AAMC Reporter: March 2005

Physician-Politicians Heed Call to Serve

Rep. Vic Snyder, D-Ark.

Becoming a doctor was not the only career U.S. Rep. Vic Snyder (D-Ark.) had in mind as a student. Before applying to college, he volunteered for political campaigns and even parked cars at a New York event for Nelson Rockefeller in 1964.

But when the time came to choose a career, Snyder entered family medicine. Years later, he merged his political interests with his medical career by running for state senate in 1990. As a physician-politician, he had the best of both worlds. The Arkansas legislature's biannual schedule allowed him to be a full-time doctor except for three months every other year when he was also a part-time senator.

Making policy decisions about health care issues, such as managed care or public health needs whetted his appetite, and he waged a successful congressional campaign in 1996. Being a doctor, he said, prepared him well to serve in Congress.

"As a doctor, you have to know a lot about a lot of things — nose bleeds, chest pains, pregnancy," he said. "In the legislature, it's the F-22 fighter, juvenile diabetes or the budget."

Historically, doctors played a more pivotal role in government. When the nation's founders were drafting the Declaration of Independence and the Constitution, 10 percent of the individuals involved were physicians.

Following the recent election, several peers joined Snyder in Washington, D.C., forming the largest physician presence in Congress in more than 40 years. But there are still only 12 doctors, just 1.1 percent of the legislature, charged with shaping national policy. With a physician, Bill Frist, leading the U.S. Senate, physicians are again assuming a higher profile in government.

House Calls

With debates over Medicare and Medicaid on the horizon, some in academic medicine argue the U.S. legislature needs more medical professionals to address the issues. But finding a dependable strategy to draw doctors into political life is particularly tricky, especially when there are more discouraging factors than encouraging ones to run for office.

Although writing letters and lobbying representatives can influence public policy, moving to Washington with a nonpolitical background and a grassroots perspective could help doctors achieve healthcare changes in a nonpartisan way. Congressional colleagues often view physician-politicians as members speaking from the public's point of view, rather than as Washington insiders.

Realizing they must get involved with politics in some way is the most important epiphany doctors can have, according to newly elected U.S. Rep. Tom Price (R-Ga.) an orthopedic surgeon for 20 years. Medical professionals cannot afford to think that politics does not have a direct effect on their work.

"I always find it interesting when one of my colleagues says, 'I'm not interested in politics,' because everything we do in medicine is affected by a political decision," Price said. "Once you appreciate that, the extra importance of political interest and involvement stares you in the face."

Price, who served four terms in the Georgia Senate before running for Congress, challenged all physicians to step up to the table and join the national healthcare discussion. Everyone benefits, he said, when doctors who understand daily medical life participate in decisions that affect patient care.

Political Diagnosis

Rep. Charles Boustany, R-Louisiana

Concern over the direction of American healthcare prompted Price to run for state office in 1996. As a state senator, and now as a congressman, his priorities are tort reform and giving patients greater control over their healthcare decisions. While the facts he learned in medical school might not help him accomplish his goals, the medical method of problem solving will, he said.

Medical students learn to search out the primary cause of a sickness and treat it at the source. This training makes doctors uniquely qualified to pinpoint the root problems facing the healthcare system.

"You can't treat the right disease if you don't make the right diagnosis," Price said. "Physicians are trained to identify fundamental problems."

U.S. Rep. Charles Boustany (R-La.) is one doctor who followed Price's advice and chose to be an active participant in the national healthcare dialogue. During his practice as a cardiac surgeon, beginning in 1990, he realized how public policy affects medicine and ran for office in late 2003. Now that he is a congressman, he wants to help bring patient ownership back into healthcare, including health savings accounts, improving health insurance and increasing competition to bring costs down.

Even though he never held office before winning his congressional seat, the grueling schedule a surgeon endures year-round prepared him well for the demanding schedule of a congressman.

"I've never been in politics directly, so I bring a fresh perspective from the trenches," Boustany said. "As a physician, I'm used to dealing with people from all walks of life and pulling 18-hour days regularly. I'm no stranger to hard work."

But as he leaves his daily surgery practice behind, Boustany said he understands why more doctors shy away from entering an arena as public as politics. Not only is the campaign process brutal, exposing a candidate's entire personal and professional life, but it also drains time from his medical responsibilities. Most physicians, he said, are not willing to make the trade-off because they have grown cynical about the negative way politics can affect healthcare.

Dueling Ambitions

Many physicians worry they will miss certain aspects of medicine if they choose to suspend their practice to pursue public office. Interacting with patients is the most rewarding aspect of being a doctor, and there is no substitute for that personal communication in family medicine, according to Snyder.

"I like the intimacy you develop with patients over time, how you get to know them and watch the families and the kids grow up," he said. "The sharing that comes with that is something you don't get in another line of work."

According to Chadd Kraus, co-author of a study titled "Is There a Doctor in the House...Or the Senate?" which was recently published in the Journal of the American Medical Association, doctors must realize that the most effective way to influence congressional actions affecting their practices is to win a campaign.

"I hope there will be more physicians at the table," said Kraus, a researcher at the Johns Hopkins University Bloomberg School of Public Health. "They are specifically trained to carry out the daily burdens of medicine, whether it's dealing with malpractice reform or medical funding, and political office gives them a chance to shape policy directly."

Rep. Michael Burgess, R-Texas

Some parts of medical practice never leave a doctor's thoughts, even when they enter a different line of work. U.S. Rep. Michael Burgess (R-Tex.) is serving his second term, but he still dreams about various aspects of his obstetrics/gynecology practice. By day, he crafts legislation and debates issues, but at night memories of delivering countless babies and performing successful surgeries occupy his mind. The dreams are a reminder of how much he let go when he left his practice, he said.

Such longings are common among physicians in office. U.S. Rep. Ron Paul (R-Tex.) felt that way when he served in Congress the first time. During his first 12-year stint, he preferred to treat his obstetrics/gynecology patients rather than casting votes on legislation.

"I realized that I did not want to be a professional politician," Paul said. "I felt very strongly about that, and I was anxious to go back to my practice."

Concerns over the nation's economy, not healthcare, drew him back to the House of Representatives, however. He's been back in office since 1997.

Shifting Focus

In his research Kraus highlighted other, more tangible factors that could weigh heavily upon a physician's decision not to run for office. In the patient-focused U.S. healthcare system, doctors spend years attending to one person at a time, but politics forces them to consider how policies affect large groups. Although this problem did not affect physicians already in Congress, it may be difficult for others to transition to working from a broader perspective, according to Kraus.

In addition, with so few physicians holding a place in congressional history, current practicing doctors do not have many predecessors after whom they can fashion a successful political career.

Even though a lack of role models might discourage some doctors from pursuing a political career, Price said the time invested in medical school and residency training is probably the primary reason his colleagues avoid public office. Walking away from years of training is difficult for some physicians.

"We've all trained for years and years, and we won't use any of that vast training here," Rep. Price said. "It's hard to ask anyone to give that amount of time up to go to medical school and then not be able to use it in the legislature."

Other doctors may be concerned that a career transition into politics, even if it is temporary, may cause them to lose some of their medical skills. While physician-politicians can take continuing medical education courses, nothing substitutes for hands-on activity in a profession where knowledge and technology change so rapidly.

Having physicians in Congress, despite the challenges they face in considering public office, is beneficial both for the legislature and the country as a whole. Healthcare occupies a prominent role in current public policy and physicians can provide an eyewitness view of the field, according to Boustany.

"Congress will be more efficient if it has all walks of life represented," Boustany said. "Physicians have been underrepresented for many years in the legislature, but they bring valuable input and expertise in some areas to the healthcare discussion."

By Whitney L.J. Howell

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