A recent study published in the Annals of Internal Medicine found that 22% of 256 medical specialists in four US cities could not serve a patient who uses a wheelchair. The doctors said that people who used wheelchairs could not get into their inaccessible building, could not get onto an exam table, or would not be able to receive assistance to transfer to an exam table. Gynecology was the subspecialty with the highest rate of inaccessible practices (44%). The journal published an editorial that describes the study and refers to a requirement in the Affordable Care Act that the Access Board develop accessibility standards for medical diagnostic equipment. Proposed standards were published in February 2012 and an advisory committee is working on refinements.