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We welcome Ron M. Aryel, a pediatrician who shares his powerful journey through medical school and residency as a physician with cerebral palsy. Facing discrimination, ableism, and hostility from colleagues and superiors, Ron persevered and built a remarkable career. Join us as we discuss the challenges of navigating medical hierarchies, the importance of empathy, and the need for systemic changes to support physicians with disabilities in the medical field.
Ron M. Aryel is a pediatrician.
He discusses the KevinMD article, “How a doctor with cerebral palsy defied the odds and transformed health care.”
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Transcript
Kevin Pho: Hi, and welcome to the show. Subscribe at KevinMD.com/podcast. Today, we welcome back Ron M. Aryel. He’s a pediatrician. Today’s KevinMD article is “How a Doctor with Cerebral Palsy Defied the Odds and Transformed Health Care.” Ron, welcome back to the podcast by KevinMD.
Ron M. Aryel: Thank you for having me. It’s always a privilege to be here.
Kevin Pho: Alright, so your latest article really focuses on your story and overcoming obstacles with a diagnosis of cerebral palsy. What led you to write this article and share your story in the first place? And then, of course, could you talk about the story itself?
Ron M. Aryel: Well, you know, when I experienced slights, insults, and obstacles throughout my career because people perceived me to be less than human, I couldn’t let it bother me at the time. I mean, it did, but I had a job to do, so I did it. I protected my interests the best I could. Medical school and residency are temporary situations, so you have to survive them, get through to the other side, and then you finish them. Once you’re done, you’re done.
But I didn’t really put it together in my head as some kind of common theme until after I finished. I thought, perhaps, I should tell the story because now that I have a coherent picture of what happened to me and I’ve processed it, I think it’s important for other people to see that less than 4 percent of physicians in the United States have any kind of physical disability. The stereotype of a disabled person is that if you’re the doctor taking care of the disabled person, then you’re the hero, right? You go to the children’s hospital, stand next to the patients who have braces on, and you’re seen as the hero. But for that child to grow up and become your boss or your doctor, that’s a threat to the ego of some physicians—especially those suburban types I met whose parents raised them to be God’s gift to mankind. Of course, they had to be able-bodied and athletes and check off a lot of stereotypic boxes that I couldn’t.
Kevin Pho: Tell us about some of the aggressions, slights, and obstacles that you had to overcome throughout your medical career.
Ron M. Aryel: When I first got into medical school, it was funny because my interview was very atypical. The usual medical school interview asks, “Why do you want to come to medical school?” “Why do you want to become a doctor?” And then you think of the answers you want to give. My interview was not like that. I showed up, and a lady biochemist interviewed me. She said, “First, we introduce ourselves. Hi, my name is so and so, I’m a biochemist here, I run a research laboratory.” I introduced myself as, “My name is Ron Aryel, and I am the prospective medical student interviewing with you today. Thank you for having me.”
Immediately after that, she said, “Let me take you around and introduce you to the people you’ll meet when you get here.” We walked around her lab and the adjoining lab, and she introduced me to a bunch of people. We talked about their research interests, and then we went back to her lab and sat down. She talked to me about her research interests, and we got into a very intricate discussion about what was going on in her lab. I actually had some inkling of the things she was working on, so I helped her figure out a little research conundrum that she was having. I promised her that when I got back home, I would Xerox some articles for her and mail them. This was before the internet, so if you wanted to share something, you had to drop it in the mail, put a stamp on it.
That was the entire medical school interview. Afterwards, I got into medical school and thought, well, that was pretty easy. But I didn’t realize that the hard part was about to begin. She had already decided I belonged, but my fellow students decided that I did not belong. There was no way to get on their good side, no way to get past it. They had already decided that I was a trespasser, so the only thing I could do was turn them into trespassers and do what I had to do to finish school. My attitude has always been, “I’m here, you’re here, don’t mess with me.”
Anybody who’s a racial minority or has a problem in a setting where all the white guys think they belong, and you don’t, knows that the attitude is, “I’m here, you’re here, don’t mess with me.” That’s the attitude I took, and it got me through medical school.
In residency, that was a different story because now I’m dealing with residents who accepted me, but some of the faculty did not. There was an associate residency director who made a concerted effort to eliminate any person with physical disabilities from the hospital because he believed those people should not be doctors and those people should not be nurses either. He had jurisdiction over the nurses, but the nurse with cerebral palsy who rode with me on the ambulance—well, they referred to her and to me as “Special Olympics,” which was stupid at the time. I kind of laughed it off, but later on, I realized it was stupid, insulting, and unprofessional—pretty grade school stuff.
Kevin Pho: So, this was something that you had to endure during medical school—this name-calling, unacceptance, and aggression—as if medical school wasn’t already hard enough.
Ron M. Aryel: Yeah, medical school is very difficult. I also noticed that there were a handful of Black students, for example. The vast majority of students were white suburban students from affluent families. There were a few Black students and a couple of Asian students, and the groups that were isolated stayed isolated. The Black students kept to themselves; the Asian students more or less kept to themselves. And there was nobody like me, so I kept to myself because there was only one of me.
Kevin Pho: Was it difficult for you to do that—being literally by yourself because there was no one you could identify with?
Ron M. Aryel: It was very difficult, but I would get occasional feedback from non-medical professionals—the orderlies, clerks, and support staff who were not actual medical professionals. They would occasionally comment that I was inspiring them. To see someone with this handicap being a medical student and later a resident was very inspiring to them. That gave me some encouragement, and I realized I was modeling for somebody.
There was one person, a physical therapy student, who lived in the same building as I did. She helped keep me sane because she saw me and said, “Oh, cool, cerebral palsy, I’m a physical therapist. Great! You’re going to be my homework.” I walked on graph paper for her and worked on copy paper that she used for gait analysis. I became her homework. The other PT students examined each other for homework, and she examined me. She turned in the best homework, but she kept me sane. We became friends, and she was my only friend in that whole place. She didn’t have a very high opinion of the other medical students either.
Kevin Pho: And you wrote in your story that this discrimination didn’t stop once you got out of medical school. It persisted with you throughout your career.
Ron M. Aryel: That’s right. After medical school, a computer matches you to a residency program based on their ranking and your ranking. So, I had no choice; I was assigned to a residency, so I saluted and showed up at that residency. It was a suburban residency, kind of at the edge of a big city, and there were a lot of suburban attitudes there. There were still some bad racial attitudes. The Medicaid clinics—the house officers kind of looked down on some of the patients because of their socioeconomic levels. I didn’t because I’m used to living and working around people of all socioeconomic levels.
The house officers respected me, the other residents respected me, but the associate residency director had just taken over, and he said, “This is the standard. This is what we’re going to be doing. You can’t meet the standard.” He didn’t say it in so many words, but my physical handicap was a big no-no for him.
The first year, I had a legitimate problem. I didn’t have good time management or good organization skills, so I had to work on that because it did create problems. That was my responsibility, not the residency program’s. It took me a while to fix that, but by then, he said, “Well, you know, I’m done with you.” There was no way to get on his good side. So, I just did the best job I could. By the time I was in my third year, I was a clear choice for chief resident. That sounds arrogant, maybe, but I had checked every box and done everything that someone who is a leader among the program would do. But as you know, selecting chief residents is a very subjective thing. There’s a lot of likability, a lot of politics—who’s politically popular—and that’s the person who’s going to get picked, not necessarily the best-qualified person.
Our program did have some excellent chief residents, but I wasn’t going to be picked. He sure as hell wasn’t going to pick me because I was disqualified due to my disability and his stereotypes and cruelty, and he enjoyed it.
Kevin Pho: And even after you finished and became an attending physician, some of your colleagues still discriminated against you. You still experienced stories like this, right?
Ron M. Aryel: Yeah, oh yeah. There were some attendings who supported me and some attendings who didn’t. When I started my private practice in Reno, Nevada, I didn’t get much cooperation from other primary care attendings. They were busy making money, wanting to see a patient every 10 minutes to make money. I accepted any patient who walked in and became a regional expert on a number of rare diseases because of it. While I was putting in 15-hour days in the clinic, they were going home at 5:30 or 6 o’clock to see their families, go out to dinner, and have a nice social life.
So, I was seeing the toughest patients, but I was becoming a much stronger doctor for it. My reputation became that if you were really sick, you came to see me. Intensive care units would send me their patients instead of the doctors who took care of more affluent patients. I had to be satisfied with what I was doing. I was doing the right thing—what I felt to be real doctor work, real medical work. That’s what I decided to do.
In the end, you make your career what it is. I worked within the limitations I had. If I had been born to a lot of money, that could have insulated me from a lot of these things. If you come from a very wealthy family, you can buy into a hospital and appoint yourself chief of staff because money talks. But unfortunately, I didn’t have those kinds of resources. I couldn’t use money to insulate myself from the discrimination, so I just did the best I could.
Kevin Pho: Tell us how your story and all these obstacles and discrimination that you’ve overcome have made you into the physician you are today. How has that influenced your medical career?
Ron M. Aryel: I decided that everybody has value, right? Every patient and every medical student have value. You deal with everybody as an individual. Everybody has shortcomings—I do too—and you try to help each person in the best way you can within that person’s reality. So, I would take any patient into the office with any kind of condition and try to make it better. I would take any medical student from any background and try to make that medical student better. If I had stereotypes, because we all have stereotypes in our heads, I would try to confront that and get rid of it. I would learn something new from the person in front of me—medical students, other residents, parents, patients themselves—they all taught me something.
As an attending physician, I’m not the one teaching everybody else exclusively. It’s not a one-way street. I’m teaching somebody else, and they’re coming back and teaching me. So, I learned from all kinds of people at all kinds of levels, and I try to stay humble. That’s what it meant for me.
Kevin Pho: What kind of advice do you give to other medical professionals who need to advocate for themselves in the face of injustice? This happens every single day in every single setting. Tell us the types of advice you could share with these physicians who are facing injustice.
Ron M. Aryel: First of all, you have to be as confident as you possibly can be. Study, learn, and focus on doing your craft—your job—as best you can so that your reputation becomes one of someone who really knows what they are doing. That’s number one. Number two, always stay humble and learn from everybody. Try to attract friends and supporters based on your honesty and your willingness to learn. If you can make allies, you can make your situation a little easier. It’s always good to have friends.
If you make yourself indispensable—if your skill set becomes indispensable—it becomes a lot easier to navigate those situations. It’s always good to have friends. It’s always good to be politically smart too. I learned that you can’t fight discrimination only with a lawyer or threats of lawsuits. Sometimes you have to do that, but a lot of times, there are less confrontational ways to get around it. You have to learn when to fight a battle and when not to fight a battle.
Sometimes the person who’s causing the discrimination wants to be the big, bad alpha. Sometimes you just have to let them be that and avoid them while doing your job anyway. But then sometimes, when you’re backed into a corner, you have to know how to use your other tools, such as a lawyer or a good knowledge of the law. My associate residency director violated the 1990 Americans with Disabilities Act and state law, but because residency is a temporary situation, it would not have been the best option to go and sue. The time frame of a lawsuit would have been a lot longer than the length of time for residency, and I needed to preserve my options to get a fellowship, which I did.
But I did have the option of suing under the 1990 Americans with Disabilities Act, and he violated state law as well. But it was kind of a balancing act. What I told him was, “I’m going to defend my interests, and I’ll do it my way.” It turns out that gave him a little bit of pause. By the time I was getting ready to graduate, I had enough friends among the faculty that he had to finally back down. The political capital he would have had to expend to dismiss me from the program would have been more than he wanted to spend.
Kevin Pho: Some of these experiences you described happened decades ago. Has the culture of medicine changed today from what you’re observing and hearing from your colleagues? Has medicine become more inclusive since those first stories you told during medical school?
Ron M. Aryel: I think that, in some ways, it has because you see a lot more doctors from different backgrounds. There are still shortages; there are still far fewer minority doctors than white doctors. I think that’s still a problem. And I think there’s also the attitude of money. This is a capitalist society, and part of the issue is everybody wants to make money. So, the hunt for money is still an obstacle to making medicine a little more inclusive. Primary care doctors are still hunting around to make their minimum $200,000-a-year salary, and they’re neglecting patients in order to maintain that income. Specialists are refusing to see patients unless they make their $400,000-a-year salary.
The hunt for money is interfering with that because now we’re talking about money instead of treating patients. That also tends to reinforce the stereotypes rather than spending time breaking them down.
Kevin Pho: We’ve been talking to Ron M. Aryel. He’s a pediatrician. Today’s KevinMD article is “How a Doctor with Cerebral Palsy Defied the Odds and Transformed Health Care.” Let’s end with your take-home messages to the KevinMD audience.
Ron M. Aryel: Be the best doctor you can be. Recognize that we’re all human, no matter what the color of your skin is, how your arms and limbs work, where you come from, or what language you speak at home. We’re all human, and we all need to take good care of each other. As a doctor, nurse, or any kind of medical professional, you have to do the best you can for the person—the human—in front of you, no matter what they look like or who they are. That’s your duty.
Kevin Pho: Ron, thank you so much for sharing your story, perspective, and insight. Thanks again for coming back on the show.
Ron M. Aryel: Thank you, sir.
