More than a third of U.S. physicians do not know their legal requirements under the Americans with Disabilities Act (ADA), the federal civil rights law that prohibits discrimination against individuals with disabilities, according to a study funded by the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD). More than 70% of physicians did not know that they share responsibility with patients to determine reasonable accommodations—how to adjust policies, practices, and procedures to ensure patient care.
The study was conducted by Lisa I. Iezzoni, M.D., of Massachusetts General Hospital, and colleagues. It appears in Health Affairs.
Enacted in 1990, the ADA prohibits discrimination against people with disabilities and guarantees that they have the same opportunities to participate in life as everyone else. The law defines a disability as a physical or mental impairment that substantially limits one or more major life activities. Under the law, public and private medical practices that see patients must provide reasonable accommodations to people with disabilities. These practices must accommodate patients’ disability-related needs and cannot refuse patients because of a disability.
To learn about physicians understanding of their legal obligations under the ADA and the process for making decisions about accommodations, researchers conducted a representative survey of 714 U.S. physicians in the following specialties: general internal medicine, rheumatology, neurology, ophthalmology, orthopedic surgery, and obstetrics and gynecology.
Almost 36% of survey respondents said they knew little or nothing about their responsibilities under the ADA. Of these, slightly more than 41% attributed lack of formal education or training as a moderate-to-large barrier to their learning more about the Act. Slightly more than 71% provided incorrect answers about who makes decisions about reasonable accommodations for patients with disabilities. The correct answer is that patients and physicians make the accommodations jointly. Just over 20% provided incorrect answers about who pays for reasonable accommodations for patients with a disability. Under the ADA, owners of the practice must pay for accommodations. More than 68% believed they were at risk for lawsuits for failing to provide adequate accommodations.
The authors wrote that their findings underscore the need for more physician training about disability and physicians’ responsibilities under the ADA in medical school, postgraduate training, and in continuing medical education programs. They described lack of knowledge about making decisions on accommodations as troubling. They noted that, without proper accommodations, patients with disabilities may receive substandard care. For example, some studies have found that patients who use wheelchairs are routinely examined in their chairs rather than being moved to examination tables. Similarly, patients who are deaf or hard of hearing may not receive the services of a sign language interpreter.
“To achieve more equitable care and social justice for patients with disability, considerable improvements are needed to educate physicians about making healthcare delivery systems more accessible and accommodating,” Dr. Iezzoni said.
Iezzoni, L.I., et al. U.S. physicians’ knowledge about the Americans with Disabilities Act and accommodation of patients with disability. Health Affairs. 2022.