Physicians are using excuses to intentionally dissuade people with disabilities from their practices, researchers say in a new study exposing just how pervasive discrimination against this population is in health care.

In focus groups, doctors described making strategic choices to turn away individuals with disabilities. They reported telling patients with disabilities that they would require specialized care and that “I am not the doctor for you.” In other cases, physicians said they simply indicate that “I am not taking new patients” or “I do not take your insurance.”

The findings come from a study published this month in the journal Health Affairs. It is based on focus groups conducted in late 2018 by researchers at the Northwestern University Feinberg School of Medicine, the University of Massachusetts and Harvard Medical School with 22 primary care and specialist doctors who were selected from a national database.

Many of the participants described accommodating people with disabilities as burdensome and some used outdated language like “mentally retarded.” Doctors frequently indicated that individuals with disabilities account for a small number of patients, making it hard to justify having accessible equipment. They also had little knowledge of their obligations under the Americans with Disabilities Act, with one suggesting that the law works “against physicians.”

The latest study builds on findings published earlier this year from a survey of 714 doctors that was done by some of the same researchers. Just 56% of physicians who participated in the survey said they welcome people with disabilities at their practices and only 41% indicated that they could provide such patients with a similar quality of care to others. Meanwhile, more than a third of doctors queried said they had little or no knowledge of their legal obligations under the ADA.

“Taken together, the focus groups and survey responses provide a substantive and deeply concerning picture of physicians’ attitudes and behaviors relating to care for people with disabilities,” the study authors note.

The findings suggest that bias continues to greatly influence health care more than 30 years after passage of the ADA, which prohibits discrimination against people with disabilities, including in medical services.

Tara Lagu, a professor of hospital medicine and medical social sciences at Northwestern University and an author of the study, described the doctors’ attitudes toward the ADA in particular as “upsetting and disappointing.”

“Our body of work suggests that physician bias and discriminatory attitudes may contribute to the health disparities that people with disabilities experience,” Lagu said. “We need to address the attitudes and behavior that perpetuate the unequal access experienced by our most vulnerable patients.”