Where We Stand
Section: Health Care Access
Policy: Disability Policies
Appendix AB

Disability Policies

Number 1 - Definition of Disability 

The Americans with Disabilities Act (ADA) of 1990 defines a person with a disability as someone who:

• has a physical or mental impairment that substantially limits one or more major life activities,
• has a history or record of such an impairment (such as cancer that is in remission), or
• is perceived by others as having such an impairment (such as a person who has scars from a severe burn but is wrongly assumed to have a disabling condition because of those scars),

Therefore, the definitions protect these individuals by law[1].

However, the OMA, in line with the American Medical Association and World Health Organization, chooses to view disability through the biopsychosocial model. This model redefines and reframes disability by focusing on the context people find themselves in rather than the medical model, which focuses on “normal” vs “abnormal” and frames an individual’s disability as the problem[2].

The biopsychosocial model defines disability based on:

• biological sources of impairment: physiological or anatomical characteristics of an individual.
• psychological coping strategies and sources of impairment: How an individual's thoughts, emotions, and behaviors influence their experience of disability.
• social structures that turn impairment into disability: environmental and societal barriers (or facilitators) that affect an individual's participation and well-being.

This model forms the basis of the International Classification of Functioning, Disability and Health (ICF), the WHO framework for measuring health and disability at individual and population levels[3]. The ICF is a universal classification system of disability and health for use in health and health-related fields, and acknowledges that every human may experience a decline, temporary or permanent, in health and therefore experience disability[4]. The OMA's definition of disability is informed by the ICF framework, though is not limited to it. While the ICF provides a clinically grounded model, it lacks the principles of intersectionality.

Recognizing that disability is dependent on context and that accessibility (or lack thereof) affects outcomes, OMA also recognizes that health disparities among people with disabilities cannot be fully addressed without acknowledging the additional barriers faced by those with intersecting marginalized identities, such as race, ethnicity, gender identity, sexual orientation, age, and behavioral health diagnoses[5],[6],[7].  Whether the individual is a clinician or patient, whether a disability is well-documented in the medical record or not, whether a disability is permanent or temporary, and whether their disability is visible or invisible, the OMA is shifting focus from a person’s disability to the medical, social, and structural solutions which improve  the overall health and well-being of people living with a functional difference.

In acknowledging the limitations of the ADA and the expanded understanding of disability by national and international health organizations under the biopsychosocial model, the OMA aims to protect the rights and opportunities of individuals living with all types of disabilities. Ableism is a set of beliefs, stereotypes, and practices aimed at people living with disabilities and is based in the belief or desire to “cure” or “fix” a person’s disability to make them “normal”. Such a mentality portrays individuals with disabilities as being defined by their disability, and inherently less than or inferior to those without disabilities[8],[9]. Structural ableism in healthcare refers to a system of historical and contemporary policies, institutions, and societal norms and practices that devalue and disadvantage people living with a disability. These systems privilege people who are represented as able in body and mind and result in different access to healthcare resources and worsened health outcomes[10]. The ableist mentality and systems of structural ableism present a point of view and interpretation of the world from a perspective that is inherently blind to the diversity of ways of interacting with the world and society.

Number 2     Patient-Related and Person-Centered Disability Policy 

The personal, financial, and societal costs of health disparities have long been recognized[11],[12]. While some progress has been achieved in reducing disparities by race, ethnicity, sex, and gender, disability status continues to be associated with poorer health outcomes[13]. Evidence suggests that ableism, defined as prejudice and discrimination aimed at disabled people, often with the implicit goal of “curing” their disability, is a key driver of these disparate health outcomes both in society at large and in medicine[14],[15],[16],[17],[18],[19]. Despite hard-won rights, largely codified in the Americans with Disabilities Act (ADA), people with disabilities continue to face disproportionate risk of harm when compared to those without disabilities, including higher rates of sexual victimization, greater threat from eugenics, and poorer social determinants of health such as income and housing insecurity[20],[21],[22],[23]. Bioethicists have recently acknowledged that both their field and the medical profession have failed to properly uphold disability rights and that drastic, rapid reform is paramount[24].

Multiple factors contribute to disparities in healthcare for people with disabilities[25]. People with disabilities face numerous physical, communication, knowledge, structural, and attitudinal barriers to care[26]. Most physicians do not use accessible equipment for routine care of patients with mobility limitations[27]. Inaccessibility to receiving care contributes to increasing health disparities for patients with disabilities; therefore, accessibility must be a priority for healthcare institutions, starting with adherence to ADA guidelines. Beyond physical accessibility, patients with disabilities must be granted autonomy and dignity in their healthcare decisions. Surrogate decision makers should only be used as a last resort. Guidelines and policies on promoting autonomy and decision-making for patients with disabilities have been published by many prominent organizations, including the American Medical Association[28], American Association on Intellectual and Developmental Disabilities[29], American Academy of Pediatrics[30], and Disability Rights Oregon[31]. Health professionals, including clinicians, public health professionals, and researchers should collaborate with people with disabilities on identifying and overcoming gaps in care.

Improving patient care and health outcomes also requires equipping the current and future healthcare workforce with updated and accurate knowledge about disability health disparities with active involvement of those with lived experiences. Inadequate training causes clinicians to lack confidence in providing care: 36% of physicians reported having little to no knowledge of about their legal responsibilities under the ADA[32] and only 41% of physicians feel that they have the ability to provide equal quality care to patients with disabilities [33]. In addition, biases within healthcare contribute to disparities.  A recent study found that the majority of physicians had implicit biases against people with disabilities, despite self-reporting as unbiased[34]. This emphasizes the need for curricula that centers on recognizing and reducing biases. Many physicians also conceptualize disability as primarily medically-focused, ignoring the contributing social factors, further indicating the need for education that builds disability cultural humility[35]. Importantly, the contribution of implicit bias on healthcare disparities can decrease when physicians acknowledge the presence of bias and intentionally practice strategies to combat it, such as perspective-taking (i.e. consciously envisioning another person’s viewpoint) and individuation (i.e. focusing on specific information about an individual rather than their social category)[36]. There has been extensive research looking into educational gaps and recommendations for improving curricula on disability healthcare[37],[38],[39],[40]. Still, most medical schools have limited opportunities for in-depth education or meaningful engagement with people with disabilities[41]. Updating curricula to emphasize unbiased, culturally informed, patient-centered care has strong potential to improve outcomes, reduce disparities, and strengthen trust in the patient-clinician relationship.

Government also plays a critical role in improving healthcare for and minimizing health disparities among people with disabilities. One of the most direct mechanisms is through insurance-related legislation and policy. The Affordable Care Act (ACA), and resultant Medicaid expansions in some states, including Oregon, have allowed nonelderly adults with disabilities who lack supplemental security income (SSI) to obtain otherwise inaccessible insurance coverage[42]. As of early 2025, Medicaid is the primary source of health and long-term care insurance for one in three Americans with a disability, meaning any reduction in Medicaid access would disproportionately harm people with disabilities[43]. Expanded insurance coverage improves access to ongoing disability care services as well as recommended preventative care, which can often stymie the development of additional disabilities or complications[44],[45].

Policies that protect public health, such as preventing mask bans (at least in healthcare settings) and actively combatting anti-vaccine sentiment are also critical. Both masks and vaccines reduce the risk of developing disabilities (e.g. long COVID) and protect people who are more vulnerable to infectious diseases complications due to their existing disability[46],[47],[48],[49]. Other important policies include promoting community integration for people with disabilities, such as minimizing institutionalization, improving access to education, and increasing suitable employment opportunities. Such government actions would not only promote well-being for people with disabilities directly but also combat long-standing systemic barriers and biases that can socially isolate those with disabilities[50],[51],[52],[53]. Thus, to reduce disparities, expand autonomy, and improve health outcomes for people with disabilities, government policy must expand access to comprehensive insurance coverage, counter mask bans and anti-vaccine rhetoric, and promote community integration for disabled people wherever possible.

These policy recommendations allow the OMA to advance healthcare and equity for patients with disabilities by decreasing disparities, upgrading education for current and future clinicians, and advocating for government action.

Number 3     Clinician and Learner Related Disability Policy 

Principle 1 - Protections for Students and Trainees with Disabilities 

The OMA recognizes that increasing diversity among clinicians to reflect the diverse patient populations they care for leads to improved patient care and outcomes. While 26.8% of people in the United States reported having a disability in 2019, only 3.1% of physicians and 4.6% of medical students reported having a disability[54],[55],[56]. No data currently exists on the percentage of Physician Associates (PA) or PA students with disabilities, and there is limited data on disabilities in graduate medical education (GME) programs. Given this discrepancy, it is important to evaluate the barriers that limit the number of learners with disabilities who are entering medical and PA schools.

Although 93.3% of schools surveyed reported providing disability accommodations, cultural and structural barriers continue to make it difficult for students with disabilities to access medical education in the first place[57]. Technical standards for medical schools vary widely and often have vague “organic” standards that emphasize deficits/limitations rather than abilities. Additionally, only one-third of schools surveyed used language that expressed a clear willingness to provide accommodations for students[58]. It is recommended that technical standards shift to a “functional” model, where the skills a student must master are clearly defined and can be achieved with or without accommodations and assistive technology[59].

Of GME programs with publicly available policies, only 68% contained a statement about disability that was in accordance with Accreditation Council for Graduate Medical Education (ACGME) requirements[60]. When prospective students struggle to find information on technical standards and accommodations for medical school, PA programs, and GME programs, they may be discouraged from applying to these programs or seeking necessary accommodations while at the program. Additionally, although the Association of American Medical Colleges (AAMC) recommends a confidential and qualified point person for disability services, over half of the 32 institutions surveyed required residents to disclose a disability directly to the program director[61]. This practice may discourage residents from disclosing disabilities due to fear of experiencing bias, including losing an offer. It may also limit access to accommodations if the program director lacks familiarity with or willingness to implement ADA requirements and disability resources. Both the ADA and several American Medical Association (AMA) policies support the above protections for medical and PA students, as well as residents[62],[63],[64]. 

Principle 2 - Protections for Clinicians with Disabilities 

While the ADA prohibits discrimination based on disability in employment, the culture of medicine and misconceptions about disabilities can lead to discrimination and barriers in obtaining accommodations. A misconception some cite is that patient safety will be compromised if accommodations are provided. However, the AMA emphasizes that patient safety remains paramount and affirms that with reasonable accommodations (as defined by the ADA), clinicians with vision, hearing, mobility, or mental health disabilities can provide safe and effective care[65].

Due to fear of reprisal, clinicians may be hesitant to disclose their disability or request accommodations, which may be especially challenging for those who acquire a disability mid-career[66]. State licensing boards play a vital role in ensuring clinicians practice medicine safely; however, it is essential that they adhere to ADA requirements, particularly the restriction against inquiring about physical or mental health conditions unless those conditions directly affect professional competence[67]. A study on PA licensing found that only 18 of 47 respondents, which included 46 states and Washington D.C., complied with ADA requirements in evaluating both initial and renewal licensing applications[68]. As a result, 35% of PAs surveyed expressed reluctance to seek mental health care due to concern of licensure repercussions[69].

When it comes to concerns over the cost of providing reasonable accommodations, research shows that 58% of accommodations have no cost, while the rest typically cost around $500, with tax incentives existing to assist the employer in covering these costs. As stated by the ADA, businesses with 15 or more employees are required to provide reasonable accommodations unless doing so would impose an “undue hardship” [70]. Additionally, under Oregon’s state anti-discrimination laws related to employment that is more protective than federal law, businesses with 6 or more employees are required to provide reasonable accommodations[71]. Beyond legal compliance with state and federal anti-discrimination laws like the ADA, creating accessible learning and work environments benefits both clinicians as well as their patients with disabilities. For example, height-adjustable exam tables designed for clinicians who use wheelchairs can also improve accessibility for wheelchair-using patients[72]. Furthermore, studies suggest that physicians with disabilities bring valuable lived experiences that improve cultural humility and patient-centered care, particularly for patients with disabilities[73].

Thus, as supported by AMA and ADA policy, it is crucial to ensure that protections and accommodations for clinicians with disabilities are clearly defined and upheld[74],[75].

Principle 3 - Promoting Accessibility and Inclusion in Professional Spaces 

Ensuring that clinicians and students with disabilities have equitable access to professional opportunities is essential for fostering an inclusive and diverse medical community. Barriers to participation in conferences, continuing medical education (CME), and professional events can prevent clinicians with disabilities from accessing the same learning opportunities, career advancement, and networking experiences as their peers. As supported by the AMA, hospitals and educational institutions should prioritize making all facilities fully accessible to clinicians with disabilities[76]. It is currently challenging to quantify the impact these barriers may pose for clinicians with disabilities as minimal research on this subject exists. Thus, it is recommended that future studies explore the barriers, effectiveness of accommodations, and outcomes of clinicians with disabilities[77].