Most doctors have patients affected by social drivers but feel ill-equipped to address them, survey finds

Doctors have long known that factors such as food insecurity, housing instability, transportation problems and financial problems can impact a patient's health. 

Patients who are now returning to physicians’ offices and hospitals for routine checkups, deferred elective procedures, prescription refills and more are presenting with conditions made worse by lost jobs and the struggle to afford food, transportation or rent brought on by the COVID-19 pandemic.

But most doctors say they lack the time and ability to address social determinants of health (SDOH) for their patients, according to a new survey by the Physicians Foundation.

The first of three parts of the 2022 Survey of America’s Physicians focused on social drivers in patients and how they affect providers. It is the first time the organization has put out a survey focused entirely on SDOH. The survey reached more than 1,500 physicians, most of whom are specialists.

It found that 6 in 10 feel they don’t have adequate resources to effectively address SDOH, though nearly all want more. The top challenges most reported included limited time during patient visits and an insufficient workforce to navigate patients to community resources. Many others also cited barriers like insurance compliance and lack of reimbursement for addressing SDOH. More than three-quarters also agreed that there are either not enough community resources or there is not enough information on how to access them.

“Physicians realize how big a problem this is, and they want to help,” Physicians Foundation President Gary Price, M.D., told Fierce Healthcare. “There aren’t many things you can ask physicians about that you’ll get these kinds of overwhelming majority opinions.”

Most physicians had at least some patients affected by social determinants, with the top social factors being financial instability and transportation access. Younger physicians saw a slightly greater portion of these patients.

Price suspects one explanation could be because they are closer to their training years, which often take place in large hospitals in urban areas with high concentrations of patients affected by social drivers. Ironically, he noted, the more one deals with these problems without resources, the more one’s burnout increases. In turn, Price said, “one of the responses is to sort of put on blinders because you can't do anything about it. That’s one of the reasons we did the survey.” 

More than 6 in 10 surveyed reported feeling burned out in their efforts to address the social drivers of health. Even more believe managing social drivers has a major impact on physician mental health and well-being. The vast majority also believe the U.S. can’t improve health outcomes or reduce costs without addressing SDOH, which means a systemic change is needed to support these ongoing efforts, the Physicians Foundation said in its report.

Top solutions surveyed physicians identified included investing in local resources and the capacity to refer patients there, screening patients, reducing administrative burdens, creating financial incentives for physicians and including SDOH in risk scoring.

Also identified as policy solutions were reimbursement for physician efforts to address social drivers, incentivizing payers to invest in local resources and integrating social drivers into payment policy. Recently, the Physicians Foundation proposed quality measures to the Centers for Medicare & Medicaid Services that, if approved this spring, would be the first time social drivers are recognized in federal payment programs.