Three decades after the Americans with Disabilities Act took effect, new research finds that many physicians remain unaware of their obligations under the law when caring for people with disabilities.

More than a third of doctors surveyed had little or no knowledge about their legal requirements under the ADA and 71% did not know who determines reasonable accommodations.

The findings come from a survey of 714 doctors in outpatient practices across the nation that was published this month in the journal Health Affairs.

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“Despite the fact people with disabilities comprise 25% of the population, they often confront barriers to basic health care services such as physical examinations, weight measurement and effective communication with their physicians,” said Dr. Lisa I. Iezzoni of Harvard Medical School and Massachusetts General Hospital, the lead author of the study. “The lack of knowledge about who makes accommodation decisions raises troubling questions about health care quality and equity.”

The ADA bars discrimination against people with disabilities, including in medical services. Under the law, health care providers must work with patients to decide what reasonable accommodations are needed in order for individuals with disabilities to receive proper care.

Iezzoni said that people with disabilities should inquire about how doctors can address their needs when scheduling an appointment. Doctor’s offices should document needed accommodations within patients’ electronic health records and ask each time a new appointment is scheduled if a person’s needs or preferences have changed, she said.

Studies show that people with disabilities often receive substandard care, with individuals examined in their wheelchairs rather than on exam tables and those who are deaf going without sign-language interpreters, for example, the researchers said.

The latest survey suggests that at least some physicians are concerned with 68% indicating that they believe they are at risk for ADA lawsuits.

The findings highlight the need for improvements in medical training, according to those behind the study.

“Medical schools are currently training students about combating racism, and there should also be training in combating discrimination against people with disability, also known as ‘ableism,'” said Eric G. Campbell, a survey scientist at the University of Colorado and a senior author of the study. “Every practicing physician can expect to see increasing numbers of people with disability, and they need to know how to accommodate them.”