The magazine of the Sonoma County Medical Association

EDITORIAL: MEDICINE & POLITICS

Rob Nied, MD

Has the current morass in Washington DC inspired you to run for Congress? According to the New York Times, 26 physicians are running for Congress this year, and Kentucky senator Rand Paul, an ophthalmologist, is considered a likely presidential candidate. Compare that with a total of 25 physicians who served in Congress between 1960 and 2004.

Commoditizing physicians and patient care, declining reimbursement, the Affordable Care Act, and increasing bureaucratic regulation have made the business of medicine increasingly unpalatable, so it is understandable that we physicians want to stand up and fight for our profession. Our country’s founding fathers would be proud—more than 10% of the signers of the Declaration of Independence were physicians.

A few years ago, The Daily Beast published an entertaining article by Dr. Kent Sepkowitz about physician politicians (“Why physicians make crazy politicians,” May 26, 2010). He postulates that physicians are used to taking charge and have a sense of personal responsibility for the world around them. We also share a sometimes outsized belief in our own ability to “fix things.”

Having more physicians in Congress might seem like a good idea, but the ones who are already there don’t necessarily represent the views of physicians in general . . .

The reality is that physicians across the United States have the same disparate views and biases as any group of 600,000 people. Considering that most of a physician Congressperson’s time is spent advocating and deciding on policy matters far removed from their medical training, it may not be in our collective best interest to elect more of them.

Of course, physicians don’t need to hold political office to influence the most important public policy decisions, even at the national level. Politicians know that one thoughtful letter or call from a constituent represents the views of tens or even hundreds of peers who did not bother to publicize their opinions. Personal relationships between physicians and key legislators, forged over a decade of interaction, ultimately led to the “GPCI fix.” The adjustment in the Medicare Geographic Practice Cost Index—which only happened in California—will increase payments to physicians in 14 California counties by $50 million annually and over $400 million in the next decade. Sonoma County physicians will see a 4–9% increase in payments. For other national policy issues, such as repealing the Medicare SGR, personally lobbying our elected representatives is the single most powerful thing we can do.

Some political issues, however, require a more organized, collective effort, such as the current effort to defeat Proposition 46. Organizing a statewide public-relations campaign is too large of a project for one person, one county medical society, or even the largest medical group. The California Medical Association—the collective voice of almost 40,000 physicians—represents our common interests at the state level. The physicians and medical students standing on the California State Capitol steps in support of universal access formed the most lasting image of this year’s Legislative Leadership Conference, which is organized by CMA. To do that work requires people and money. It is important that each of us contribute our share.

Unfortunately, public opinion of organized medicine is not much higher than public opinion of Congress. Corporate medicine has often been guilty of protectionism and favoring special interests. Most people, however, still have a great deal of admiration for individual physicians. A 2011 poll found that 77% of the respondents trust physicians in general and 93% trust their personal physician, a number that is rare in today’s society.

Ultimately, the most effective advocacy for the issues we hold most dear is the clout and respect we have in our own community. We shouldn’t underestimate that. Sonoma County physicians, almost uniquely in California, are embedded in our community. We live and play here. Simply being present and active in our community influences public opinion, effects change and helps educate.

The real question is not whether you should run for Congress. Instead, it’s what are you passionate about? Over the coming year, SCMA will be launching an effort to better connect our members with organizations in Sonoma County that share our common interest in the health and vibrancy of our community. What inspires you? ::

Read the entire editorial in Sonoma Medicine . . .

Dr. Nied, a Santa Rosa family physician, is president of SCMA.
Email: robert.j.nied@kp.org

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