Friday, November 4, 2016

Physicians and voting

[I voted early]

As Election Day approaches, some experts are calling for greater physician participation in the voting process, but not everyone expects that will happen.

In an article published online October 31 in the Annals of Internal Medicine, Katrina Armstrong, MD, MSCE, and David Grande, MD, MPA, both from the Perelman School of Medicine at the University of Pennsylvania, Philadelphia, highlight data showing that physicians vote less often than expected.

The most recent study on the subject, which analyzed data from the 1996 and 2002 elections, show that physicians vote at rates that are 9% lower than the general population and 22% lower than lawyers. Moreover, comparison to earlier studies show the rates have not changed much since the late 1970s.

"Physicians should try to make participation in the political process and public debates part of our professional lives. Elections and decisions by policymakers have a profound influence on the system physicians practice in and the opportunities patients have to access and afford care," Dr Grande said in an interview with Medscape Medical News.

In the article, Dr Armstrong and Dr Grande point out several reasons for low voting rates among physicians. Physicians are often highly engaged in their professional lives and may place lower social value on voting compared with clinical responsibilities. Long work hours, overnight call, and lack of clinical coverage may also create barriers.

Innate tendencies may also play a role, according to Eitan Hersh, PhD, an assistant professor of political science at Yale University, New Haven, Connecticut, who was not involved in the article.

"The main reason why doctors don't vote as much as lawyers is that general interest in politics is just lower among physicians. People who choose fields like law enjoy the political process and being part of it. People who choose fields like medicine are not particularly interested in politics," Dr Hersh told Medscape Medical News…

"As a profession we should prioritize voting: covering for colleagues, modifying schedules when appropriate, and encouraging other physicians to vote," Dr Grande suggested…

Whether physician voting patterns will be any different in the current election, which has many Americans on tenterhooks, is anybody's guess, according to Dr Grande.

"On one hand, healthcare has been a big part of political and policy debates over the last 8 years, which might increase physician interest in voting. On the other hand, the current election and political climate might cause some physicians to tune out even more. I hope that is not the case," he said.

However, if past years are any indication, those physicians who do turn out are likely to cast their ballots more liberally.

A recent analysis of campaign contributions for the 1991 to 1992 and 2011 to 2012 election cycles showed a shift toward Democratic affiliation among physicians, away from the predominantly Republican alignment of prior decades…

Although more than half of physicians are registered Democrats, a recent study found that about two thirds of physicians in surgical specialties identify as Republican, whereas two thirds of those in infectious disease, psychiatry, and pediatrics vote Democrat. Experiences in clinical practice, initial self-selection as medical students, the changing demographics of physicians, and changing practice patterns may all play a role. Financial matters may also be involved. Fields, such as surgery, with higher average salaries tend to vote Republican.

Dr Hersh doubts whether physician voter turnout will be much different in this election than in the past, but he thinks voting choice may be.

"Republican-oriented physicians will be the kinds of Republicans who refuse to vote for Donald Trump. So I would bet that doctors will vote overwhelmingly Democratic this year," he predicted.

Grande D, Armstrong K. Will Physicians Vote? Ann Intern Med. 2016 Nov 1. doi:

10.7326/M16-2470. [Epub ahead of print]


  1. In a bitter presidential race with two polarizing candidates, analysts have been uncertain whether disinterest or disgust would have an impact on turnout.

    The question is even harder to answer when it comes to the more than one million licensed physicians in the US.

    Considering how educated doctors are, and how much money they make, it surprises many people to learn that physicians are less likely to vote than the average US resident.

    About 42% of the nation's physicians cast ballots the last time the trend was analyzed: elections from 1996 through 2002.

    In that study, published in the Journal of General Internal Medicine, 64% of lawyers voted while the turnout in the general public was 50%.

    On Nov. 8, will physicians vote according to their party allegiance (the majority are Democrats), and among those who do vote, what will the deciding issues be?...

    “It is really hard to say if this election will be any different,“ Grande said. He has not done a follow-up study. In the study he and colleagues suggest that medical schools may chose entrants who are “civically disengaged” and more focused on science. Or, it could be that doctors care so much about the civic good they are doing in practicing medicine that voting seems relatively trivial, they said.

    In the Nov. 8 election, two factors might lead to more doctors voting, he said, the fact that it is a presidential election, and the uncertainty over the future of health care in the US post-Affordable Care Act. The two candidates have wildly divergent views on that topic and that could bring doctors to the polls, he said.(continued)

  2. (continued)“Over the last eight years, health care has been an enormous issue politically so perhaps that will engage doctors more,” he said. “However, health care was frequently a big political issue in past elections even back during the time period we studied, so it is really hard to say if things will be different,” Grande added.

    Like Grande he[Clarence Lam, MD, MPH] thinks healthcare will be a big issue and that “There’s a very different view between the two candidates.”

    But he also believes that many physicians are simply disinterested in politics.

    As scientists, physicians think linearly, Lam said. The forces that shape policy make up a process that is at odds with how their own minds work. “It’s not how they are trained,” he explained, “Doctors know a diagnosis leads to action then to outcome.’

    “Things are going in different directions,” he said. Casting a vote—unlike making a treatment decision—may not have the desired result, or any result.

    Frustrated, physicians may decide they have better things to do with their very scarce time.

    It is also a matter of debate whether physicians’ party allegiances are based on health policy or other medicine-related issues or whether their party preferences comes from other priorities. Those include how important money is to them...

    They were also able to correlate medical specialties with party affiliation. One of the most striking patterns to emerge was that the higher the typical salary for a specialty, the more likely the physician was to be a Republican, with Democrats clustering in lower paying specialties. Surgeons, for example, are mostly Republicans.

    One possibly confounding factor is that since women physicians tend to be lower paid, and also tend to identify as Democrats, their increasing presence in certain specialties has had the unintended consequence of bringing the pay in that field down while at the same time making its practitioners more likely to be Democrats.

    Researchers found doctors overall are more likely to be Democrats, a switch from a few decades ago when business concerns were paramount for physicians since the default model was a being in a small or solo practice.

    Still, taking money out of the equation, there is a close connection between believing in a party’s tenets and how physicians practice their specialties. That's particularly true when it comes to emotionally charged issues like abortion, or giving hepatitis C drugs to patients who still use illegal drugs, and whether to query patients about having guns in their homes, the authors noted in a New York Times interview about their studies.

    Political ideology may or may not influence whether a physician votes, but it could shape how he or she practices medicine.

    - See more at:

  3. Democrat presidential candidate Hillary Clinton won by a landslide last month — among physicians who read Medscape, that is.

    Of 1575 physicians who completed an online Medscape Medical News survey on the election results, 55% reported that they had voted for Clinton compared with 26% for President-elect Donald Trump. Another 4% of physicians said they had voted for Libertarian candidate Gary Johnson or someone else, and 12% chose not to answer the question.

    The percentage of physicians who supported Clinton approximates two other survey findings. Sixty-four percent of physicians said they were very disappointed (60%) or somewhat disappointed (4%) by the election results, and 56% said they strongly (42%) or somewhat (14%) opposed repealing the Affordable Care Act, which Trump has promised to do.

    Of the physicians who completed the survey, 61% were male, and 38%, female. Six of 10 were 55 years of age and older.

    Another Medscape Medical News survey published in October 2015 suggests that a majority of Medscape physician readers leaned toward a Democrat candidate all along. When asked whom they backed for president last year, 29% named Clinton, and 17% named Sen. Bernie Sanders (I-Vt). That's 46% of physicians in the Democratic camp compared with 44% who named one of 15 listed GOP candidates. At the top of the Republican heap was retired neurosurgeon Ben Carson, MD, at 20%, followed by Trump at 8% (Dr Carson is Trump's choice to head the Department of Housing and Urban Development).

    According to the postelection survey, nurses were stronger Clinton supporters than physicians. Sixty percent said "I'm With Her," whereas 28% voted for Trump. Ninety-three percent of nurses who completed the poll were female, and 6% were male.

    Trump won the White House by garnering 306 Electoral College votes to Hillary's 232 despite losing the popular vote by more than 2.8 million, according to the Cook Political Report. The preference for Clinton among Medscape readers reflects exit polling by CNN that showed that college graduates favored her over Trump 52% to 42%. The gap widens more among voters with postgraduate education — 58% for Clinton vs 37% for Trump.

    In contrast, Trump won a slim majority — 51% — of voters who were not college graduates, whereas 44% of them supported Clinton.