Personal story of Dr. Erin Norris

We spoke with Dr. Erin Norris, a hospital-based academic rheumatologist, who shared her story about disability and the impact on her practice, as well as navigating the accommodations process at her hospital. Through sharing her story, Dr. Norris hopes that other physicians with disabilities will know that they are not alone. She also hopes to draw attention to the need for hospital and university policies and procedures to promote inclusion of physicians with disabilities, and to protect physicians who need to go on medical leave.

1. What sort of challenges did you face at work related to illness? 

I was diagnosed with multiple sclerosis in July 2010 and continued to work full-time until my planned maternity leave in November 2010. I returned to work in September 2011, but only six weeks later, I had a debilitating MS relapse that necessitated a four-month medical leave.  

My treating MS Physiatrist insisted I return to work on a part-time basis to maximize my potential for continued participation in my professional role. She wrote a letter prescribing a reduced number of working hours, including being removed from the on-call schedule (my full-time duties had included being on call for two weeks every two months to manage the inpatient consult service). This accommodation request was approved by the hospital, and in February 2012, I went back to work part-time. At my Junior Faculty Review in 2014, my university approved a part-time clinical academic appointment due to exceptional circumstances, which allowed me to keep my job.

“Illness is a universal human experience, and physicians are human.” - Dr. Erin Norris

3. How did the COVID-19 pandemic impact your practice? 

When COVID hit, we all went virtual. My colleagues started going back to work in-person a few months later, but I was immunocompromised from the drug I was taking for MS and could not yet return to in-person work. As it was impossible to conduct a proper joints exam virtually, I began redirecting most new referrals to my colleagues. My patient volumes shrunk even more.  

In March 2021, I contracted severe COVID and was hospitalized. I took another medical leave to recover from both the infection itself and from the COVID-associated exacerbation of my MS symptoms. Three months into my leave, I was asked by the hospital when I would be returning to work. I let them know that I had been referred to a comprehensive outpatient MS rehab clinic and that I planned to come back when that eight-week program was finished. At this point, I was told that the hospital was going to close my clinic and send all my patients to other rheumatologists or back to their family doctors. 

Devastated by this prospect, I called a close colleague and mentor who agreed to continue seeing most of my patients during the months I was off. At this point I also made a complaint to the Human Rights office at my hospital. I had no idea that Ontario Human Rights Code applied to me, I just knew I was being treated unfairly. It felt like I was at the mercy of the administration because I was not an employee of the hospital, nor was I unionized staff. Unfortunately, physician rights related to disability accommodation is something that is poorly understood, and the office determined that my human rights had not been violated because I had made provisions for my patients that resulted in most of them not being dispersed. It was overall a very discouraging time. I thought a lot about leaving medicine altogether. 

4. What accommodations did your care team recommend? 

The team at my outpatient rehab program provided me with a letter of support in November 2021 that included the following accommodation recommendations:  

1. Return to work gradually, starting with 1-2 virtual half-day clinics per week 

2. Accessible technology for efficiency with electronic documentation (e.g., using a tablet and electronic pen to complete my notes) 

3. One hour of additional administrative support for each working day (to start, this would have been 30 minutes to one hour extra per week, amounting to a maximum of 1.5 hour extra per week based on previous clinic volume)  

4. An ergonomic assessment of working areas prior to returning to work in-person (e.g., clinic room, locations where clinic staff walk with patients, and any other office areas used to complete documentation, preparation, research, etc.)  

5. A clinic room for patient assessment that is accessible and in close proximity to the waiting room and elevator  

6. Support for obtaining patients’ height, weight and to accompany them to the clinic room, either in the form of an assistant or use of a walker for carrying files  

5. What accommodations did the hospital offer you? 

In April 2022, five months after submitting my letter of request, I received a letter from the hospital that offered the following accommodations:  

• One of my clinics was moved to a less-desirable Friday timeslot  

• A note from my treating physician would be required when I was ready to return to in-person clinics  

• Any additional administrative support would be paid by me, not by the hospital, as per hospital and departmental processes  

• An ergonomic assessment of the two clinic areas where I work, which may include purchasing technology for documentation  

• The clinic manager would attempt to have support for obtaining patients’ height/weight in the osteoporosis clinic area; however, the letter stated that this would need to be aligned with patient volumes in the clinic. They did not guarantee this accommodation. The letter stated that there was no issue obtaining support for measuring patients’ height/weight in the rheumatology clinic area

• Mandatory weekly check-ins with my informal mentor for the first six months after return to work

These accommodations would not allow me to eventually return to work in-person: I physically could not get my rollator walker into the space where I would be measuring patients’ heights and weights. In the end, it did not matter: two weeks after receiving this letter, I was accepted for a stem cell transplant to treat my MS. I extended my medical leave. 

When I finally returned to work in March 2023, I did not want to repeat my previous experience, so I told my hospital that I did not require any accommodations. Instead, I self-accommodated by arranging to do all my clinical work virtually. My hospital has supported me in working virtually, and my clinical work now involves providing virtual osteoporosis consults. I also arranged for all my formal, in-person teaching sessions to occur at a closer, more accessible university-affiliated hospital. Additionally, since COVID, the format of meetings and rounds has changed to virtual or hybrid, which allows me to easily participate.

I continue to advocate for physicians with disabilities. I am on the Equity of Access Committee at my hospital where I provide the perspective of both a physician and a person with lived experience of disability. I was also a committee member of the Disability Inclusion Working Group at my university. We developed 31 recommendations to meaningfully address disability within the faculty, and our report was presented to the Dean in 2023. Finally, I am part of a group developing a national mentorship program for physicians with disabilities and participate in a national Community of Practice for physicians with disabilities and chronic conditions.  

6. What do you wish you knew earlier in your illness journey? 

At the beginning of my illness journey, I wish I knew that:  

•  The Ontario Human Rights Code applied to me as a physician working in a hospital, regardless of whether I was an employee. I think most people, event those in senior administrative positions, are unaware of this fact
• It is critical to develop formal policies and procedures to address inclusion of physicians with disabilities and chronic conditions, and to implement them at hospital, university, and provincial levels. The lack of policies and procedures is a systemic failure that leaves many physicians feeling abandoned, with no choice but to walk away from their work

7. What would you say to other physicians who identify with your story? 

The key takeaway message that I want other physicians to know is that although it feels lonely, you are not alone. Physicians with disabilities are not rare – a 2021 National Physicians Health Association survey of 3,864 physicians found that 20.5 per cent self-identify as having a disability. Many individuals with chronic illness do not identify as having a disability even though they experience barriers that could benefit from workplace accommodations. 

I also want other physicians to know they have rights, even if their workplace tells them that they do not, and even if there are no policies at their workplace to support them.  

Finally, I want other physicians to know that there is a community of physicians with disabilities that is worth seeking out. A community can offer support and create momentum for change: the more our stories are shared, the more the extent of the problem is recognized, and the more improvements we will see to inclusion. If we can find each other, we can effect change, and that benefits everybody.  

Legal disclaimer: 

The OMA is providing this space for physicians to share their personal stories about their experiences with disability. The experiences and challenges faced by each individual with disabilities are unique. The stories presented here do not reflect the specific needs or experiences of everyone, and may not reflect the present state of commitments or policies at any facility. While we are providing this information to support inclusion of all physicians with disabilities, you should inquire about the policies specific to your facility and personal circumstances.