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What happens to patients with disabilities when the government signals their lives don’t matter, and what does that mean for the doctors fighting alongside them? Ashna Shome, a pediatrics resident with cerebral palsy, joins the show to discuss her KevinMD article, “The impact of policy cuts on ableism in health care.” She explains how proposed Medicaid cuts, the rollback of physical access requirements for federal buildings, and harmful rhetoric around autism and vaccines are compounding to create a more hostile environment for the one in four U.S. adults living with disabilities. You will hear how anti-vax discourse tacitly suggests that developmental disabilities are worse than death, why she now relies almost exclusively on the American Academy of Pediatrics as a trusted source of health information, and how her own experience navigating medicine with cerebral palsy has shaped her advocacy. Shome also makes a compelling case for physician unionization as a tool for disability justice, arguing that the artificial barrier between doctor and patient must be dismantled. If you care about disability rights, health equity, or the future of physician advocacy, this conversation demands your attention.

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Transcript

Kevin Pho: Hi, and welcome to the show. Subscribe at KevinMD.com/podcast. Today we welcome Ashna Shome. She is a pediatrics resident. Today’s KevinMD article is “The impact of policy cuts on ableism in health care.” Ashna, welcome to the show.

Ashna Shome: Thank you. Thank you for having me.

Kevin Pho: All right, so briefly tell us about yourself and then explain why you decided to share this story and article on KevinMD.

Ashna Shome: My name is Ashna. I am a pediatrics resident here in the Bronx. My journey into medicine has been very influenced by the fact that I also have cerebral palsy. That has become a really crucial part of why I even got here. It exposed me to medicine as a career really young, but it has also really galvanized me to fight for people like me. There are so few people who are “out” about having disabilities in medicine, and so many of our patients have disabilities, yet we don’t always care for them as well as we could. So my goal is really to fight for people like me and also fight for better care for our patients.

Kevin Pho: You mentioned offline that you are almost finished. You are in your third year of pediatric residency. Congratulations.

Ashna Shome: Thank you.

Kevin Pho: Tell us about some of the major obstacles that you had to face during your medical journey as someone with cerebral palsy.

Ashna Shome: It is a constant, really ongoing challenge. It is challenging to kind of make a space for myself. My personal needs are relatively limited, I would say. I just can’t stand for long periods of time, but even getting access to a chair or having to disclose to every single attending why I need said chair can take quite a toll, and it is pretty draining. The other part of it for me is hearing the quieter stories, the things people struggle with that they don’t feel comfortable telling others, but they might tell me. I find that to be really hard to deal with, and I want better for all of us. I want us to be able to be honest about our limitations and what we need, because it will only ever be better for us and better for our patients who have the same needs.

Kevin Pho: I am sure that these obstacles you have overcome have influenced your relationship with patients, right?

Ashna Shome: A hundred percent. Yes, I think for me it is obvious that the line between which side of the desk you are on, the doctor side or the patient side, is thin and it can slip. At any moment, you can have any sort of disability at any time in your life, and your role can change instantly. I think that has made me a little bit more humble as a provider, I hope, and a little bit more empathetic to some of the struggles people go through when trying to balance work and, in my case, usually their children’s needs as a pediatrician. I think it has really made me a better doctor, and I think more people like me should be in health care.

Kevin Pho: You wrote this article on KevinMD, “The impact of policy cuts on ableism in health care.” For those who didn’t get a chance to read your article, tell us what it is about.

Ashna Shome: Yes, my article is really a response to the federal government’s onslaught of attacks on anything that cares for people in this country who are poor and disabled, especially Medicare and Medicaid funding. The more we go into this Trump administration’s vibe of cutting down on money and active, gross, ableist rhetoric, the worse our country is going to become. It is going to be harder and harder for people to access care, which is terrible for them as individuals. It is also terrible for us on the other side because we are only going to be asked to balance more, to do more for our patients, and somehow try to pull together all of these pieces and keep the wheels on the cart, for lack of a better metaphor.

Kevin Pho: Now for those who aren’t familiar with those specific policy cuts, tell us about what some of them are in the context of your article, and how are you seeing those policy cuts in the hospital or clinic every day?

Ashna Shome: The number one thing that I wrote this in response to was the so-called “Big Beautiful Bill,” which entailed a lot of cuts to Medicaid and Medicare. I have to say, I am really lucky where I am in New York State. They have done a lot of work to insulate us so far from those changes, and I don’t think I have felt the brunt of it yet either as an individual or as a medicine provider. However, I do think that this is only going to get worse. This was almost a tone set for how the next few years of the Trump administration are going to go. I think we all need to be very much on our guard and very ready and willing to advocate for better for our patients as their doctors.

Kevin Pho: So what is an example or story of some of those ramifications? You don’t have to talk about a specific patient, but tell us a scenario that comes up that you see every day.

Ashna Shome: A big one is food access. Some of these cuts have limited who is eligible for WIC and SNAP. SNAP is food assistance for adults, but WIC is specifically for children and families. A lot of the policy changes being proposed are also very punitive towards immigrants here in the Bronx. I work with probably a majority of immigrants from other places, and their eligibility for SNAP and WIC is tenuous at best right now. To hear people struggle and suffer and be so worried about how they are going to feed their children, who are everything to them, is heartbreaking work.

Kevin Pho: So it is not just the policy, it is also the rhetoric that we are hearing from this administration as well. Talk to us and give an example of that, and tell us about some of the ramifications of just the rhetoric and some of the things that we are reading every day in the newspaper.

Ashana Shome: Yes. I think some of the worst rhetoric has actually been around pediatric things. One is the idea that Tylenol causes autism if taken by a pregnant parent. Firstly, this is false, as I think many people know. Secondly, it is a very insidious, slippery slope. The way that we are talking about autism and developmental disabilities right now is very punitive. It is like people with those conditions are disgusting, and it really ends up questioning their worth in society, which is never going to be the right way to go.

I think this is also very alive and well in a lot of the anti-vax discourse. What we are tacitly saying with anti-vax discourse is basically that having autism or another developmental disability is worse than dying a horrific death from measles or polio or something like that. While I don’t think that is necessarily what your average anti-vax parent is saying, I do think it is what people in power are saying. We really need to be cautious and mindful of the rhetoric we use in the clinic when we talk about these disabilities, but also be watchdogs for what our government is saying and why they are saying it. As a pediatrician, I know full well the value of children with autism, what they bring to their families and their communities, and they don’t deserve to be spoken of in the way that people in power are doing so.

Kevin Pho: How has the conversation changed when you talk specifically about vaccines with parents and families?

Ashna Shome: I mean, it gets worse by the day. I live in New York City with the specific intent of not being in a place that is very permissive about vaccine policy because here it is very much required. I didn’t anticipate that much of my career would be dealing with vaccine hesitancy, but I was wrong. We are just seeing it skyrocket. Every month it is just more and more. Frankly, I don’t blame the parents one bit. Yes, there are some people who are bad actors, but most of them are taking cues from the government and the people in power, as they should. So when I am telling them something very different from what the entire U.S. government is telling them, they are right to be confused and concerned and have questions.

I don’t feel like we are on a good path. I think it is so crucial for us as doctors to be loud, to take up space, and to use our professional organizations and advocacy organizations to make our points as clear and as firm as the government is doing.

Kevin Pho: So this is an effect of the politicization of medical information. In the past, we could point to government agencies like the CDC for reputable health information, but now because these organizations have been politicized, it is hard to recommend what was once objective information to these families. What kind of resources do you share with them?

Ashna Shome: I am really grateful for the AAP and all of the work they have been doing. I am using things almost exclusively from the AAP now. I feel like they are the most trusted source for pediatric health information at this point. They are doing amazing legislative advocacy work. They just had the new vaccine schedule paused through some lawsuits that they filed. So they are my go-to now.

Kevin Pho: One of the things that you mentioned in your article was the removal of physical access requirements for buildings receiving federal funds. Tell us about that major shift in national policy and the effects that could have.

Ashna Shome: I believe it is still in a proposal phase. I haven’t followed it up too much since the time of writing. But at that time they were in data collection for this idea that they would change policies to allow federal buildings to just not have access requirements anymore, which is a very longstanding piece of federal policy. To just take away access for federal buildings is truly crazy. You are saying it doesn’t matter if people in wheelchairs can get in. It doesn’t matter if people who are blind have access to braille. It is a very clear message: lives like mine do not matter.

That is not a shock if you followed political discourse in 2026 or maybe the ten years prior. But I do think it is such a blatant message of who is prioritized in the America of 2026, and it is not me and it is not my patients. I continue to fight against that as much as possible.

Kevin Pho: One of the things you mentioned earlier was that physicians like yourself need to speak up. You are a member of the Committee of Interns and Residents, so tell us about how a union like that can help fight for disability justice at a national level.

Ashna Shome: I feel so lucky to be part of CIR. We now unionize about a third of U.S. residents, which is incredible. I do think that unions are really the only future for medicine as a career. I think a lot of how we have gotten to where we are in the big picture in the U.S. is the death of expertise. Physicians really do have so much valuable knowledge to share, and we have kind of created our own monster in a sense. We have separated ourselves from patients and acted like we are not the same, like we are better. That historical attitude has trickled down into the relationship we have with any patient.

I think unions are really crucial to step in and repair that relationship because they are a reminder that we are not different. We are also workers. We are part of the labor movement. When we unionize, it forces us to learn that history and to break down that extremely artificial barrier that is created between physician and patient. It protects us in the same way that unions have always protected people. They help us get dental insurance and vision insurance, but they also help us to do the big picture work that physicians need to be doing right now, which is getting together and speaking loudly in one voice. As physicians, we have more things in common than not. Most of us want the best for our patients. Most of us want accessibility for our patients. We care about these things deeply. Unions allow us to turn that care into action, and I think that is so powerful and extremely necessary right now.

Kevin Pho: I think that thought is very powerful, that we physicians do need to organize collectively. We are seeing some attending institutions in Boston unionize as well. One of the critiques I have heard about unions is that sometimes they just don’t get things done. You did mention vision and dental insurance, but through your lens, just tell us about some of the wins that your union has given you and how that has affected your life as a resident.

Ashna Shome: I think the wins that have affected my life are the simple ones. A couple of years ago before our last contract fight, I was in a program that was on track to be one of the lowest paid, if not the lowest paid in New York City. That is no longer true. Money makes life livable. Simple things like having vision, having dental, and having access to lawyers are things that have helped me and allowed me to help my colleagues as well. Those are the little wins, but I think the big wins matter a lot and are more flashy.

For example, we have been pretty successful at securing funding for abortion training in New York State. That is thanks to union advocacy. We have a really functional relationship with many city councilors and the mayor’s office here in New York City. They listen to us and care about our perspective, especially in hospital systems. That is all thanks to our union advocacy. To the critique that unions aren’t effective because they are slow: they are always going to be slow. Anything made up of more than five people is going to be slow. But I think it is the slow, necessary change that comes from actually representing people, hearing a variety of voices, coalescing things, and bringing it forward in an actually useful way, not just the sort of slapdash policymaking that we are seeing these days.

Kevin Pho: In your article, you cite a statistic that one in four U.S. adults live with disabilities. For those who may be listening to you on this podcast, tell us the advice that you could share with them to survive some of these rhetorical and policy attacks on disability rights.

Ashna Shome: My advice is probably controversial, but my advice is to be out about your disability. I think it really matters if you have the mental and emotional bandwidth to be loud, talk to people, and take up your space. It matters, and it also matters because if somebody tells you they don’t want you in the room because of your disability, you probably weren’t safe there to begin with. Even though it is very difficult, I think it is a necessary difficulty for yourself and for others.

The other thing I would say is to know your people and find your people. There are always people who are going to support you and be there for you. I have friends who have shown up for me and been caretakers when I have needed it. My family has always shown up for me. I think finding those people, trusting them, and trusting your community, while so against the American ethos these days, is the necessary thing to do if you are disabled.

Kevin Pho: We are talking to Ashna Shome, a pediatrics resident. Today’s KevinMD article is “The impact of policy cuts on ableism in health care.” Ashna, let’s end with some take-home messages that you want to leave with the KevinMD audience.

Ashna Shome: My take-home message is basically that disabled people exist and matter, and disabled doctors exist and matter. We have so much to say and so much to contribute to our health care system, especially now in this political context. I would also say that it is really necessary work to break down some of the stigma and the harm around disability because every time we do that, we are chipping into the bad attitudes and the problematic patriarchal history of medicine. It dissolves these false lines we have drawn between doctor and patient, or sick person and well person.

It also connects us to the larger labor movement. Doctors are a part of it. We are not different from other workers. We are not special. Especially in 2026, when many of our communities are under attack, we are not going to be exempt. The only way we can save ourselves from that is to truly come together, advocate for each other, and advocate for our patients.

Kevin Pho: Ashna, thank you so much for sharing your perspective and insight, and thanks again for coming on the show.

Ashna Shome: Thank you.