When asked, “How important do you feel healthcare equity is within the next decade?” 83% of physicians on Sermo said it was very or extremely important. Just 10% said it wasn’t important at all. That’s a sharp divide and it raises a set of vital questions: What’s causing this strong support? Why do some still resist the idea? And how do these perspectives on healthcare disparities shift depending on a physician’s location, specialty, or daily experience?
In this article, we dig into the answers, using Sermo poll data and member comments to explore how physicians are defining, debating and addressing healthcare disparities in 2025.
Types of health disparities across the world
The National Library of Medicine defines a healthcare disparity as “a difference between population groups in the way they access, experience and receive healthcare.” But those differences, and the forces behind them, can look very different depending on where you are and how your system is structured.
In a recent Sermo poll, 59% of physicians pointed to socioeconomic inequality as the single greatest barrier to equitable care. “In most things – healthcare included – equity issues are driven by socioeconomic status,3” noted one pediatrician. “This is quite clearly a fact.”
That insight reflects statements from the World Health Organization (WHO), which states, “The lower the socioeconomic position, the worse the health.4” Examples of health disparities cover areas like differences in housing, education, social protection and job opportunities. These are tangible, day-to-day barriers, which is why many physicians see the challenge as a practical one. The disconnect, some suggest, arises when conversations about equity focus too heavily on theoretical or policy-level ideals, such as high-level commitments to “close the care gap” without concrete implementation. While their patients continue to face very real economic and logistical obstacles, such as affording transport to a clinic or paying for medication.
When we shift focus to universal healthcare systems, the situation looks different. In countries like the UK or Argentina, cost isn’t the first hurdle. Instead, 15% of physicians in this Sermo poll cited geographic and rural access as the main challenge. In these systems, patients might technically have coverage, but that doesn’t mean they can easily use it. Rural areas are more likely to face accessibility issues, limited staffing and fewer specialist services, so, as the National Library of Medicine points out, “Poor geographic access can persist even when affordable and well-functioning health systems are in place.”
In contrast, in the Sermo poll, 17% of physicians, primarily from insurance-based systems, said the biggest issue was insurance itself. Without coverage, many patients simply delay care, skip medications or avoid treatment altogether. The National Bureau of Economic Research backs this up, showing that uninsured individuals experience significantly worse health outcomes over time.
So, what’s the takeaway here? The healthcare disparities that patients experience are determined in part by the healthcare model of the particular country. Countries with universal healthcare have accessibility issues and staffing shortages. Countries with an insurance model have large patient populations that are uninsured and can’t access affordable healthcare. Disparities are a global issue, but doctors can still make an impact by implementing solutions in their own practices to help improve access for the communities they treat.
When equity becomes political
If there’s one thing the Sermo community makes clear, it’s that clinicians hold strong and often divergent views, especially on healthcare equity. While a strong majority see it as a critical issue, a notable minority still question its relevance altogether.
So, what’s driving that resistance?
For some, the issue isn’t the outcome but the language. One Family Medicine physician summed it up bluntly: “I am a physician. I provide care for everyone in need. However, I am sick and tired of having this DEI or whatever it’s called rammed down my throat. Let’s find something else to discuss besides this boring topic.”
This highlights a common confusion between two related but distinct ideas: health equity, the pursuit of fair access to care and improved outcomes, and DEI (Diversity, equity and inclusion) initiatives, which often refer to institutional policies and training programs aimed at addressing systemic biases.
While DEI is one route to achieving equity, not all equity work is branded as DEI, and not all DEI programs are seen as directly improving patient care. Other comments pointed to the term “equity” as politically loaded or vague, seen by some as a distraction from patient care, or even as a code for reverse discrimination. Furthermore, this is a sentiment that often exists right alongside a genuine desire to improve access and outcomes for underserved groups: many who are critical of DEI initiatives still believe in fair treatment and removing barriers to care.
This is echoed in a related Sermo poll on cultural competence training. While 79% of physicians supported making it mandatory (38% strongly agree, 41% agree), 21% disagreed to some extent. The split speaks to the deeper debate about implementation: how can equity training be made to feel clinically relevant and practically useful, rather than performative or imposed?
There’s no one-size-fits-all answer here. But to move the conversation forward, we need to meet physicians where they are. That means separating equity and DEI from ideology, framing equity as good medicine and designing policies and programs that earn trust.
What physicians are doing on the ground
For all the debate around DEI, many physicians are quietly making changes in their own practices to reach more patients and improve access.
In a recent Sermo poll, 28% of surveyed doctors said they’ve introduced cultural competence training for staff, the most common practice-level intervention among physicians on Sermo. It reflects growing recognition that communication, empathy and cultural understanding can directly improve patient outcomes. For some, this training takes the form of short, scenario-based workshops; others have brought in community representatives to help staff understand local needs and customs.
But practice goes beyond training, and physicians are also bringing in:
- Sliding-scale fees: Around 10% of physicians in the Sermo poll offer income-based payment models, making it easier for uninsured or underinsured patients to afford care. In some practices, this means a reduced consultation fee, and in others, it can mean flexible repayment plans for procedures and ongoing treatments.
Universal health coverage reforms such as South Africa’s National Health Insurance Act create frameworks where financial barriers for low-income patients are reduced through risk pooling and subsidized care. Similar policies globally support sliding scale or income-based payment models by ensuring coverage or subsidies for vulnerable populations. - Community outreach partnerships: Another 10% said they partner with local organisations, from churches to non-profits, to reach vulnerable populations. Examples may include: running mobile clinics at community events, offering free blood pressure screenings at food banks or hosting health sessions spoken in several languages.
Health equity policies that promote funding for Federally Qualified Health Centers in the U.S. or community health worker programs are examples of government and organizational support to build community-clinical linkages. - Data-driven equity projects: While just 6% are actively collecting data on patient demographics, outcomes and barriers to care, those who do say it helps them target their resources more effectively. For example, some studies map patient travel times to identify the need for satellite services in distant towns, and several jurisdictions have established health equity impact assessment requirements and encourage standardized patient demographic data gathering aligned with equity goals for continuous quality improvement.
- Telemedicine expansion: Many Sermo members from specialties across the community speak about the importance of virtual consultations in bridging care gaps, particularly for rural or underserved areas. Telemedicine allows patients to connect with specialists without the cost or time of long-distance travel, and can be especially valuable for follow-up care, chronic disease management and mental health support.
The American Hospital Association continues to work toward reforms such as the elimination of in-person visit requirements for tele-behavioural health or prescribing of controlled substances, coverage for audio-only telehealth services, and expanding on digital infrastructure for underserved areas. - Licensing flexibility: Some physicians are pushing for policy changes that make it easier to practise across state or regional lines. One U.S. dermatologist, for example, holds licenses in all 50 states, enabling her to deliver care nationwide. Others advocate for a national medical license in the U.S., similar to that of physician assistants, to eliminate the barrier of maintaining 50 separate licenses. Locum tenens companies sometimes even cover licensing fees for physicians willing to work in high-need areas. This is a simple step that can expand access well beyond a physician’s local community.
The common thread is pragmatism, and most physicians focus on doing what works for their patients. These interventions are shaped by the needs of the local population and the resources at hand, but without system-wide support, such as licensing reform, outreach funding and investment in telehealth, they risk remaining patchy and uneven. For equitable care to last, physician-led initiatives need to be matched with policy, infrastructure and funding that enable them to scale.
The support physicians really need
If there’s one thing physicians aren’t short on, it’s intent. Many are already adapting their practice to be more accessible and responsive to patient needs.
In our poll, nearly half (46%) of physicians said that all of the following would help: better training, clearer educational materials, insurance reform and improved infrastructure. Not just one fix. All of it. That tells us physicians recognise this problem needs a coordinated, system-wide response.
When broken down further:
- 15% wanted improved insurance coverage for vulnerable patients
- 15% called for better patient education tools
These help patients better understand and act on their own care, and examples include:
– Digital materials with clear language and visual aids to support patients with lower health literacy.
– Culturally and linguistically tailored resources that reflect diverse backgrounds.
– Patient portals that are linked to health records for personalised, easy-to-access information. - Another 15% asked for more targeted training
This can help healthcare teams be aware of disparities and how to respond to them effectively in day-to-day practices, and examples include:
– Training on how social determinants (such as housing, income, or employment) affect patient outcomes, raising awareness of the broader factors that drive health inequities.
– Health-inequalities courses, including e-learning modules, to strengthen clinicians’ skills in equitable communication and understanding diverse patient backgrounds.
– Leadership training to empower clinicians as advocates for systemic change, enabling them to support community-driven strategies and influence organisational approaches to equity. - Just 7% said public outreach support would help most
This can help healthcare professionals to meet patients where they are and tailor programs to their needs, and examples include:
– Using community health workers to deliver preventative services (e.g., cancer screening, immunisations) and manage chronic conditions (e.g., hypertension, diabetes).
– Recruiting community health workers from the communities they serve to provide navigation, culturally relevant health education and social support.
– Partnering with faith-based organisations to support screening, immunisation, health promotion and chronic disease management.
That last figure is telling. Outreach is important, but this highlights that many physicians simply don’t have the time or resources to lead it themselves. Instead, their priorities lie in tools that work in clinical settings, resources that improve communication, and policy changes that reduce barriers.
One Cardiologist captured their frustration well: “[Healthcare equity is] a great problem which requires a solution. However, in my life, I have learned that this issue is always on the shoulders of the physician.”
It’s a sentiment physicians often hear echoed: they are expected to fix what is, in essence, a structural issue. Without coordinated support from groups like insurers and policymakers, progress becomes slow.
Your takeaway
Physicians want to improve healthcare equity and many are already making practical changes, from telemedicine to sliding-scale fees.
However, without wider support, like policy reform, funding, and infrastructure, these efforts remain isolated.
The path forward lies in shared responsibility: combining physician-led initiatives with government-led policy change, so that overcoming global health disparities becomes a sustainable, built-in practice of healthcare delivery worldwide.
