eMethods. Notes on Sampling Method
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Nouri Z, Dill MJ, Conrad SS, Moreland CJ, Meeks LM. Estimated Prevalence of US Physicians With Disabilities. JAMA Netw Open. 2021;4(3):e211254. doi:10.1001/jamanetworkopen.2021.1254
Disability is an increasingly important topic in medical education,1 and recent association guidance has recognized it as an essential component of diversity.2-5 Although information about the prevalence of disabilities among medical students is well established,4,5 there are no parallel data for physicians. To our knowledge, our survey study represents the first systematic report of the prevalence and characteristics of practicing physicians with disabilities using data from the Association of American Medical Colleges 2019 National Sample Survey of Physicians.
The National Sample Survey of Physicians collected data from a sample of 6000 practicing physician members of a health care professional panel (eMethods in the Supplement). A total of 86 951 qualified physicians were invited to participate in the survey in February 2019, and the survey was closed in approximately 2 weeks once the desired sample of 6000 participants was reached. Minimum sample strata response counts were required for combinations of specialty groups, gender identity, and age. The final sample was deemed representative of practicing US physicians compared with the 2018 American Medical Association’s Physician Masterfile, except for international medical graduates (by 6%). The sampling error was ±1.3% at a 95% confidence level using a point estimate of 50%. The study was approved by the American Institutes for Research Institutional Review Board and deemed exempt from further review because the data were deidentified. This study followed the American Association for Public Opinion Research (AAPOR) reporting guidelines.
The survey allowed physicians to self-disclose their disabilities from a list of 8 possible disability categories using the Americans With Disabilities Act definition. Physicians self-identified race/ethnicity from a list of survey options, and also self-identified their gender assigned at birth as well as their current gender identity. For each category, respondents could select all responses that applied. In addition to demographic characteristics, physicians were asked about their practice characteristics, including employment arrangement, work location (rural or urban), specialty, and use of telehealth services. The 95% CIs were generated for physicians with and without disabilities (2-sided P < .05 was considered to be statistically significant). We used Stata SE version 15.1 (StataCorp) to perform unpaired, 2-sided independent t tests to compare prevalence rates and means between these groups.
This study used a representative sample of 6000 physicians, 178 of whom (3.1%; 95% CI, 2.6%-3.5%) self-identified as having a disability. The survey sample included 3768 (62.8%) men, 2055 (34.3%) women, and 20 (0.3%) transgender, genderqueer, or other. The mean (SD) age of participants was 53.0 (12.3) years. The predominant races/ethnicities (not mutually exclusive) were 4148 (69.1%) White, 1347 (22.5%) Asian, and 224 (3.7%) Hispanic, Latino, or of Spanish origin. The disability category most commonly reported was chronic health conditions (54 [30.1%]; 95% CI, 23.3%-36.9%), followed by mobility (51 [28.4%]; 95% CI, 21.7%-35.1%), psychological (25 [14.2%]; 95% CI, 9.0%-19.4%), other disabilities (eg, essential tremors: 24 [13.4%]; 95% CI, 8.3%-18.4%), hearing (22 [12.1%]; 95% CI, 7.3%-17.0%), adult attention-deficit/hyperactivity disorder (19 [10.4%]; 95% CI, 5.9%-14.9%), visual (14 [7.8%]; 95% CI, 3.8%-11.8%), and learning (5 [2.6%]; 95% CI, 0.2%-4.9%). Multiple disabilities (eg, hearing and mobility) were reported by 28 physicians (15.7%; 95% CI, 10.3%-21.1%).
Physicians with disabilities were significantly older than those without disabilities (mean [SD] age, 54.8 [12.7] vs 52.5 [12.2] years) (Table 1). Among physicians with disabilities, 16 (9.2% ) identified as members of a racial or ethnic group underrepresented in medicine, and 26 (14.7%) served on active military duty, either currently or in the past. Ten physicians (5.8%) with disabilities identified as bisexual, and 3 (1.7%) identified as gay or lesbian.
Compared with the 5671 physicians without disabilities, higher percentages of the 178 physicians with disabilities reported working in medical schools (14 [8.1%] vs 242 [4.3%]), in nonteaching hospitals (18 [10.0%] vs 366 [6.5%]), and locum tenens (9 [5.0%] vs 76 [1.3%]), but the differences were not statistically significant. Although physicians with disabilities worked fewer hours per week on average (mean [SD], 43.2 [19.9] vs 47.1 [15.5] h/wk; P = .001), they had more on-call days (mean [SD], 1.0 [1.5] vs 0.6 [1.2] d/wk; P < .001) and were significantly more likely than physicians without disabilities to work in rural areas (31 physicians [17.3%] vs 621 [11.0%]; P = .008) (Table 2).
To our knowledge, this is the first study to examine the prevalence of US practicing physicians with disabilities; we estimated an overall disability prevalence of 3.1%. Many of the physicians also identified as members of other groups likely to face discrimination. Given the bias, harassment, and discrimination experienced by groups traditionally underrepresented in medicine,6 these findings may have important implications for physicians at the intersection of multiple marginalized identities. Limitations of this study include participant bias and underreporting of disabilities, which may lead to an underestimate of disabilities in the population.
These data provide a benchmark to track growth in this population of physicians. Many physicians with disabilities reported multiple underrepresented identities. Accordingly, research examining harassment, discrimination, and bias is needed to inform efforts to create more inclusive and equitable workplaces and to support retention in the profession.
Accepted for Publication: January 20, 2021.
Published: March 12, 2021. doi:10.1001/jamanetworkopen.2021.1254
Correction: This article was corrected on April 15, 2021, to include previously omitted information in the Funding/Support statement.
Open Access: This is an open access article distributed under the terms of the CC-BY License. © 2021 Nouri Z et al. JAMA Network Open.
Corresponding Author: Michael J. Dill, MA, Center for Workforce Studies, Association of American Medical Colleges, 655 K St, NW, Washington, DC 20001 (email@example.com).
Author Contributions: Mrs Nouri and Mr Dill had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.
Concept and design: Dill, Conrad.
Acquisition, analysis, or interpretation of data: Nouri, Dill, Moreland, Meeks.
Drafting of the manuscript: All authors.
Critical revision of the manuscript for important intellectual content: All authors.
Statistical analysis: Nouri, Meeks.
Administrative, technical, or material support: Dill, Conrad.
Supervision: Dill, Moreland.
Conflict of Interest Disclosures: None reported.
Funding/Support: This study was supported, in part, by the Association of American Medical Colleges (AAMC) (Mrs Nouri, Mr Dill, and Ms Conrad).
Role of the Funder/Sponsor: The AAMC had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.
Additional Contributions: We thank Xiaochu Hu, PhD (AAMC), for her statistical expertise and careful review of multiple drafts of the article. She was not financially compensated for her contribution.