Why Physicians Won't Unite to 'Rescue' Medicine

Leigh Page

Disclosures

September 04, 2014

In This Article

Political Divisions Are Widening

The medical profession used to be heavily Republican, which made lobbying easy, but that is changing, too. A study[6] this year found that although a majority of physicians was still Republican, they were more likely to have voted for President Obama in the 1992 election than for the last Democrat president, Bill Clinton, 20 years earlier.

What's more, physicians are becoming more polarized in their views, researchers found. Whereas many female, primary care, and employed physicians had moved into the Democrat fold, surgeons and higher-earning doctors were more likely to vote Republican than 20 years before.

Another phenomenon during the past two decades is that some medical societies, especially primary care groups, have taken on social issues that used to be off-bounds; as a result, it has alienated some members. For example, the American Academy of Pediatrics (AAP) came out in support of adoption of children by gay parents[7] and contraceptives for sexually active teens,[8] and decided to strongly discourage corporal punishment of children[9] and gun ownership.[10]

These policy changes prompted Den Trumbull, MD, a pediatrician in Montgomery, Alabama, to resign from the AAP and help found a new group, the American College of Pediatricians, which champions family values, total abstinence for teens, and enlightened corporal punishment for children.

Dr. Trumbull recalled that the AAP used to be neutral territory for ideological disputes. "There was a time when the primary interest of the AAP was to educate physicians in medical matters and to help them practice the way they wanted," he said. "Then about 20 years ago, the AAP started taking positions on social issues."

Dr. Trumbull, the current president of the breakaway pediatrics group, would not reveal how many members it has, saying only that it would look tiny compared with the AAP, but he did note that a former AAP president, Joseph Zanga, MD, cofounded the new group.

Nowadays, political divisions among doctors currently have to do with implementation of the ACA. About two dozen states refused to implement the law's expansion of Medicaid coverage, and in many of those states, medical societies didn't initially oppose those decisions, even as pro-expansion physicians pushed heavily for their societies to take a position.

In Florida, which hasn't expanded its Medicaid program, physicians' views on the issue had been teetering back and forth until just recently. A survey by the Florida Medical Association (FMA) last year found that 58% of members would support an expansion. There was a divide between primary care physicians, who generally supported it, and specialists, who generally did not, and even those in favor of an expansion didn't think it was high enough a priority to risk passage of other pro-physician initiatives in the legislature.

But this year, when the Medicaid expansion actually started in other states, members changed their mind. In their meeting in late July, FMA delegates voted to support an expansion. Now the FMA must sell its new policy to the Florida House of Representatives, which has steadfastly opposed a Medicaid expansion.

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