Chronic Illness: Professional Barriers

Ill-health is sometimes thought of as something personal and private. Something to be acknowledged, perhaps when first diagnosed, but the details only to be shared with a few close friends.

Some of us do choose to manage our health in this way; others prefer to share their experience more widely. Either way, the effects of chronic ill-health are not confined to our private lives. Its influence spreads though every area – including our professional lives.

If you develop a long-term health conditions and you’re one of the lucky ones, you’ll be able to continue in the profession. But many of us don’t just want to continue – we want to progress. We want to improve, we want to diversify, we want to excel. And here, we find a new set of hurdles.  

Barriers to Entry

The bars to professional success can start before we even qualify. The RCVS offers guidance to universities on admitting students with disabilities, but leaves it up to them to make specific decisions. The degree of flexibility that they offer is, in our experience, very variable.

To register for a vet degree, students must have the potential to fulfil the Day One Competencies.   Omni-potential is an admirable aim for a vet course, but sadly it closes doors to students who might become gifted clinicians, but cannot, say, tip a sheep or remove a horse’s shoe. Being able to perform basic surgery is also required to graduate, but not for many vet roles, including some specialisms, public health or industry jobs.

If you develop a health condition that bars you from performing these types of activities after you graduate, the RCVS does not expel you, but expects you to use your judgement in what tasks you should and should not perform. It would be helpful if some of this flexibility could be extended to students. 

The RCVS LWP consultation offers a unique opportunity for us to remove some of those barriers and make the profession more accessible. Please consider responding with this in mind.

Barriers to Employment

If you manage to qualify despite your health condition, or only develop one after you qualify, then sadly this doesn’t mean you’ve avoided these barriers.  

We know from the BVA discrimination report that vets with disabilities are subject to discrimination, both when being hired and at the end of employment. Indeed, disability discrimination is seen disproportionately here, compared with other forms of discrimination.

Employees with chronic health issues are often viewed as “problems”. Employers’ understanding of their responsibilities (and their employee’s rights) can be lacking, flexibility can be in short supply, and inappropriate disciplinary proceedings are not uncommon. Vets have been driven to leave not because they cannot physically do their job, but because their practice is unwilling to make the necessary (and often minor) adjustments to allow to them to continue.

Much of this is not down to malice or prejudice, but a lack of understanding can be just as difficult to overcome in these situations. Fortunately, this is also something that can be improved. If you’re managing a team with staff who have chronic health conditions, my previous blog gives you a starting framework to help you support them.

Barriers to Progression

If you manage to make it into the profession, sadly the struggle doesn’t end there. If we want to progress, we can find yet more hurdles.

Most managerial roles are full-time only, as if a practice can’t survive if the most senior person isn’t constantly available. However, most practices operate some sort of shift pattern, and 4-day weeks seem increasingly common. A practice that is wholly reliant on one person to operate is unlikely to be a resilient one. But when recruiting for these positions, those who work part time, or who do full-time but can’t do extra, are often side-lined. If you think someone with a chronic health condition can’t do that kind of role, think again – it may even make us more suited.

What about clinical advancement? CPD budgets (both time and money) are often proportionate to hours worked, disadvantaging those whose health forces them to work part-time. Employers may be reluctant to given anything extra to those “problem employees” and overlook the true value in doing so. Many of us whose practices have made the effort to accommodate us have become long-term, loyal employees, making us a very worthwhile investment.

Barriers to Specialisation

When I asked our members what professional barriers they’d encountered, the most common response was being unable to do a residency. 

I have so far found it impossible to obtain any data on the rates of disability or chronic illness amongst specialists. Anecdotally, many of the European Colleges I contacted did not know of any disabled specialists; one could name one.

Residencies are intense and can be challenging even for healthy individuals. Part-time training options are available, but often via the “Alternative Route”, which is usually unstructured and unfunded; not a straightforward option for anyone, but especially those managing ill-health. Several people were keen to point out that it’s theoretically possible to do a standard residency program part-time, but no-one offered me any examples*. Contrast this with the NHS, where you can do consultant training from 50% hours, and (under new guidance currently being rolled out) you don’t even have to have ill-health or caring responsibilities to be eligible for this. 

Hope for a profession without barriers to excellence

These barriers that our profession is raising, intentionally or not, are limiting our collective potential. If the playing field is not equal, then we are not getting the best possible students, vets or specialists.

The BVA good workplaces policy position outlines how workplaces can better support their teams. Through improved workplace cultures and a greater focus flexibility, we can make life better for everyone in our profession. There are pools of talent out there that we could take better advantage of, and we are likely to be a better profession for it.

* If anyone reading this can offer more information or personal experience on this subject, I’d love to hear from you – you can contact me via the BVCIS website.