All through her 20s, Taylor Carty chased her dream of becoming a doctor.
Carty, now 30, was diagnosed with cerebral palsy when she was a baby, and was inspired by the many doctors and health care professionals who helped and encouraged her.
"I knew it was the path I wanted to pursue," she says.
In 2022, it looked like her dream was about to become a reality. She was accepted to Wayne State University School of Medicine in Detroit. Her grandfather, who was a physician, attended medical school there.
"I was ecstatic because it was the culmination of just years of hard work and my dream of potentially helping children and young adults with disabilities," Carty says.
More than 25% of adults in the United States report having a disability, according to the Centers for Disease Control and Prevention. Despite that, people with disabilities are underrepresented in the field of medicine. The Association of American Medical Colleges (AAMC) says that about 3% of doctors in the U.S. have a disability.
Carty is trying to change that.
She often uses a wheelchair and has limited mobility in her left hand, which makes some physical tasks challenging. After her acceptance, she deferred her admission to handle an insurance issue, while she focused on meeting the standards set by Wayne State for performing certain medical procedures – such as CPR and stitching wounds.
"The one thing that made suturing more difficult was that I can't turn [my left hand] over, palm facing up," Carty explains. "I can get it to about neutral."
Students at accredited medical schools are required to meet such technical standards, created to make sure all doctors have basic skills they'll need to treat patients. Though each school can set its own specific requirements.
Wayne State's standards require students to be able to perform these procedures unassisted.
"I had been able to master suturing [with] a one-hand knot by myself," Carty says. But she was having trouble with other life-saving maneuvers like inserting a breathing tube and CPR.
She asked Wayne State's Student Disability Services for videos to help her practice the procedures, and she suggested technology that could perform some of the tasks for her. They exchanged emails for several months.
"It soon became apparent that there would be some difficulty," she says.
Carty says she formally requested accommodations from Wayne State, or modifications to meet the standards, under federal disability rights law. She asked that she be allowed to direct another person to perform or assist with some of the required procedures.
After a year of back and forth, Wayne State rescinded her acceptance in 2023.
"It was heartbreaking," Carty says.
Ten months later she filed a discrimination complaint with the U.S. Department of Justice.
Many experts say technical standards need to be more inclusive
Since 2021, the Association of American Medical Colleges has encouraged medical schools to update their technical standards to be more inclusive of students with disabilities.
A team of researchers is looking into how many schools have followed the AAMC's recommendations. Carol Haywood, an assistant professor at Northwestern University's Feinberg School of Medicine, is one of those researchers.
"One thing that we're seeing is that there has not been a lot of documented activity to update technical standards, despite the recommendation in 2021 to do so," Haywood says. "By and large, most schools still have a majority of standards that are restrictive to students with disabilities."
But many doctors who have disabilities say the representation of disabled physicians is crucial to the profession.
Dr. Vovanti Jones is a physical medicine and rehabilitation specialist at the University of Missouri. Jones has muscular dystrophy.
She says many of her patients suddenly find themselves with a disability or unable to walk.
"I do think my patients build a different relationship with me than they do with my able-bodied colleagues a lot of the times," says Jones, who uses a wheelchair herself.
"They know that I understand, right? If you're sitting in a room and you're like 'my back hurts because I've been stuck in this wheelchair all day' or 'I can't do this' and I come in and say 'oh, I understand. My butt hurts too!' "
Sharing a laugh and finding common ground with her patients, Jones says, helps her patients.
Rules for what a doctor must be able to do
Carty's Justice Department complaint alleges Wayne State violated the Americans with Disabilities Act and Section 504 of the Rehabilitation Act. The federal laws require public universities to make their programs accessible and provide reasonable accommodations.
Wayne State informed Carty that her requested modifications were not reasonable.
Her lawyer, Claudia Center, who's also the legal director of the nonprofit Disability Rights Education and Defense Fund (DREDF), says the law is clear:
"Those requirements say that Wayne State should not have these rigid manual tasks that they require doctors to perform, and should instead either modify those or allow the student to access reasonable accommodations to perform the tasks."
The university declined to speak or provide a statement to NPR, and said it doesn't comment on pending litigation or related matters.
But the accrediting organization that sets the guidelines for MD technical standards defends them as "essential" and "a matter of public trust." Dr. Veronica Catanese is co-secretary of the Liaison Committee on Medical Education (LCME).
These standards, she says, establish "the attributes, the qualities that are part of the profession of medicine – what individuals should expect of their physicians when they interact with them."
Catanese says the LCME allows medical schools to develop their own specific rules, with or without accommodations, with the goal of providing the best care.
"If someone has a ruptured appendix," Catanese explains, "there are very simple physical signs that can really determine whether something is acute and life threatening. Those skills of physical examination are where the motor and physical abilities are involved."
Some medical schools have changed their requirements to focus more on what students know, and less on their physical abilities. The University of California, San Diego School of Medicine recently updated its standards.
"If you're in the hospital setting, CPR is never done as a one person-to-one person. It's part of a big team going on with a code," says Dr. Sean Evans, who is associate dean for medical education at UCSD. "The old guy doctors are never the people doing it. It's really hard work. It's not done by one person."
Evans led the team that revised the medical school's requirements to say students can direct treatment with a partner or team, instead of doing it by themselves.
"Having members of our team who understand and have lived in that space, whether it's dealing with a physical disability or an invisible, emotional or mental or learning disability, I think that makes our team much richer in terms of the spectrum of care we can provide to our patients," Evans says.
Making room for change in the medical profession
Dr. Jones, the rehab doctor in Missouri, says there has been some progress, but not enough:
"There's still a lot of people from that old school mentality that are out there that discourage individuals who may have a disability from entering the medical field, without even truly understanding what their needs are or how to make the appropriate accommodations."
Taylor Carty is now working on a Master of Public Health degree at UCLA. She says she wants to create change through policy to help more people with disabilities become physicians.
"I know there's a young child who is putting on that stethoscope," she says, "and I want to make that accessible for them."
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