This week’s contributor is Bianca Frogner, a professor in the Department of Family Medicine and Director of the Center for Health Workforce Studies at the University of Washington School of Medicine. Her research focuses on how the health workforce can be used effectively to deliver high quality, accessible and affordable care. Bianca is a member of the 2022 Tradeoffs Research Council.

About 1 in 8 people in this country – and nearly a third of those older than 65 — live with a disability. The range is wide: It could be one or more difficulties, for instance, with hearing, vision, cognition, mental illness or mobility. Despite federal protections against discrimination, people with disabilities experience significant health disparities, including poorer quality of care and less access to care due to cost, compared to those without disabilities.

A recent Health Affairs study by Tara Lagu, Lisa Iezzoni and others finds that the attitudes and actions of physicians may be contributing to these differences in health care. The researchers invited primary care and specialist physicians from a range of geographic regions to online focus groups to share their experiences caring for patients with disabilities. The online platform allowed the physicians a level of anonymity in sharing their candid responses. Those responses surprised even the researchers, whose takeaways included that:

• Medical buildings and equipment such as exam tables are not designed with accessibility for the patient in mind.

• Most physicians interviewed lack the knowledge, experience, skills and tools needed to adapt to patients’ physical needs, such as mobility, hearing or vision impairments. 

• Schedules and insurance reimbursement policies can constrain physicians’ abilities to adequately accommodate patients’ needs.

• Some physicians, for a variety of reasons, are blatantly refusing care to people with disabilities.

The authors attribute these doctors’ failures to make accommodations for patients with disabilities, in part, to both explicit and implicit biases against patients with disabilities. One solution raised in the study is better training for doctors in how to provide culturally competent care for this population. The researchers also emphasized the important role that caregivers play in facilitating care when it does happen – a fact that other studies have observed and recommended be further incentivized.

The study’s limitations include the relatively small sample size of 22 physicians, though this qualitative study was designed to generate more in-depth studies.

The importance of physician willingness and knowledge to care for people with disabilities is only growing. One in 13 people newly diagnosed with COVID experience long COVID, which was recently added as a disability protected under the Americans with Disabilities Act and the Affordable Care Act. As health systems adapt to this new wave of patients with disabilities, it is urgent that physicians get the additional training and support needed to prevent the exacerbation of health disparities and discrimination against patients with disabilities.