Workplace accommodations for doctors with disability and chronic illness

The Ontario Human Rights Commission acknowledges that defining disability is a complex, evolving matter. They state that a disability may have been present at birth, caused by an accident, or developed over time.

The Ontario Human Rights Code defines disability as:

1. Any degree of physical disability, infirmity, malformation or disfigurement that is caused by bodily injury, birth defect or illness and, without limiting the generality of the foregoing, includes diabetes mellitus, epilepsy, a brain injury, any degree of paralysis, amputation, lack of physical coordination, blindness or visual impairment, muteness or speech impediment, or physical reliance on a guide dog or other animal or a wheelchair or other remedial appliance or device
2. A condition of mental impairment or a developmental disability
3. A learning disability, or a dysfunction in one or more of the processes involved in understanding or using symbols or spoken language
4. A mental disorder
5. An injury or disability for which benefits were claimed or received under the insurance plan established under the Workplace Safety and Insurance Act, 1997; (“handicap”)

Accommodations are made on a case-by-case basis and are not one-size-fits-all. They should be based on the individual’s particular needs and situations. The same disability can have different accommodations, depending on the individual.

Examples of accommodations for physicians

The following examples will show what may be possible within your hospital. They are not necessarily required by law. All of these examples are from real cases. They may provide a starting point for you in thinking about the types of accommodations that could be helpful to you, and for discussing with your workplace.

For physicians, accommodations may include work role modifications, schedule modifications, or assistive technologies, including:

• Work role modifications
  • Reduced inpatient bed coverage
  • Reduced coverage of acute care or procedural settings, with increased clinic time
  • Access to work in structured settings (clinic, operating room) versus acute or unstructured environments (emergency department, acute care)
  • Opportunities for job splitting
• Schedule modifications
  • Reduced or restricted overnight coverage
• Assistive technologies
  • Sign-language interpreters
  • Standing or hydraulic wheelchair for standing-based activities (i.e. operating room)
  • Text-to-speech technology to convert written text to audio
  • Dictation services/software
  • Screen magnification on hospital devices
  • Height adjustable tables with removable ergonomic chair
  • Noise-cancelling headphones for loud hospital environments
• System-based requirements
  • Robust backup coverage models to accommodate potential absences or work restrictions due to flares of illness, changes in disability, or other life circumstances
  • Access to clear accommodations guidelines at the hospital level
  • Physically accessible environments in clinical workspaces (for example, moving a physician to a clinic room closer to a waiting area for a mobility disability or further away for a sensory or hearing disability)

While accommodations are a shared responsibility, hospitals have a duty to accommodate employees and independent contractors to the point of undue hardship (i.e. up to the point when the cost of accommodating is too high or would be a risk to health and safety).

Undue hardship

It is up to the hospital to prove undue hardship, and to do so, they are only allowed to consider:

• Cost of the accommodation
• Funding considerations
• Health and safety requirements (including patient and staff safety impacts)

Who pays for the accommodation?

The organization is responsible for paying for the accommodation. Some physicians have told us that the hospital has told them they had to pay for their accommodation because they are independent contractors. This is not correct; the hospital must pay for accommodations for all workers who require them, including independent contractors, who are also covered by the Ontario Human Rights Code. 

If the accommodation would cause undue hardship due to cost, the organization may not be required to cover the cost; however, the bar for undue hardship is generally high and hospitals will be expected to meet this standard based on their resources as a publicly-funded institution.

Patient safety

Accommodations made for physicians must not risk the safety of patients or other staff. For example, a physician with active tuberculosis could be excluded from patient care. Similarly, a physician with dementia could lose privileges, or a physician with substance use problems may be prevented from providing patient care until it is determined that they are fit to provide care.

• If a physician’s condition or accommodation exposes or is likely to expose any person in the hospital to injury, the hospital can alter, restrict, suspend or revoke hospital privileges
• If your hospital privileges are at risk of being affected, you can contact the Canadian Medical Protective Association to request assistance. The CMPA’s role in assisting members with hospital matters is to ensure that members are treated fairly when there is a loss or threat of loss of privileges

Essential duties of the job

Physicians who are accommodated must still be capable of performing or fulfilling the agreed upon essential duties and requirements of their job to established clinical standard. If they are no longer capable, the hospital is not required to accommodate.

The essential duties of any particular job should be determined on a case-by-case basis.

1. Make an accommodation request.
   1. The process for making an accommodation request differs depending on the hospital. It is usually advisable to talk to your human resources department first, however you could also approach the Occupational Health and Safety team or your chief of staff. Another option could be to talk to your Medical Staff Association president to find out if they can tell you the starting point for your hospital. The route you choose may depend on your specific situation, including your relationships with various people at your hospital, the personalities of the individuals involved, as well as how well your hospital has accommodated physicians with disability in the past
2. Explain your needs, preferably in writing.
   1. You do not need to share specifics of any medical conditions. Whether you choose to do so is at your own discretion
   2. Organizations should only collect information that is necessary related to the accommodation request, which involves a description of functional limitations and not diagnosis
3. Answer questions or provide information about relevant restrictions or limitations, including providing information from health-care professionals, where appropriate and as needed. This may include filling out specific forms.
4. Take part in discussions on possible accommodation solutions. Your treating physician will typically propose accommodations to be considered by the workplace
5. Cooperate with any experts, such as a third-party evaluator, whose assistance is required to manage the accommodation
6. Meet agreed-upon performance and job standards once accommodation is provided
7. Work with the employer on an ongoing basis to manage the accommodation process
8. Discuss your accommodation needs only with persons who need to know, such as your hospital’s human resources department

If your accommodation includes a leave of absence and/or reduced working hours, contact your insurance provider to find out your options.

For more information on disability insurance through OMA Insurance, please speak with a licensed OMA Insurance advisor at 1-800-268-7215 and press three or set up an appointment.

As part of the initial registration process for licensure, the CPSO asks physicians about conditions that could impair their ability to practice medicine, which physicians must report. At the time of annual license renewal, the CPSO requires physicians to report any conditions that may compromise their ability to practice medicine and are not currently adequately treated. In these cases, as long as these conditions are being appropriately managed, there is no concern and no requirement to report.

When physicians disclose a condition at the time of licensure registration or renewal, they may be referred to the OMA Physician Health Program for support. Given recent attention to questions about illness and disability in physician regulation, the Ontario Hospital Association has recently released guidance on asking effective and appropriate health-related questions in the hospital credentialling process.

The OMA Physician Health Program’s mandate is to provide free and confidential support to Ontario physicians and their families. This includes timely connections to services and supports for addictions, mental health, behavioural challenges, and well-being. This also includes connections to assessment, and accountability support. These services may assist in determining appropriate workplace accommodations for the individual physician.

The PHP provides comprehensive confidential services to members. Physicians can call the PHP anonymously at 1-800-851-6606 to speak with a clinical coordinator for advice and support in navigating their mental health and well-being.