Medicine was not built for disabled people, and two new ACP papers detail what needs to change

Annals of Internal Medicine, March 2026. DOIs: 10.7326/ANNALS-25-04524, 10.7326/ANNALS-25-04518

One in four American adults lives with a disability. They visit the same hospitals, need the same specialists, and develop the same chronic conditions as everyone else. But the healthcare system was not designed with them in mind, and that design failure creates measurable disparities in access, quality, and outcomes.

Two companion position papers from the American College of Physicians (ACP), published in Annals of Internal Medicine, address this gap from two directions: one focused on patients, the other on physicians and trainees. Together, they represent the most comprehensive policy framework the ACP has issued on disability in medicine.

The patient side: barriers that compound

The first paper examines health disparities among U.S. adults with disabilities and the barriers they face in accessing care. The obstacles are both physical and systemic. Examination tables that do not lower. Imaging equipment that cannot accommodate wheelchairs. Offices without accessible entrances. These are not rare oversights; they are widespread features of a healthcare infrastructure built around assumptions about what patients' bodies can do.

Beyond physical access, the paper addresses insurance coverage gaps, inadequate training of health professionals in disability-competent care, underrepresentation of people with disabilities in clinical research, and poor data collection that makes it difficult to track disparities. When health systems do not collect disability status as a demographic variable, they cannot measure the problems or evaluate whether interventions are working.

The ACP's recommendations span several policy domains: expanding insurance coverage, mandating accessibility standards for healthcare facilities, integrating disability competency into medical education, increasing inclusion of people with disabilities in research studies, and improving data collection to enable ongoing monitoring.

The physician side: an exclusionary profession

The second paper turns the lens on medicine itself. Medical schools, residency programs, and clinical workplaces present their own set of barriers to people with disabilities. The paper argues that a physician workforce reflecting patient diversity, inclusive of disability, is essential for reducing disparities and improving equity.

The recommendations target multiple levels. Medical schools should ensure that language and content in education are respectful to students with disabilities. Accommodation processes should be transparent, confidential, and timely. Too often, requesting accommodations involves navigating bureaucratic systems that are themselves barriers, processes that are slow, opaque, or stigmatizing.

For practicing physicians, the paper calls on hospitals and health systems to implement policies that combat ableism and provide effective disability accommodations across clinical settings. This includes accommodations for all medical staff, trainees, and patients, recognizing that accessible design benefits everyone who uses a facility.

Ableism as a systemic issue

Both papers position disability as an aspect of diversity that should be considered in all policy decisions, the same way race, gender, and socioeconomic status are increasingly incorporated into health equity frameworks. This framing is deliberate. Disability has historically been treated as an individual medical problem rather than a social and structural one. The ACP papers explicitly challenge that framing.

The papers do not provide new data or research findings. They are policy position statements, synthesizing existing evidence and expert consensus to generate recommendations. Their strength lies in the institutional weight of the ACP, one of the largest physician specialty organizations in the United States, endorsing comprehensive reforms.

Implementation is the hard part

Position papers articulate what should happen. Making it happen is another matter. Many of the ACP's recommendations require action from entities beyond the organization's direct control: federal and state legislatures, insurance companies, hospital systems, and medical school accreditation bodies.

Some recommendations, like mandating accessible medical equipment, would require capital investment that many facilities may resist. Others, like changing medical education curricula, face the practical challenge of an already-packed training schedule. And combating ableism, like combating any form of discrimination, requires cultural change that policy alone cannot deliver.

The papers also accompany an editorial in the same issue of Annals of Internal Medicine that contextualizes the recommendations within the broader disability rights movement. Whether these publications catalyze concrete action or join the long list of well-intentioned position statements that produce little change will depend on whether healthcare institutions treat them as mandates or suggestions.