Disability Accommodation Access and Requests in US Internal Medicine Residents With Disabilities.

Importance: Despite the growing number of residents with disabilities, barriers to equitable access persist in medical training. Program access to accommodation has been linked to improved training and mental health outcomes, but little is known about possible resident and program characteristics associated with access to and requests for needed accommodations. Objective: To examine demographic, training, and disability-related factors associated with program access and accommodation requests among internal medicine (IM) residents with disabilities. Design, Setting, and Participants: This national cross-sectional study looked at accredited IM residency programs in mainland US and Puerto Rico. Participants were IM residents who took the 2023 Internal Medicine In-Training Examination and reported having at least 1 type of disability. Main Outcomes and Measures: The primary outcomes were program access, defined as receiving accommodations or not needing them, and requesting needed accommodations. Multivariable logistic regression models were conducted for each of the outcomes. Results: Of 19 205 respondents, 1824 (9.5%) reported a disability; participants were predominantly men (979 men [53.7%]), US medical graduates (1398 participants [76.6%]), and enrolled in categorical IM programs (1532 participants [84.0%]). With regard to race, 340 participants (18.6%) were Asian, 415 (22.8%) were from groups underrepresented in medicine (including self-reported Black or African American or Afro-Caribbean; Latinx or Latino or Hispanic; Native American or American Indian or Indigenous or Alaskan Native; Native Hawaiian or Pacific Islander), and 823 (45.1%) were White. Among 1052 with complete accommodation information, 811 (77.1%) had program access and 241 (22.9%) did not. In multivariable regression models, having cognitive disabilities (adjusted odds ratio [aOR], 0.27; 95% CI, 0.15-0.49) and identifying as women (aOR, 0.55; 95% CI, 0.40-0.75), Asian (aOR, 0.53; 95% CI, 0.34-0.82) and underrepresented racial or ethnic groups (aOR, 0.58; 95% CI, 0.38-0.87) were associated with lower odds of program access. Among 699 residents coded as needing disability accommodations with classifiable responses, 200 (28.6%) did not request them. Fear of stigma (164 respondents [82.0%]) and unclear institutional processes (60 respondents [30.0%]) were the most cited reasons for nonrequest for needed accommodations. Requesting accommodations was less likely among residents with cognitive disabilities (aOR, 0.16; 95% CI, 0.08-0.31) and who identify as women (aOR, 0.37; 95% CI, 0.25-0.54), genderqueer or nonbinary (aOR, 0.11; 95% CI, 0.02-0.68), Asian (aOR, 0.50; 95% CI, 0.30-0.85), or underrepresented in medicine (aOR, 0.60; 95% CI, 0.37-0.97). Conclusions and Relevance: These findings suggest that despite growing disability representation, substantial inequities in access to and requests for accommodations persisted for IM residents with disabilities, particularly those with cognitive disabilities and marginalized identities. Institutions should implement inclusive, transparent policies to foster psychological safety and disability inclusion.