How Practice Affects Politics

Medicine is changing rapidly. And I am not just talking about the dizzying avalanche of new scientific information. I have often written in this column about the under-the-radar, uncontrolled changes occurring in the fundamental economic basis of mainstream American medical practice.

New York Times

A May 30 "As Physicians' Jobs Change, So Do Their Politics" underscored my observations by portraying a game-changing phenomenon. In the newly Republican-controlled Maine legislature a previously, long-wished-for, liability-limiting statute was finally passed — and then rejected by the "powerful doctors' lobby." Why did this happen?

Maine's doctors, as many others around the country, are newly involved in a change of attitude; either by starting their careers in salaried positions or by "abandoning the ownership of their practices en masse" for such positions, usually with hospital-based organizations. And without the high costs of their small businesses, such as malpractice insurance costs out of their pockets, "their politics and points of view have shifted dramatically ... because they help patients."

Although it may seem cynical, we know that people respond at a fundamental level to economic incentives. The economic profession is built in part on that truism. So why should it be different for doctors? Yes, we have an overarching moral and legal commitment to put the interests of our patients before ours, but you do not have to be adept at rationalization to realize that "without any margin, there is no mission." In other words, if you cannot yourself make a living, then you will not be in a position to help your patients. Or so the mantra goes for our non-profit brother organizations.

And it is no longer revolutionary to note, as the article does, that many doctors "believe that profit-making business has no role in either insuring people or providing their care." Did I just see a pig fly by?

three-quarters

doctors who did not have their own practices were twice as likely as those who owned a practice to support the overhaul, as were female doctors.”

Think Maine's experience is an isolated one? The article documents that in Texas while of doctors opposed to the health care law in 2010 “And guess which 2 groups are on the rapid increase?

The key point in the article is that "Because so many doctors are no longer in business for themselves, many of the issues that were once priorities...have been displaced by public health and safety concerns." Which is a more congruent fit for us anyway, if you think about it.

And here is another shocker, "There are no national surveys that track doctors' political leanings, but as more doctors move from business owner to shift worker, their historic alliance with the Republican party is weakening...." I'll skip the smart remarks, in both directions, just to say that to be most efficient and effective, health care ideally should be above politics. I know, "grow up;" there is hardly anything more politicized than health care these days.

Medicine, with all of its tentacles, is simply too interwoven with all aspects of our lives to avoid being engulfed by the public policy brouhaha. I do think we can take some satisfaction from the fact that it would not be so if we had not managed over these many years to become effective enough, (and expensive enough) to be that involved. We were not part of the national economic discourse when the only tools we had to help people, and charge them for, were poultices, leeching and handholding.

One last interesting note was mentioned. A doctor who was a former Maine Medical Association president said that "...in his experience, conservatives prefer to own their own businesses” and “‘medicine is not about running your own shop anymore.’” The political implications for medicine and its representatives, individual and collective, stands on the momentous decisions we face in organizing — or maybe reorganizing — health care for the 21st century and they are considerable, if not startling.

There used to be an old political saying about national elections that comes to mind; "So goes Maine, so goes the nation." Still true? Stay tuned. This bumpy health care ride that doctors and citizens are on just got a lot more interesting.