Key PointsQuestionWhy do resident physicians with disabilities refrain from requesting needed accommodations?FindingsIn this cohort study including a weighted sample of 173 first-year resident physicians with disabilities, 50.6% of those with reported need for accommodations did not request them. Fear of stigma or bias and lack of a clear institutional process were the most reported reasons for not requesting needed accommodations.MeaningThese findings suggest that greater transparency and compliance with best policies for disability disclosure systems are needed in graduate medical education, and program directors should investigate factors contributing to an unsafe or unsupported environment for requesting accommodation within their programs.