Barriers, facilitators and solutions to equitable career progression for disabled doctors: an integrative review.

Abstract

Disabled resident doctors face persistent structural, cultural and institutional barriers to career progression. This integrative review synthesises empirical and grey literature to identify the challenges disabled doctors encounter, the practices that support their careers and the potential solutions applicable to healthcare, in particular National Health Service (NHS), settings. Integrative literature review using a content analysis approach to data analysis. Included sources were published in English and examined disabled doctors' career progression or included disabled doctors as a separate subgroup. Opinion pieces without empirical grounding and articles not available in full text were excluded. International postgraduate medical education, with consideration for transferability and applicability to the UK NHS. Focused on the experiences and careers of disabled resident doctors, at any stage of their career, prior to completion of training. Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses-Equity guidelines, 53 sources were included and analysed. Structural ableism, inaccessible systems and stigma around disclosure were consistently identified as barriers to career progression. Facilitators included mentorship, affirming supervisory relationships and identity-affirming networks. Promising practices included universal design approaches, anticipatory rather than reactive approaches to making adjustments and integration of disability equity into organisational governance. However, most initiatives remain unevaluated, and UK-specific evidence is limited. While awareness of barriers is growing, evidence-based solutions remain underdeveloped and unevenly implemented. To build a sustainable and representative medical workforce, workforce policy and planning must not only remove barriers to progression for disabled doctors, but also embed disability inclusion into the structures and cultures that shape medical career paths.