Last Thursday, the New York Times took note of a change on the political leanings of physicians. They pointed to changes in Maine and Oregon, and even noted some defrosting of the conservative dominance in Texas, but the centerpiece seemed to be the unprecedented support of the AMA for health reform.
Thanks for noticing, New York Times, but I say, and I think I speak for the rest of Doctors for America when I do so, “Welcome to the party!”
We have been pointing out, from very early on in our epic struggle for health reform, that doctors do support health reform. In 2002, the Charter on Medical Professionalism was published by the American Board of Internal Medicine Foundation, the American College of Physicians Foundation, and the European Federation of Internal Medicine. Among other things, it called for a commitment to social justice and a fair distribution of finite resources. In 2006, a number of prominent physician organizations adopted principles for health reform that included principles of health care for all (including undocumented aliens!) via public-private cooperative efforts. In 2007, the American College of Physicians (ACP) released its position paper advocating for a universal health system based on European models.
By the time the health reform debate was in full swing (or high dudgeon!) in 2009, we took note that not only the AMA, but most of the other largest physician groups were supporting health reform. Specifically those representing family physicians, osteopaths, pediatricians, psychiatrists, surgeons, OB/GYNs and others supported the House Bill. As the process moved to the Senate, and the SGR fix went away, we lost a couple, but the overwhelming majority remained committed to reform. Even a challenge by conservatives at a national AMA meeting in 2009 was beaten back handily.
During those years, and still today, the preconceived notion of all physicians being a monolith of conservative thought takes a bit of work to dispel. And although there are not many surveys of physicians political leanings and preferences, there are a few that I am aware of, so let me run down a few here to show that this should not be a surprise.
“The political self-characterization of US physicians, especially including women physicians, has been poorly described. We used data from the 4,501 respondents to the Women Physicians' Health Study (WPHS), a stratified random sample of US women M.D.s surveyed in 1993–1994, to assess US women physicians' political characteristics. US women physicians were most likely to consider themselves politically moderate (36.6% of respondents). More considered themselves liberal (28.4%) or very liberal (8.8%) than considered themselves conservative (20.5%) or very conservative (5.8%). US women physicians predominantly bring moderate and liberal voices to political discourse. Organizations that wish to attract US women physician members should consider promoting less conservative policies."
2004: Study of Minnesota physicians showing almost 2/3 support for single payer health care.
Among these medical students, 5% self-characterized as politically very conservative, 21% conservative, 33% moderate, 31% liberal, and 9% as very liberal.” Being male, white, Protestant, intending to specialize in Surgery or anesthesiology/pathology/radiology, or currently or previously being married significantly (P ≤ .001) increased the likelihood that a student self-identified as very conservative or conservative. Disagreement or strong disagreement with the statements, “I’m glad I chose to become a physician” and “Access to care is a fundamental human right,” were also both associated with being very conservative or conservative. Being more liberal was reported by blacks and Hispanics; those intending to become ob-gyns, psychiatrists, and pediatric subspecialists; and atheists, Jews, and adherents of eastern religions.
A total of 59% supported legislation to establish national health insurance (28% "strongly" and 31% "generally" supported), 9% were neutral on the topic, and 32% opposed it (17% "strongly" and 15% "generally" opposed). A total of 55% supported achieving universal coverage through more incremental reform (14% "strongly" and 41% "generally" supported), 21% were neutral on the topic, and 25% opposed incremental reform (14% "strongly" and 10% "generally" opposed). A total of 14% of physicians were opposed to national health insurance but supported more incremental reforms. More than one half of the respondents from every medical specialty supported national health insurance legislation, with the exception of respondents in surgical subspecialties, anesthesiologists, and radiologists. Current overall support (59%) increased by 10 percentage points since 2002 (49%). Support increased in every subspecialty since 2002, with the exception of pediatric subspecialists, who were highly supportive in both surveys.
Only 9% of physicians preferred the current employer-based financing system. Forty-nine percent favored either tax incentives or penalties to encourage the purchase of medical insurance, and 42% preferred a government-run, taxpayer-financed single-payer national health insurance program. The majority of respondents believed that all Americans should receive needed medical care regardless of ability to pay (89%); 33% believed that the uninsured currently have access to needed care. Nearly one fifth of respondents (19.3%) believed that even the insured lack access to needed care. Views about access were independently associated with support for single-payer national health insurance.
2009: Two articles from the New England Journal of Medicine:
"Overall, a majority of physicians (62.9%) supported public and private options. Only 27.3% supported offering private options only." and
“...a large majority of respondents (78%) agreed that physicians have a professional obligation to address societal health policy issues. Majorities also agreed that every physician is professionally obligated to care for the uninsured or underinsured (73%), and most were willing to accept limits on reimbursement for expensive drugs and procedures for the sake of expanding access to basic health care (67%). By contrast, physicians were divided almost equally about cost-effectiveness analysis; just over half (54%) reported having a moral objection to using such data "to determine which treatments will be offered to patients.
...the 28% of physicians who consider themselves conservative were consistently less enthusiastic about professional responsibilities pertaining to health care reform.
So, again, to the national media, welcome to our world!