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Putting a Human Face on Stem Cell Research Politician Physicians Combine Medicine & Public Service New GME Policy Aims to Ensure Quality Education, Patient Care
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Diagnosing a Nation: Physician Politicians Combine Medicine and Public Service
For Vermont Gov. Howard Dean, it was Jimmy Carter. For Rep. Jim McDermott (D-Wash.), it was the Vietnam War. For Rep. Vic Snyder (D-Ark.), it began in high school when he coordinated volunteers for Nelson Rockefeller's presidential bid. Like most public servants, these three men can point to a catalyst that sparked their interest in politics and launched their political careers. Unlike most politicians, these men are also medical doctors. With only one M.D. in the Senate and eight in the House of Representatives, Reps. McDermott and Snyder are among a handful of physician/politicians who serve their country as federal lawmakers. Gov. Dean has the distinction of being one of the nation's two governors who are physicians. (John A. Kitzhaber, M.D., is the governor of Oregon.) A graduate of the Albert Einstein College of Medicine, Gov. Dean worked as a volunteer on Jimmy Carter's re-election campaign while an internal medicine resident. When he completed his residency in 1981, Gov. Dean opened a practice in Shelburne, Vt., with his wife, Judith Steinberg, also an M.D. For 10 years, Gov. Dean combined the busy schedule of a doctor with that of an elected official. In 1982, he was elected to the Vermont House of Representatives, where he served until 1986, when he was elected lieutenant governor, a post he held until 1991. That year would mark a turning point in Gov. Dean's political career. On Aug. 14, 1991, Gov. Dean was attending to a patient when he received a call informing him that Vermont's governor, Richard Snelling, had suddenly died of a heart attack. Gov. Dean finished treating his patient - the last one he would care for as a physician - and took the oath of office to become Vermont's new governor. In 1992, he was elected to a full term and has since been his state's choice for its leader, although he has announced that his current term will be his last. In his decade as governor, Gov. Dean has established himself as a champion of children's health, the uninsured, and health care reform. "My experience as a physician has served me well in public office," he says. "In medical school, I learned to analyze situations with logic and scientific consistency - to come to a conclusion, act, and move on without a lot of second-guessing," Gov. Dean explains. "I gained the ability to deliver bad news without becoming defensive." When asked about his legislative priorities, Gov. Dean puts universal access to health insurance at the top of his list. Under his leadership, Vermont has enacted programs that guarantee health care coverage to virtually every child in the state. He has also worked to expand health insurance to low-income residents, giving Vermont one of the lowest uninsured rates in the country. And he has taken on the issue of rising drug costs and the resulting economic burden on seniors. "We've been generous to seniors, but drug companies' costs have gone up so fast, we can't afford our own programs anymore," explains Gov. Dean. In response, Vermont has joined Maine and New Hampshire to form an interstate buying cooperative that will allow the three states to purchase drugs at the same prices available to HMOs and insurance companies. Vermont's popular governor has also signed what he describes as "the best managed care protection law in the country." Is There a Doctor in the House? Gov. Dean's zeal to insure the uninsured is shared by Rep. McDermott, a psychiatrist whose service in the U.S. Navy Medical Corps treating Vietnam's casualties of war spurred him to run for the Washington State House of Representatives in 1971. "It's an absolute crying shame that the richest country in the world cannot provide both acute and preventive care on an insurance basis to all of its citizens," says Rep. McDermott. "Every other major industrialized country in the world has managed to do so. In my view, there's no excuse for us not doing the same."
Rep. McDermott has spent his long political career championing causes such as universal health insurance. But he began that career practicing medicine. After graduating from the University of Illinois at Chicago College of Medicine in 1963 and completing residencies in adult and child psychiatry, Rep. McDermott served in the U.S. Navy Medical Corps as a lieutenant commander and chief psychiatrist from 1968 to 1970. What he saw there determined his next course of action. "I felt something had to be done about what was going on in this country at that time," Rep. McDermott recalls. "I wanted to stop the war, so I decided to get involved in politics. I knew I could do more for my patients in public office than I could sitting in my medical office and seeing them one at a time." But Rep. McDermott did continue to see patients, and he began to instruct future doctors as well. When elected to Washington state's House of Representatives in 1971, Rep. McDermott was already working as both an assistant clinical professor at the University of Washington School of Medicine and in private practice. "I was working at least 70-hour weeks," he recalls. "It was a little crazy." Rep. McDermott's political career advanced with his election to Washington state's Senate in 1975. While there, he started the Washington Basic Health Plan, the first such program in the country to provide health insurance to low-income, uninsured individuals. In 1987, after 15 years of legislative service, Rep. McDermott served for a year as a Foreign Service medical officer based in Zaire. The next year he returned home to run for an open congressional seat and was elected to represent Washington in the U.S. House of Representatives. Rep. McDermott says that giving up medicine was difficult. "As a doctor, you have the advantage of hearing people say, 'Thank you,' " he explains. "In politics, you don't hear that very often. Even with all of the problems in medicine today, I still say it's easier to be a practicing physician than a practicing politician. I could have a much better life as a physician, staying at home and having my weekends to myself. Instead, I fly back and forth across the country all the time. There are days when I say to myself, 'You must be nuts to do this.' But I care enough about what I'm doing to keep it up. " Rep. McDermott, whose accomplish- ments in Congress include founding and chairing the Congressional Task Force on International HIV/AIDS, credits his medical experience with giving him the people skills that he believes are essential for effective public service. "As a physician, you are always dealing with people's emotions, their fears, their anxieties, their feelings of helplessness," he explains. "Understanding what people feel is very useful when you are trying to solve the problems of the country. The more you know, the better able you are to respond positively. You're like a physician taking a history on a patient; you want to know what's bothering him or her before you try to fix it." Bringing Patient Concerns to the Floor
Rep. Snyder, a family practice physician turned politician, agrees that there are parallels between being a legislator and being a doctor. "As a physician, you may go into one room, and the person there has a nosebleed; then you go in another room and treat a patient with a urinary tract infection; in the next room is a patient with a sprained ankle. And in the midst of it all, your assistant tells you a person experiencing chest pain has just walked into the waiting room. That's like the legislative experience. You have a lot of fairly brief meetings on many different topics and are expected to know something about all of them, whether it's telecom law, defense policy, international relations, education, or health care. As a family practitioner, you learn how to switch gears rapidly." Rep. Snyder, who graduated from Oregon Health Sciences University in 1979, stopped practicing medicine only two years ago. Interested in politics since age 16, when he headed a high school committee that did grassroots campaigning, Rep. Snyder was elected to the Arkansas Senate in 1990, eight years after beginning his career as a family practice physician. He continued to practice medicine while in the state legislature, where he served until 1996. That year, he won election to the U.S. House of Representatives and was re-elected in 1998 and 2000. But still Rep. Snyder, who has also earned a law degree, continued to see patients for up to 14 evenings a month. In 1999, time constraints forced him to discontinue medical practice, but he says he still reads medical journals to keep himself up to date with the ever-changing world of medicine. Rep. Snyder affirms that treating patients has given him up-close and personal insights into how public policy affects their care. One piece of legislation he is particularly proud of sponsoring changed Medicare coverage of immunosuppressive drugs after organ transplantation. He says patients who had waited years for kidney transplants were in danger of having their new organs fail because Medicare only covered these expensive drugs for a limited time after transplantation. "I spent several weeks on the House floor approaching Democrats and Republicans and asking them to co-sponsor legislation to cover these drugs as long as patients needed them," recalls Snyder. "The bill passed, and today I can personally see the impact it has had on people's lives." A member of the House Committee on Veterans' Affairs and the House Armed Services Committee, Rep. Snyder often deals with health-related issues as they affect veterans'. "As the only doctor on the veterans' committee, I can provide a different perspective on some issues," he says. An advocate for increased funding for the VA health care system, Rep. Snyder says his background has given him an appreciation of the unique roles of VA hospitals. "I often draw attention to the relationship between our VA health system and medical schools," he says. "There's a lot of pooled talent there for doing excellent research. I want to make sure we are doing everything we can to support that research infrastructure with dollars." Masters of two demanding professions, Gov. Dean and Reps. McDermott and Snyder say that while their career paths have been unorthodox, they have few regrets. Rep. McDermott, now a 30-year political veteran, says he is sometimes asked if he has become bored with his work. He answers that no matter how long you have been a politician, if you walk up Capitol Hill, look at the Capitol dome, and don't get excited, "You either have been here too long or you never should have been here in the first place." |
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