Prevalence of Implicit Bias in Practicing Physical Therapists

Background: Implicit biases (IB) are unconscious or automatic attitudes and stereotypes that all people hold towards individuals or groups based on social group membership, categories, or traits. While implicit biases are unconscious or automatic, one is by definition more aware and conscious of their explicit biases. In the healthcare setting, implicit biases can and do impact perceptions, interactions, and clinical decision-making involving patients. Most research regarding the prevalence of implicit bias in healthcare, to date, focuses on physicians and nurses, but no evidence exists regarding implicit bias prevalence in physical therapists (PTs). Our objectives were to determine the difference, if any, between levels of race- and disability-related implicit biases using Implicit Association Test (IAT) score comparisons between PTs practicing in orthopedic and pediatric settings.
 
Methods: A total of 59 licensed orthopedic and pediatric PTs completed the IAT race and disability subtests, self-reported levels of explicit racial and disability biases, and demographic characteristics.
 
Results: On average, participants reported slight levels of IB favoring White over Black people despite reports of neutral explicit bias (EB). Similarly, participants reported moderate levels of IB favoring individuals without disabilities over those with disabilities despite reports of only neutral to slight EB on average. PTs practicing in pediatric settings reported significantly higher levels of race-related IB than those practicing in orthopedic settings (Wilcoxon S=623.5, p=0.014), but there was no significant difference between the levels of disability-related IB based on practices setting (Wilcoxon S= 850, p=0.245).
 
Conclusions: This sample of PTs demonstrated rates of IB on the basis of race or disability status similar to other healthcare providers and the general population. Furthermore, participants generally rated their EBs towards racial minorities and individuals with disabilities more favorably than IAT test results indicated. The disconnect between IBs and EBs was confirmed in our study and highlights the continued need for IB awareness and subsequent bias reduction interventions for healthcare providers given the negative consequences.