The physician shortage is a real, persistent, and worsening problem, not only in the United States, but around the globe. Studies suggest that there is currently a worldwide deficit of more than 4.3 million healthcare providers. And it is typically the most vulnerable populations who are most starkly affected, including those individuals who are living with disabilities. The worsening physician shortage, combined with the reality of a healthcare system overburdened by a lingering pandemic, leaves persons with disabilities at particular risk for inadequate care, unconscious healthcare provider biases, and dangerous care “rationing.”
Access to Care
One of the most significant impacts of the physician shortage on patients with disabilities is in patients’ ability to access the care that they need.
Those who have chronic, disabling medical conditions typically require more frequent, more intensive, and more consistent medical care. Unfortunately, the worsening labor shortage in healthcare all but assures that the medical system will grow less and less able to supply the comprehensive, long-term care that patients with disabilities likely will need to ensure their longevity and quality of life.
The US healthcare system is expected to experience a shortfall of as many as 139,000 primary and specialized care providers. Increasingly, practitioners and health leaders in related fields, such as those in the Director of Nursing Practice (DNP) role, are being turned to for mitigating the effects of the shortage on both healthcare workers and patients. Nevertheless, until the shrinking number of healthcare providers is sufficiently replenished by teams of experts such as DNPs, it is the high-volume healthcare consumer, such as those with disabilities or chronic medical conditions, who are least likely to receive the comprehensive care they need.
Unconscious Biases
The labor shortfall isn’t just a logistical issue; for healthcare providers, it’s also a psychological one. Overworked and understaffed medical teams are at extreme risk of anxiety, depression, and burnout, and these impacts link directly to compromised quality of patient care. When healthcare providers are struggling physically, mentally, and emotionally, they are far more prone to succumb to unconscious biases that might have never affected their standards and practices of care in ordinary circumstances.
Studies show that specific groups are more likely to be the target of unconscious bias in healthcare. These include minorities, women, and persons with disabilities. For women with disabilities, the combined effects of care provider burnout, staff shortages, and unconscious bias can be especially dire.
Women, for example, are far less likely than men to receive adequate care for their pain. Similarly, women are far more likely to receive incorrect or delayed diagnoses, particularly for conditions such as heart disease. As healthcare providers grapple with scant time and seemingly insurmountable patient loads, the likelihood that women with disabilities will be particularly at risk for insufficient care is great.
Healthcare providers, for instance, may attribute women’s complaints of pain or new symptoms to their disabilities, rather than following up to ascertain where a new condition has arisen. This is a particularly pernicious issue insofar as women are more likely than men to experience long-term disability and yet, for healthcare providers as well as laypersons, it is men who are perceived to be at greatest risk of disability. Such unconscious biases, operating in a condition of severe understaffing, only exacerbates the likelihood that the healthcare needs of women with disabilities will go unmet.
The Impacts of COVID-19
The COVID-19 pandemic has been, far and away, the most significant public health crisis of the modern era. However, the pandemic also speaks to a troubling global trend in which infectious disease outbreaks are increasing in both severity and frequency. Before the 21st century, severe global pandemics emerged roughly once a century.
Due to an increasingly mobile world population, though, the number and severity of disease outbreaks have substantially increased. This phenomenon is not likely to subside anytime soon, as cities become more crowded, international travel remains commonplace, and the global population experiences rising rates of obesity and chronic disease, increasing their susceptibility to infectious disease.
This means that not only will the healthcare system face the burdens of the physician shortage itself, but will also suffer the effects of epidemic and pandemic waves. For persons with disabilities, the COVID-19 pandemic has revealed stark truths about the unconscious biases which may impact healthcare providers’ treatment choices and practices.
More specifically, the outbreak has yielded significant reports of care “rationing.” In the face of care rationing, persons with disabilities were more likely to be denied care based on dubious “quality of life” assessments, with little regard to the wishes of the patient or their family.
The Takeaway
The physician shortage is a long-standing and worsening problem, and its effects are particularly acute for patients with disabilities. As the shortage continues, persons with chronic illness and injury are likely to experience decreasing access to consistent care as well as the harmful impacts of unconscious biases against patients with disabilities, which may lead to care rationing.