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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: Well, thank you for having me. It’s always a privilege to be here.
Kevin Pho: All right. So your latest article really is autobiographical, and you talk about your story and overcoming obstacles with a diagnosis of cerebral palsy. So what led you to write this article and share this story in the first place? And then, of course, you could talk about the story itself.
Ron M. Aryel: Well, when I experienced, throughout my career, slights and insults and obstacles to doing my job 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, and I protected my interests the best I could. And medical school and residency are temporary situations, so you have to survive them and get through them 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’d finished. And I thought perhaps I should tell the story because now that I kind of had a coherent picture of what happened to me, I 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.
And the stereotype of a disabled person is, if you’re the doctor taking care of the disabled person, then you’re the hero, right? You get the children’s hospital with the patients who have the braces on and all that, and you’re the doctor standing next to them, 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 the types that I met, who were often suburban types whose parents raised them to be God’s gift to mankind. And, of course, they had to be able-bodied and athletes and all that. So they checked off a lot of stereotypic boxes, and, of course, I couldn’t.
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Kevin Pho: So tell us the story. Tell us about some of the aggressions, the slights, and obstacles that you had to overcome throughout your medical career.
Ron M. Aryel: Well, when I first got into medical school, it was funny because my interview was very, very atypical. You know the usual medical school interview: “Why do you want to come to medical school? Why do you want to become a doctor?” And then you’ve got to think of the answers that you want to give. My interview was not like that.
I showed up in medical school. A lady biochemist interviewed me. First, we introduced ourselves. “Hi, my name is so-and-so. I’m a biochemist here. I run a research laboratory.” And I introduced myself: “Well, my name is Ron M. Aryel. I am the prospective medical student interviewing with you today. Thank you for having me.”
And then immediately after that, she said, “Let me take you around and introduce you to the people you’ll meet when you get here.” And we walked around her lab and an adjoining lab, and she introduced me to a bunch of people. And we talked about their research interests. Then we went back to her lab and sat down, and she talked to me about her research interests, and we got into a very intricate discussion about what was going on in her lab.
And I actually had some inkling of some of the things she was working on. I had some knowledge of a few of those things, and so I actually helped her figure out a little research conundrum that she was having. And I promised, “When I get back home, I’m going to Xerox some articles for you and mail them to you.” This is before the internet. This is pre-internet. So if you want to share something with somebody, you drop it in the mail, put a stamp on it, and that was the entire medical school interview.
And then afterwards, I got into medical school, and I said, “Well, that was pretty easy.” I’ve never had an interview. But what I didn’t realize was that the hard part was about to begin. She had already decided I belonged. But my fellow students decided that I did not belong, and that’s what happened.
There was no way to get on their good side. I made overtures, but there was no way to get past it. They had already decided that I was a trespasser. So the only thing I could do is 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.” And that’s anybody who’s a racial minority who has a problem in a setting where all the white guys think they belong and you don’t. The attitude is always, “I’m here. You’re here. Don’t mess with me.” And that’s the attitude that I took, and that’s what got me through medical school.
And then in residency, well, that was a different story because now I’m dealing with the other residents, who do accept me, but some of the faculty did not. And there was an associate residency director who made a concerted effort to eliminate any persons with physical disabilities from his hospital because those people should not be doctors, and those people should not be nurses either.
He had no jurisdiction over the nurses, but the handicapped nurse, a nurse with CP who rode with me on the ambulance, they referred to her and they referred to me as “Special Olympics,” which was stupid. At the time, I kind of laughed it off, but later on, it’s stupid. It’s insulting. It’s unprofessional. It’s pretty grade-school stuff.
Kevin Pho: So this was something that you had to endure during medical school, this name-calling and this unacceptance, these aggressions, as if medical school wasn’t already hard enough.
Ron M. Aryel: Yeah. Medical school is very difficult. And what I noticed also is that there were a handful of Black students, for example, in medical school. The vast majority of students there were white suburban students from affluent families. There were a few Black students. There were a couple of Asian students. And the groups that were isolated stayed isolated to themselves. 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. So that was it.
Kevin Pho: How difficult was it for you to do that, just being literally by yourself because there was no one that you could identify with over there?
Ron M. Aryel: Well, it was very difficult. But what I realized is that I would get occasional feedback from nonmedical professionals, that is, the orderlies, the clerks, people who were there, who were support staff that were not actual medical professionals. And I would get occasional comments from them that I was inspiring them. It was very inspiring to walk around having this handicap and being a medical student, later a resident. So that gave me some encouragement. I realized, “OK, so I’m modeling for somebody.”
And there was one person. She was a physical therapy student there who had an apartment in the same building that I did. And she helped keep me sane because she saw me. She said, “Oh, cool, cerebral palsy. I’m a physical therapist. Great. You’re going to be my homework.” So I walked on graph paper for her. It was actually the copy paper they used for gait analysis. So I became her homework.
The other PT students examined each other for homework, and she examined me for homework. So she turned in the best homework. But she kept me sane. We became friends, and she kept me sane, and she was my only friend, basically, in that whole place. And she didn’t have a very high opinion of the other medical students.
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: No, that’s right. As you know, and you’ve been through it, after medical school, a computer matches you to a residency program based on their ranking, based on your ranking. So I had no choice. I had only a choice of where I would go. I was assigned to a residency, so I saluted, and I showed up.
That residency was kind of a semisuburban residency, kind of at the edge of a big city. And so there were a lot of suburban attitudes there. There were still some bad racial attitudes. So, in the Medicaid clinics, the house officers looked down on some of the patients because of their socioeconomic levels. I didn’t because I’m used to living and working around all kinds of people and all kinds of socioeconomic levels.
And 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, big no-no for him.
The first year, I did have a problem, a legit problem, which was kind of scattershot. I didn’t have good time management. I didn’t have good organization, so I had to work on that because that did create problems, and that’s my responsibility, not the residency’s. So it took me a while to fix that, but by then, he said, “Well, I’m done. I’m done with you.” And so, again, there was no good side to get on. So I just did the best job that I could.
I think that 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, that’s a very subjective thing. There’s a lot of likability. There’s a lot of who’s politically popular, and that’s the person who’s going to get picked, not necessarily the person who’s the best qualified.
That said, our program did have some excellent chief residents. But he sure as hell wasn’t going to pick me because I was disqualified because of this arm and that leg and his stereotypes and his cruelty. And he enjoyed it.
Kevin Pho: And even after you finished and became an attending, some of your fellow attending colleagues still discriminated against you. You still experienced stories like this, right?
Ron M. Aryel: Yeah. Oh, yeah. There were some attendings, when I went on through my career, who supported me and some attendings who didn’t. And when I started my private practice here in Reno, Nevada, I didn’t get any cooperation from other primary care attendings, mostly. A lot of it was they were busy making money. They wanted to see a patient every ten minutes and make money. OK. I accepted any patient who walked in, and I became a regional expert on a number of rare diseases because of it.
So while I was working, I was putting in 15-hour days in the clinic, they were going home at 5:30 or 6:00 to see their families and 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. And my reputation was, if you were really sick, you came to see me. So intensive care units would send me their patients instead of some of the doctors who take care of our affluent patients.
But I had to be satisfied with what I was. I was doing the right thing. I was doing what I felt to be real doctor work, real medical work. And so that’s what I decided to do. In the end, you make your career what it is, and I worked within the limitations that I had.
And if I had had a lot of money, if I’d been born to a lot of money, money can insulate you from a lot of these things. If you come in from a very wealthy family, you can buy into a hospital, and you can appoint yourself chief of staff because money talks. But unfortunately, I don’t have those kinds of resources. So I couldn’t use money to insulate myself from the discrimination. So I just did the best I could.
Kevin Pho: So tell us how your story and all these obstacles and discrimination that you overcame, how has that made you into the physician that you are today? How has that influenced your medical career?
Ron M. Aryel: Well, I decided that everybody has value, right? So every patient and every medical student has value. So you deal with everybody as an individual. Everybody has shortcomings. I do, too. And you try to help each person in the best way that 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. And so if I had stereotypes, because we all have stereotypes in our heads, if I had a stereotype in my head, I would try to confront that and get rid of that. So I would learn something new from the person in front of me.
Medical students, other residents, parents, patients themselves, they all taught me something. Everybody 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 they’re teaching me. So I learn 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: So what kind of advice do you give to other medical professionals who need to advocate for themselves in the face of injustice? Because this, as you know, happens every single day in every single setting, in every single venue. Tell us the types of advice that you could share with these physicians who are facing injustice.
Ron M. Aryel: Well, first of all, you have to be as confident as you possibly can be. So you study, and you learn, and you focus on doing your craft, your job, as best you can so that your reputation becomes someone who really knows what he, she, they is doing. And so that’s number one.
And number two, always stay humble and learn from everybody. And try to attract friends and supporters based on your honesty and your willingness to learn. If you can make allies, then you can make your situation a little easier. It’s always good to have friends. And if you make yourself indispensable, if your skill set becomes indispensable, it becomes a lot easier to navigate those situations.
Yes, 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 only with threats of lawsuits or other things. Sometimes you have to do that, but a lot of times, there are less confrontational ways to get around that. You have to learn when to fight a battle and when not to fight a battle.
Sometimes the person who’s causing the discrimination, he wants to be the big, bad alpha monkey, and sometimes you just have to let him be the big, bad alpha monkey and avoid him and do 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, such as a good knowledge of the law, to do that.
My associate residency director violated the 1990 Americans with Disabilities Act. He violated state law. But because residency is a temporary situation, it would not have been the best option to actually go and sue on that basis. I managed to get to a point where I was going to graduate, and the time frame would have been that my lawsuit would have had a lot longer time frame than the length of time of residency. And I needed to preserve my options to go get a fellowship, which I did.
But I did have that option of suing under the 1990 Americans with Disabilities Act, and he violated state law also. But it was kind of a balancing act. So it turns out that what I told them is, “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. And by the time I was getting ready to graduate, I had enough friends among the faculty that he had to finally back down because the political capital that he would have had to expend to dismiss me from the program would have been more than he wanted to spend.
Kevin Pho: Now, some of these experiences that 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 that you told during medical school?
Ron M. Aryel: I think that in some ways it has because you see a lot more doctors from a lot more different backgrounds. I think there are still shortages. There are still many fewer minority doctors than white doctors. I think that’s still a problem.
And I think there’s also the attitude of the money. OK, so this is a capitalist society, and part of the issue is everybody wants to make money. And so the hunt for money is still an obstacle to making medicine a little more inclusive. OK, especially primary care doctors, our system is designed to reward specialists, and 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, and the specialists are refusing to see patients unless they make their $400,000 a year.
So the hunt for money is interfering in some ways with that because now we’re talking about money instead of treating patients. And that also tends to enhance those stereotypes. It tends to reinforce the stereotypes rather than spending time breaking them down.
Kevin Pho: We’re 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, what language you speak at home. We’re all human. We all need to take good care of each other. And as a doctor or as a nurse or as any kind of medical professional, you have to do the best you can for the person, for the human in front of you, no matter what they look like or how they act or who they are. And 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.
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