Autistic doctors face significant workplace obstacles

Recently, increasing understanding of neurodiversity has brought light to the complex ways in which everyday life can be affected by autism. Everything from clothing choices to career paths may be influenced by autistic traits, and the preferences they influence. 

One field that those with autism may be drawn towards is medicine; common autistic characteristics such an attention to detail, pattern recognition, and conscientiousness are traits neurotypical medics seek to nurture, after all. 

However, that doesn't mean the medical field a walk in the park for autistic doctors. A new study published in Frontiers in Psychiatry finds that many struggle with the demanding nature of current systems, and many have even considered suicide. The authors call for a more neurodiversity-affirmative approach to autism within medicine, promoting inclusion and adaptations to improve the situation for autistic doctors. 

Participants (n=225) of this study were members of an online support group, Autistic Doctors International, which was founded in 2019. All members had medical degrees or were in their last year of medical school, and were either formally or self-diagnosed. 

The group were questioned via survey about a number of experiences, including whether they had known they were autistic at medical school, how they felt their autism helped or hindered them at work, whether they had disclosed their diagnosis to colleagues, and whether they had faced challenges at work. Finally, participants disclosed the state of their mental health. 

Most of the sample (64%) had been formally diagnosed, while the rest self-identified as autistic. The mean age at receiving a diagnosis was 36. The majority (74%) did not know or suspect they were autistic at medical school; those who did know largely did not disclose it to their institution, and only half of those who did received reasonable adjustments. A quarter stated that medical school took them longer to complete than their peers, 89% of whom believed being autistic played a part. 

Four out of five participants believed they had worked with a doctor they suspected was autistic – but only one in five reported working with another doctor they knew was autistic, suggesting that disclosure (or perhaps recognition) is not widespread. This corroborates the sample's rate of self-disclosure, with only 32% disclosing their autism to their supervisor, 30% to their colleagues, and 29% to nobody. 

Challenges gaining adjustments continued well after medical school, with around half of participants having asked for reasonable adjustments in the workplace, and only half of that number actually seeing them implemented. Of the changes that did materialise, participants noted some of the most meaningful: being able to be more open about autism, a better work environment with less sensory overload, and more flexibility. 

Participants had mixed feelings as to whether being autistic helped or hindered their work as doctors. Nearly three quarters of the sample stated that being autistic helped them, but the same amount also felt hindered by issues with executive functioning and sensory issues. 

Mental health issues were extremely widespread within the sample, reflecting the challenges that many autistic doctors face. Of those who participated in this study, half had engaged in self-harm, while 77% had considered suicide and 24% had attempted suicide. Stigma played a part here, with the belief that autism was a 'disorder' significantly associated with having attempted suicide. 

Self-harm was more prevalent in women, non-binary, and genderfluid people, suggesting intersectional issues. Those who had requested, but had not received, adjustments at work were more likely to engage in self-harm. Disclosing a diagnosis to consultants and occupational health was also associated with self-harm.  

While these statistics are concerning, there are some caveats that should be taken into account with this study; primarily, the sampling being performed on an online peer support group. Those seeking out a support group are likely to have more extreme challenges with coping, or stronger opinions about changes that need to be made. Future research may seek to explore the issues raised in a wider population to improve the generalisability of these results.

The authors suggest that some of these issues may be alleviated by adoption of a more neurodiversity-friendly work environment, with adjustments such as quiet spaces or differently lit environments built into the workplace, rather than the onus being on workers to fight for them. A focus on fostering organisation-wide understanding of autism could also be valuable, with management, supervisors, and patients alike learning more about neurodiversity, and allowing neurodiverse doctors to be themselves at work. 

Overall, the study paints a picture of the life of an autistic doctor as being full of challenges. Both autistic and neurotypical doctors experience material challenges that make their work more difficult, such as overwhelming caseloads or work environments. This is a challenging environment for anyone, but poses extra challenges for those high in autistic traits. The issue is not autism per se, but having to work in an environment that is not set up to accommodate neurodiverse needs. 

Read the paper in full: https://doi.org/10.3389/fpsyt.2023.1160994