students with disabilities or at places where students with disabilities had had a good or bad experience based on my speaking with them.

I quickly decided that I was not going to apply to schools based on what their technical standards said. But then when I got to the point of having conversations with the schools where I was accepted about how I would or would not meet their technical standards, it looked very different based on the school. So I pursued that type of conversation with four different schools and I got four very different opinions on how this would work and the conversations went differently. And Michigan basically said, “Our technical standards are outdated and we don't believe in them and we're going to rewrite them, so please ignore them.”

Lisa Meeks:                 

The commitment is very genuine, and the actions are coming from a genuine place, but they hadn't necessarily manifested in policy at the time that you were applying. But you were almost -- Molly, you were the catalyst for rewriting these technical standards. And I think it was a situation where everyone at the table who saw your application said, “This is a no brainer applicant. We want her. How can we align saying that with also saying some of the things that were in there?” And so since then they've been rewritten twice.

Molly Fausone:

And the commitment I think was clear on the part of Michigan that, I believed them when they said we’re committed to you and we're gonna make sure that you have a good experience here. And I think they were also thinking more broadly about my experience, about we're not sure where you're gonna live. This is where most students live. We're not sure if those areas are accessible. You know, there's this new dorm being built that might be an option for you. It was clear that they were really invested in my having an overall good experience and I think that bought a lot of trust from me in saying, “Yeah, I think these guys are serious when they say that they want to make this work for me.”

One of the schools got back to me and we didn't even talk about technical standards really. They just said, “We are excited to have you in terms of the admissions department. We think you're a great fit. We would love for you to come here, but we have individual faculty members here who are not willing to pass you if you end up on their rotation. And so we can't guarantee that you will graduate. And so we are not going to officially rescind your acceptance, but if you have other options, you shouldn't come here.”

Lisa Meeks:                 

And that's so interesting to me because that's such a broad statement to say they won't pass you if you end up on their rotations. Again, that's a perception of your ability without any information.

Molly Fausone:            

Correct. Yeah, so I think that's like someone saying, “This is the disability that I think Molly has and I am inferring her level of function from that,” without having ever worked with me and really probably having a very poor understanding of how I function day to day.

Lisa Meeks:                 

Whether it's a physical disability, a chronic health disability, so much of what people believe and make decisions based on is uninformed assumptions or stereotypes of what disability is and isn't without really talking to the individual about what are your functional limitations? What are some potential accommodations? And that really is a shame that that particular school basically said we're going to discriminate against you. It sounds like there were lots of warning flags with that institution. But you know, I think that that's a problem for doctors with disabilities, nurses with disabilities, anyone going into the health profession is that there are so many people who are uninformed, and in the absence of information, we use the little bits and pieces of data that we have right to fill in a bigger picture. And with that comes the inherent bias, the reliance on stereotypes.

Part of why we're doing this podcast is to really educate the audience and hopefully we have people that are in the pipeline that want to apply, but we also have program directors and deans of admissions. And I'm really hoping we have a really good administrative following that can learn from what they're hearing from different students, different physicians.

Molly Fausone:            

So the fourth school had a lot of specific questions. They wanted to know how I was going to do pelvic exams and rectal exams and test sensation or do strength exams or whether to percuss. Very specific types of things. And part of what I told them is that I don't know how I'm going to do a pelvic exam because as a nonmedical student, I have never attempted one.

Lisa Meeks:

That’s a good thing.

Molly Fausone:

Yeah, right? I thought so. And I sort of had to say, I am not going to be able to tell you how I'm going to do everything. But I can tell you that I'm really good at figuring out how to do things in ways that are a little bit different. That's like what I do day to day. The way I get dressed doesn't look the same way that you do. The way I drive doesn't look the same way that you do. My apartment is set up somewhat differently than yours is. But I’ve found somewhat different ways to do all of those things.  So you're just going to have to trust that I can figure some of this out. And I think that's where Michigan was willing to say like, “Yeah, we trust that we can make this work.” And this other institution really felt like they needed specific answers. But I offered to come in and have them evaluate my physical function and things like that, and they turned that down. 

I think in this setting I'm an expert, right? Like I'm the expert on what I can do and what I might not be able to do. And I think maybe they didn't trust that I would give them my honest assessment of my own function. But I think that's their mistake cause I have no interest in misleading them. It's just going to put me in a bad situation. Going to the student with a disability themself or maybe someone like an OT who specializes in helping people with disabilities find ways to do different activities would have left them better informed about my potential as a medical student. But I think it's a type of situation where I didn't have a hard time imagining myself doing some of these things and they did.

Lisa Meeks:

To be fair, if you lined the class of 180 up and you said, “I want all of you to tell me how you're going to do a pelvic exam,” no one should know how to do that. I mean, we would hope that there's not… No one else knew how they were going to do it. You have to learn it. And that's not what technical standards are meant to be.

Molly Fausone:

I think they were hung up a little bit on the idea to have the undifferentiated physician, which Michigan I think quickly said like we don't really believe in the undifferentiated position. But that was something we had conversations about as well. I would not be a good surgeon. I'm aware of that. I will not try to be a surgeon.

Lisa Meeks:

But importantly, you can meet the competencies of the surgical clerkship.

Molly Fausone:

Yeah, absolutely. And beyond that. The competencies of the surgical clerkship are designed for people who are not going to be surgeons, because most of us will not be surgeons, but are meant to be structured so that you learn what are the indications for surgery? What are the complications from surgery? How do surgeons approach their work or think about their interactions with patients? Things like that. There are a number of procedures that we have to do to fulfill this surgical clerkship here, all of which I was able to do. Putting in a G-tube, putting in a Foley, removing a chest tube, things like that. I'm aware that I would not be an excellent physician in every specialty, but no one, no one will.

Lisa Meeks:

Right. Regardless of disability.

Molly Fausone:

That’s exactly what I’m saying. Yeah, regardless of disabilities. And none of us are cut out to do everything. And that's fine. And I think the way that we apply technical standards is not to say that everyone needs to be able to do everything. But we selectively apply them when we see someone that we are unfamiliar with or that makes us nervous, specifically people with disabilities. And then we say, “Oh, well, you can't become an undifferentiated physician. You're not going to be able to do everything.” And it's like, yeah, well neither can any of the other applicants that you just accepted. And you're not applying these standards to them. You're selectively applying these standards for applicants with disabilities.

Lisa Meeks:

You've accomplished a lot in the course of a few years. You've managed to collect another degree on your pathway to becoming a physician. You're an author published multiple times over in high impact journals. You are writing a book chapter. I know you're part of the admissions executive committee, one of the student representatives on that. You've been highly involved in adaptive sports. You've been an excellent student and an excellent contribution to Michigan. And so with that being said, I feel it’s sad for the other institutions the loss that they had, but perhaps it was the right place at the right time with the right person that all intersected to make a lot of change here.

Molly Fausone:            

Really building me up here Lisa.

Lisa Meeks:

Well, I happen to know you, so…

Molly Fausone:

I think it certainly was the right place at the right time. I think that the school was receptive and there was a lot of movement happening here, I think, in the area of disability specifically. And you came shortly after. Now the adaptive sports program is rolling. And the technical standards have been rewritten twice since I've come here. So yeah, I do think there was a lot sort of going for my inclusion[1]  at this institution. I don't know that that would have been the same at other institutions. And I don't know if Michigan had been thinking more about disability or had been thinking about it in terms of admissions from a diversity perspective before they encountered my application. And I happened to luck into that timing or something like that.

[FACULTY LEADERS WITH DISABILITIES]

Lisa Meeks:

Michigan has at least two apparently disabled leaders in two divisions. And I wonder if that kind of informs the entire culture of the institution that we have leaders who have disabilities, and they are excellent administrators, excellent physicians, top in their game. And then at the same time, I wonder if that informed the way that admissions approached your application. And I wonder how you being at Michigan will change the culture even more because I have to believe that your classmates will have a different view of disability because they went through an educational process with you and because they now don't see limits when they think about a person that uses a power wheelchair.

Molly Fausone:

Yeah. I think all of those things are true. So I think first having people with disabilities in leadership positions I think does inform how other people at the institution think about disability. And the administrators at the school, when I talked to them before I decided to come here, were clear about telling me that there were people with disabilities in leadership positions here, at least one of whom I talked to on the phone before I came and totally did not understand her position of power at the university. I was like, oh yeah, I just chatted with her on the phone and you know, 30 minutes later and I get here and I'm like, oh, her time is super valuable.

There was another school that had a physician with a disability, and I ended up speaking with him on the phone as well. But I do think that was important for me to see that he was there and that he had had a good experience and that helped at least a little bit.

Lisa Meeks:

But you know, the two schools that you've just said had no problem and trusted the process had physicians with disabilities in those institutions.

Molly Fausone:

Yes. And in the other two institutions, I don't know whether or not they had physicians with disabilities, but if they did, they did not make me aware of them or they did not mention them. So it's possible that maybe this wasn't something that they were familiar with or didn't have a comfort level with.

Yeah and I imagine if you have a colleague or you've had a student or a professor or someone with a disability and have worked with them and been close to them and seeing that type of environment and interaction you might have more of a comfort level with saying like, Oh yeah, I see the student with the disability applying. That's feasible. I know these other people that you know are in high powered jobs or academic positions or whatever that have disabilities. If you don't see any of those exemplars and you don't have that sort of script or visualization in your head of what that would look like, you know, I think that's when people get nervous.

[BURDEN ON STUDENTS]

When I went to go do my clinical rotations, one of the people I was working with for accommodations said like, you know, why don't you go visit the clinical sites and see if they're accessible and like what we could change about them. You know, that turns out to be a lot of work because we rotate through a lot of sites. So here I am like driving all around Ann Arbor, like visiting these different clinical sites. And I sort of knew, I was like, I'm not really nervous about this. They're nervous about this. This is for them. But it wasn't a point in my academic career that I wanted to, you know…

Lisa Meeks:

Make a big fuss?

Molly Fausone:

Yeah, I didn’t want to make a fuss about it. This wasn’t a battle I wanted to fight. I just wanted to like get into my rotations and be able to do the work I came here to do. But in order to do that, I knew that I sort of needed to appease the nervousness of other people. But yeah, so I went to a bunch of different sites and it was like, yes, they have accessible parking. It's accessible because it's a clinic. And then, yeah, I can't reach the gloves and the tongue depressors and the gauze. They’re on shelves. I'll have to carry those around in my pockets.

But I think the thing that I communicated to them after I went on rotations and they said, what feedback do you have? The whole thing about visiting the clinics, I'm not nervous going to spaces I've never been to. I do that all the time and sometimes places aren't accessible and that's fine. I'm used to that. So I'm not nervous about that. You're nervous about that.

Lisa Meeks:

Right.

Molly Fausone:

And I understand that, but it's asking a lot of the student to say, can you go visit all of these sites to make sure that it's accessible? Cause it would really make us feel better.

Lisa Meeks:

And I have to say that's not an unusual situation to have happen. And I've actually made sure in my communication when we talk about how to improve the climate or the culture to say while student driven accessibility movements or changes are wonderful and usually they get a lot more attention, right? No individual student nor student group should be solely responsible for changing a culture. And you know, you have these student groups who are creating draft policies because they've been up all night looking at multiple school policies. I always think people are well intentioned, right? In an effort to support what the student wants and to give the student autonomy, the school may say, we would love to change the policy. Can you find five exemplar policies? But you're a medical student. You have no time, and nor is it your job to be out looking at exemplar policies. There are enough resources at this point in time that schools can do their own research.

Schools can walk the wards or roll the words and say, Hey, these are things we need to think about. I mean, without getting out of a seat and without you getting in a car and going there, we could have both said the tongue depressors and the gloves are not going to be at an accessible height. Put another set. Don't move the one that's there, because then you have to bring somebody in and drywall and spackle and paint.

Molly Fausone:

And I'm gonna be there for two weeks before I go somewhere else.

Lisa Meeks:

Yeah, put another set either on a tray or put it up on the wall. There are so many things that come second nature to people who do this job in health science education that you don't even have to go out to the site to do that.

With that being said, it's really good to go out to the site, but it shouldn't be you. It should be the disability person. So yeah, I see this in especially adaptive and assistive technology, well tell us what you need and we'll buy it. Well, I've never been a medical student, I've never been in a clinic. I've never been in a surgical rotation. I don't know what I need. Can you connect me with somebody who knows that knows a little bit that I can talk to that will help?

[THE SEARCH FOR MENTORSHIP]

And I know you created a really vast network of colleagues. Why don’t you talk about that?

Molly Fausone:

I did a lot of networking before I applied to medical school. So what I was looking for was physicians or trainees that had similar disabilities to myself. And I wanted to talk to them about what the application process was like, what it was like for them to go through medical school and then what they were doing in medicine now, if they were glad they did it, what their life looked like, things like that. I'm pretty sure the first person I talked to was actually a woman who I saw in a picture and a PowerPoint slide. And I went up and asked the professor. He said like, here's myself and a group of medical students doing some sort of service work.

Lisa Meeks:

Oh, I remember that story. Yeah.

Molly Fausone:

And there's a woman in a wheelchair and I was like, well, is she a medical student? And he was like, yeah. And I was like, can I talk to her? I mean, it was like, I don't know if I have her contact information, but I ended up getting it through, you know, he talked to someone else who talked to someone else. Every time I talked to someone, I said, you know, who else do you know that has a disability that's in medicine? And I ended up probably talking to almost 20 people that had disabilities. Not all of them exactly the same as mine, but a decent number of them with cervical spine injuries, who either were in medical school or were residents or attendings and talked to them about their experience applying and their experience in medical school. And that helped me learn about different institutions, but also different ways that they did things and sort of things to watch out for, things to look for in schools. So it ended up being really helpful in the application process. It was also a lot of work and it would have been nice if there was some sort of repository that I could've gone to and found these people rather than having to sort of snowball research my way to a list of networks.

Lisa Meeks:

And we're working on that repository. This podcast will serve... I call it kind of asynchronous mentoring, right? So you’re answering some of the questions that you probably had four years ago and so the listener can, through keywords or descriptions, can do that.[2] 

Molly Fausone:

And there are some articles and stuff. I think I found some people sort of by Googling or looking them up online, things like that. But it was interesting when I was applying to schools, I realized probably like halfway through the interview process that if I mentioned that, that went a long way in reassuring schools. I think schools weren't aware that there actually are a decent number of medical students and physicians with disabilities. Not all of them applied to medical school with a disability, which made my process a little bit more challenging. Some of them had acquired a disability at some point during their career. But I think schools were really reassured to know there are a lot of people practicing medicine that have disabilities similar to myself. But that was something that I had to tell them. That wasn't something that they were necessarily aware of. And it took me a while to figure out that it was helpful for me to actually say like, Hey, I've talked on the phone to a bunch of people that have similar disabilities and are working in medicine and this is what they say. And so I think that was helpful.

[CHALLENGES OF CLINICAL YEAR]

Lisa Meeks:

So you matriculate to Michigan. Go Blue.

Molly Fausone:

Go Blue.

Lisa Meeks:

I love it. I'm so proud to be here. So you matriculate and we're going to assume no issues in didactics. You finish your didactics. It's pretty standard.

Molly Fausone:

Yeah, I can sit and listen to lecture for as long as anybody else.

Lisa Meeks:

All day long.

Molly Fausone:

Equally awake.

Lisa Meeks:

Sitting is not a problem. Is that in the technical standards? The ability to sit in long lectures?

Molly Fausone:

No one can sit like I can.

Lisa Meeks:

Then you get to the clinical part. You know, on your worst day, did you feel like this isn't gonna work, this is going to be a problem?

Molly Fausone:

I think that the days where I was like, Oh man, this is a lot, had a lot less to do with like specific tasks and a lot more to do with cumulative exhaustion and the amount of work we do and the amount of hours we work and the amount of days of the week that we work. And then, on top of that, the added burden of studying and feeling responsible for what happens on the wards. But it wasn't disability-specific. I think it was more about sometimes feeling like, oh my God, this life that we all signed up for is crazy, which I think it is.

Lisa Meeks:                 

It’s being a medical student.

Molly Fausone:            

Yeah. I think it's just your general being a medical student. The hard part about the clinical year I think is that you operate pretty close to maximal capacity like most of the time. You know, you're working six days a week, often very long days. And I think it's all sustainable, until something extra happens. Your car breaks down and you need a new car battery and you're like, ah, I do not have time to go to the dealership. And I think that's part of what makes the year stressful is, it's fine, it's fine, it's fine, it's fine, but you don't budget for these sort of extra smaller things.

Lisa Meeks:                 

They're not huge, but they may have a disproportionate impact on your overall functioning. And it's like one thing can just kind of pour over.

Molly Fausone:

If my chair were to break or something like that, I have questions about how much medicine, either the undergraduate programs or the residency programs tolerate those types of disruptions, right? I can imagine some sort of disruption that seems small, but for me throws a lot of things off. Like if my car breaks down, Uber's not accessible. I don't have another accessible vehicle. Not entirely sure how I would get to work in my power chair. I could come in my manual chair, it would involve transferring on the way in and the way out. That would take longer. It would be hard for me to get around the hospital.

Lisa Meeks:                 

I think most of us don't plan for these unintended things. Do you have to go through an extra planning? So do you know, for example, if your chair were to break, exactly who to call to have it fixed?

Molly Fausone:

I don't have a step-by-step plan in place, but I think I have a vague few first steps on a couple of different types of what-if scenarios. But one thing that I was warned about in terms of like selecting a residency program from a physician with a disability is she said, go somewhere where you have someone to bail you out. Life happens, and especially if you have a disability, those types of events can throw you off more than someone else. And she said, I would recommend going somewhere where if your chair breaks or you get sick or your car is messed up, you can call someone to bail you out. You have a family member or close friend and you can say like, I know this is totally gonna jack up your day, but I really need you to come and pick me up or take me here or whatever, which I thought was interesting advice.

Lisa Meeks:                 

But how is that different from having a support system if you don't have a disability, because I'm thinking in residency, more so than in undergrad medical education. I mean, I'm thinking of a lot of residents that I know right now where one thing in life would probably be that one to many.

Molly Fausone:

Yeah. I don't think the concept is different. I think the potential for needing help when those types of extra issues come up is higher for someone with a disability.

[APPLYING TO RESIDENCY]

Lisa Meeks:                 

Let's pick up at applying to residency. So if the transition and the application process for undergraduate medical education required a lot of research, talking to people, interviewing, having some stereotype and bias inform people's perceptions of what you were able to do, how are those same barriers presenting as you now look at going into the match?

Molly Fausone:

I think it’s a similar type of feeling where like day-to-day I don't spend a ton of time necessarily thinking about my disability. I definitely do more now that I work in medicine than I did before I came to medical school because I think it informs some of the way of how I think about patient care and how I think about my patients. But, I think it's similar to medical school in that in the application process, it becomes this thing that requires a huge amount of brain space and more time and energy than it does in any other type of scenario. I reached back out to some of the people that I talked to when I applied to medical school to talk to them about what was your interview process like? And what was your residency experience like?

It's a little bit more tricky than medical school for a few reasons. Medical school was tricky to find people that applied with a disability as opposed to how to disability at some point during medical school or residency cause I really wanted to learn how to navigate the application process. Residency, I'm looking for people that are applying to my specialty, which is internal medicine. And a lot of  the people who I talked to four years ago went into PM&R. And so there are just a lot fewer people that went into internal medicine that I can talk to that have similar disabilities. I probably had 15 or 20 people disabilities that had practiced at some point in their career with the disability. I can count on one hand the number of people that I've talked to that have a similar disability to mine that went into internal medicine.

What I've heard from someone who applied more recently was that the process felt very different than applying to medical school. Whereas medical school, maybe people range from mildly skeptical to openly hostile, the residency application process was minimally excited to mildly concerned, but a lot more neutral. I think most people choose specialties that are going to be a good fit and that it was a lot more about fit than like, can you hack it? Can you do the things we need you to do? Can you do a bunch of things that you're never going to end up doing in your actual career? They know that people are going to go into something that they're going to excel at. It sounded like a lot less discussions about specific skills and things than happened on the med school interview trail.

And then I think the way the residency application cycle and the match works doesn't leave this time point between acceptance and your actual commitment to go there that the med school application process has. So for residency, right, you apply, you're invited to interview, you interview and then you make a rank list and the programs make a rank list and you match. The tricky thing about that is there's not this time period where the schools have said we want you and then you can go to them and say, this is sort of what I need or what I'm interested in and how would this work. Because the whole time you guys are trying to navigate like how much you want them and how much they want you. And so you don't get this sort of time period where everyone can just be really clear with each other, you know, your options and they know theirs. And so it'll be interesting to see how the discussions shake out. Hopefully  like I've heard, it's maybe a little bit more open than the med school application process and I wouldn't be applying in internal medicine if I didn't think it was a good fit for the profession. So, hopefully the programs will see that as well. And we'll see how it goes.

Lisa Meeks:

I'm confident it's going to go fine. You’re a great catch for any program. You know, if people aren't as concerned, you've kind of proven that you can work through medical school and you've met all the competencies of the University of Michigan Medical School that going into residency, there's kind of a known situation there, right, that there wasn't necessarily when you went into medical school.

Molly Fausone:            

Well, that's the million dollar question. Can you ever prove your way out of people's stereotypes or bias related to your disability? One person who I talked to said, you're at the University of Michigan, it's a great institution. It has a great internal medicine program. You need to stay. And this person basically said, every time that you switch institutions or levels of training, you're going to have to prove yourself over again and you're going to have to gain trust from the people at that institution and people are going to have doubts and you're going to have to work extra hard to win them over. And basically said, if you have a place where you know you're going to have a good experience and you know you're going to be treated well, it's just not worth the risk of leaving and having to build all of those relationships over again and regain everyone's trust. The way that this person put it was that, I don't see an end in sight for every time someone with a disability switches institutions or levels of training. No matter what level you're at, whether you've done residency or fellowship or you're an attending, you're always gonna have to prove yourself again.

Lisa Meeks:

It's sad.

Molly Fausone:

I don't necessarily think it's untrue. We talked a little bit about the med school application process and how that ended up working out well, but I think we're still not at a point where you can be an average applicant with a disability and reasonably apply to medical school.

Lisa Meeks:

That is definitely a sentiment that I hear from everyone with a disability that you have to be better. Almost every individual that I have interviewed has said, you have to perform better. You have to be better, you have to do better and you have to be nice and have this great personality so p eople like you on top of everything else. And it's almost as if you don't get to have a bad day, and that kind of ties back to what I was saying about the assumption is always disability related first. You could be having a bad day that has nothing to do with your disability, but everyone's going to assume that it's disability related, especially if it's a psychological disability.

Molly Fausone:

Yeah. I think that's certainly true. Yeah. I think you just don't have the luxury of being an average applicant because if people have this other thing that they're concerned about, they're not willing to also be concerned, let's say about your academics or your communication. They say like we already have these other concerns, whether or not those concerns are legitimate or based in any type of fact. The disability is something that's concerning to people who aren't familiar with it, and they are often not willing to tolerate potential concerns in other areas of the application, which means you really need to be an excellent applicant.

[ADVICE]

Lisa Meeks:                 

So any concluding thoughts? Any advice to the people out there listening?

Molly Fausone:            

This is like general advice not for people with disabilities, but I think for people going into medicine in general, I think you have to enjoy the process. I think the process is really long, right? It's four years of medical school, three to seven years of residency, and then one to three years of fellowship, right? You're looking at a lot of years and I think there are people that approach the process as sort of a sacrifice to get to this end goal, which to me makes no sense, especially since you don't know if you're going to like that end product being a physician since you've never done it. But I think going somewhere where you know that you like the people, you know that you're going to enjoy the experience, knowing that you'd like to learn the material that you're going to be learning and sort of viewing that all as part of the beginning of your profession. I think that goes a really long way.

I had a friend who I ran into in the hospital cafeteria a little while ago. He was very tired and on a sub-I and he was like, I don't think anyone likes being at the hospital. I think we're all here cause we have to be. I said, we don't have to be. Everyday, I wake up and I choose to come here. And I don't have to and I can go and do something else and so can you. And soon we'll both have MDs and if you want to go make more money doing consulting or working for an insurance company or something, you can, you have other doors open. And we both choose to come back and work here. And I think like keeping that in mind and knowing that the people that we serve in the hospital, they certainly don't choose to be here. And we do, and I think that keeping that in mind makes you able to enjoy the process a little bit more. Keeping a good attitude goes a long way, especially if you feel like there are times that are trying in terms how other people are judging you or thinking about you.

And then I think the other thing is that I think having some ability to maintain your own confidence is really extremely helpful because I think when people are skeptical or concerned, it's helpful to say like, I know that you're worried about how I'm going to do this, but I'm not worried. Like, I know that I can do this. We have an obligation to recruit and retain the best future physicians possible and some of those future physicians are people with disabilities. Given that over 20% of the American population has a disability, if we exclude that 20% we're certainly going to be missing out on a lot of excellent future physicians. For people going into medical school that have a disability, finding a way to ground that and really believe I earned this, I belong here, there are a lot of ways that I can figure out how to make this work, I think is helpful.

Kate Panzer:

Thank you Molly for speaking honestly and openly about your experiences throughout your time in medical school. And thank you, our audience, for following along. If you know someone who could also learn from our podcast, please share it with them so our message of diversity and inclusion in medicine can be spread even more. In our next episode, we speak with Dr. Justin Bullock, a resident in internal medicine at UCSF. In the meantime, we’d like to thank the healthcare workers who are working tirelessly to keep us healthy during the coronavirus pandemic. For your own sake and for theirs, please stay home, stay safe, and we hope you join us next time.