• New Survey Examines Effects of SDOH on Doctors, Patients

    April 27, 2022, 9:43 a.m. News Staff — Results of a recent survey from The Physicians Foundation provide new insights on the degree to which social drivers of health affect not only patient health, but also physician practices and well-being. The survey found that while an overwhelming majority of physicians think these drivers, also known as social determinants of health, affect their patients’ health outcomes and that addressing them is essential to improving health outcomes and decreasing costs, significant barriers must be overcome for these issues to be properly addressed.

    sdoh concept

    “We physicians know that reducing total cost of care and achieving health equity are only achievable by addressing the SDOH,” Physician Foundation President Gary Price, M.D., an attending surgeon and clinical assistant professor at Yale-New Haven Hospital in New Haven, Conn., told HealthLeaders. “We must remain central to this discourse and decision-making as we’re closest to these issues and our perspectives are critical to improving patient outcomes.

    “But we cannot do it alone,” Price added. “Addressing SDOH requires a holistic approach, including comprehensive coordination among individual physicians, medical societies, health systems, social service systems and policymakers.”

    The survey results closely mirror those of a 2017 Academy member survey that indicated more than half of family physicians already screened patients for SDOH and followed up by referring them to community-based social services — an important finding that illustrates family physicians have been aware of the significance of addressing SDOH for some time.

    SDOH was thought prior to the COVID-19 pandemic to be responsible for as much as 80% of health outcomes. More recent research suggests that the social and economic disruptions caused by the pandemic have heightened the potential effects of SDOH on patient health and well-being even further.

    Story Highlights

    Methods and Analysis

    The Physicians Foundation survey was conducted Feb. 3-11, 2022, by email to a list of U.S. physicians derived from Medscape’s database. It was designed to be completed in no more than 10 minutes, and consisted of 11 questions that addressed a wide range of SDOH topics.

    A total of 1,502 physicians completed the survey, with 33% identified as practicing primary care (defined as family medicine, general practice, internal medicine or pediatrics). Most respondents were male (61%), white (63%), employed (67%) and between the ages of 36 and 65 (74%).

    Key Findings

    Of the physicians surveyed:

    • Ninety-five percent said at least some of their patients’ health outcomes were affected by at least one SDOH. Primary care physicians, and those who were Black, female or younger than age 45 were more likely to have patients with health outcomes affected by at least one SDOH.
    • Financial instability and transportation problems were the top two SDOHs that physicians believed their patients experienced.  On average, physicians thought that 34% of their patients experienced financial instability, and that 24% encountered transportation problems. Asian, Black and Hispanic physicians all believed a higher percentage of their patients experienced these two SDOHs than white physicians.
    • Almost nine in 10 physicians (87%) said they would like to have more time and ability to address SDOH. More than 60% reported they have little to no time and ability to effectively do so. This included 5% of respondents who reported having no time or ability at all.
    • As to the obstacles that prevented physicians from addressing SDOH, 89% of respondents said a limited amount of time during the patient visit was somewhat or very impactful to discussing SDOH. This was followed by a lack of workforce to direct patients to community resources (84%); community resources being unavailable, inadequate or difficult to access (77%); and a lack of adequate information on community resources (also 77%).

    The Impact of SDOH on Physicians

    For substantial numbers of respondents, the inability to adequately address patients’ SDOH had negative effects on their practices and well-being.

    • Eighty-three percent said the challenges of addressing patient SDOH moderately or significantly contributed to burnout.
    • Sixty-eight percent said managing their patients’ SDOH has a major impact on physician mental health and well-being.
    • Sixty-three percent reported they often experience feelings of burnout when trying to address patient SDOH. In a related question, 71% said limited time to discuss SDOH during the patient visit caused them to feel stressed or frustrated on a daily or weekly basis; another 63% said payer reporting requirements that took time away from addressing patient SDOH caused feelings of stress or frustration at least weekly.
    • Just 19% of respondents said they had adequate resources in their practice to address patient SDOH.

    Finding Solutions

    Fortunately, the survey results also revealed a number of approaches to help.

    When asked to rate the importance of nine strategies to support themselves and other physicians in addressing patients’ SDOH,

    • Eighty-one percent ranked each of three potential strategies (investing in the community, investing in technological and human capacity, and screening patients to identify social needs) as very important or somewhat important,
    • Eighty percent reported reducing existing payer reporting requirements and other administrative burdens as very or somewhat important, and
    • Creating financial incentives for physician-directed efforts to address SDOH (78%) and including SDOH in risk scoring that determines patient complexity (75%) were also considered important strategies.

    In a separate question on policy steps to improve outcomes and ensure cost-efficient, high-quality patient care,

    • Eighty-six percent said reimbursing physician-directed efforts to address SDOH was important,
    • Eighty-four percent said it was important to incentivize payors to invest the availability and quality of community resources to address patient SDOH, and
    • Eighty-one percent thought providing greater flexibility for Medicare Advantage to reimburse for addressing SDOH was important.

    Next Steps

    The report stated that physicians recognize that SDOH and the health care system are linked in ways that cannot be easily separated. While most physicians want to effectively address their patients’ SDOH in the future, many feel constrained by barriers such as lack of time or inadequate resources, which is having a negative effect not only on patient health but physician well-being.

    “To minimize SDOH’s effects on physician burnout and improve patient outcomes, change is needed,” the report said, pointing to several potential solutions and policy actions that health systems, payors and legislators could implement.

    “As we continue building broad-based understanding of SDOH and their implications for patients and physicians, it is critical that physician and patient voices remain central to the discourse and decision-making,” the report concluded. “It is through addressing SDOH that we can improve patient outcomes for everyone and ensure that the physician workforce is well supported and financially recognized for its partnership with patients.”

    AAFP Resources for Members

    Addressing SDOH to advance health equity has been a longstanding AAFP policy. In 2019, the Academy released a position paper that outlined the role family physicians can play in reducing health inequities by focusing on patient SDOH.

    Several other resources are available as well. As part of the AAFP’s The EveryONE Project™, a four-part SDOH toolkit was developed to support members in addressing social needs in their practices and communities. Among other things, the toolkit includes a team-based approach guide for addressing SDOH, resources for social needs screening in English and other languages, implicit bias training guides, downloadable practice leadership slides on SDOH and a physician advocate brief with information on how to advocate for health equity and address SDOH.

    In addition to these resources, the AAFP’s Neighborhood Navigator helps family physicians connect patients with local resources such as food, housing, finance and education.  

    The AAFP has also been active in recognizing the importance of SDOH on the advocacy front. In June 2021, the Academy sent a letter to Shalanda Young, acting director of the Office of Management and Budget, that commended the Biden administration’s commitment to advancing racial equity and that outlined the Academy’s “Health in All Policies” strategy as it relates to SDOH.

    More recently, last November the Academy repeatedly referred to SDOH and addressing patients’ social needs as part of its response to HHS’ next five-year strategic plan. The AAFP also cited SDOH when calling for investments in public health infrastructure when advising Congress on preparing for the next pandemic in a letter to the chair and ranking member of the Senate Committee on Health, Education, Labor and Pensions in February.

    Members can also access the latest information on the AAFP’s SDOH webpage, which is updated regularly.