Every day, doctors treat patients’ medical problems. But our work extends beyond what we do in the exam room or on the operating table. As a primary care doctor to a 63-year-old woman who recently suffered a crippling stroke, for example, I spent hours calling her landlord and city agencies to delay an impending eviction. We are our patients’ allies and advocates whether that means taking direct action on their behalf, navigating insurance plans to get medications covered, or persuading other physicians to expedite critical procedures.
But when it comes to addressing broader problems that cause these situations, we are less vocal than we should be. In elections between 1996 and 2002, physicians voted at rates that were 9 percent lower than the general population and 22 percent lower than lawyers. These voting behaviors have changed little since the 1970s. And while health care is a priority issue for Americans, only 22 of the 535 members of the 114th Congress are medical caregivers (17 are physicians, and five are nurses). In contrast, there are 274 businesspeople and 202 lawyers.
In conversations with colleagues, I have determined several reasons for this low civic participation. Physicians are often divided along specialty lines, making unified messaging difficult. Those practicing medicine are increasingly separated from decision-makers by layers of complex regulations, payers, and administrators, contributing to a sense of disillusionment about the political process and our ability to influence it. Like some of my colleagues, I’ve often felt removed from professional societies that have historically prioritized physicians over patient interests. And between long clinical hours and career demands, it’s tough simply to find the time and energy for additional activities.
But by staying clear of the political process, we’ve allowed prevailing narratives about health care to be hijacked by those with purely political agendas. As a result, a third of Americans falsely believe there are more uninsured people today than five years ago, even though the rate of uninsurance is at a record low of 8.6 percent. We’re precipitously close to repealing the Affordable Care Act without ensuring an alternative for the 30 million Americans who would be left uninsured, including 13 million who would lose coverage from Medicaid and the Children’s Health Insurance Program. Those who keep coverage stand to lose essential health benefits such as treatment for opioid use disorder, prenatal care, and access to contraception. Once again, rather than progressing to policy fixes for smarter, higher quality care, we’ve relapsed to disputing the need for basic health care coverage for all Americans.
Despite being key stakeholders in health care, physicians have relatively little influence over how the system works. For my patients, this means that the programs I know to be critical can be dismantled by those entirely unconnected to health care. I recently took care of a single mother with newly diagnosed cervical cancer, and it was Medicaid, a program that is on the chopping block, that helped her to obtain chemotherapy and radiation. A young man whose car accident left him addicted to Vicodin and alcohol was able to enroll in a substance use program for the first time when his plan expanded its mental health benefits under the ACA. And then there are the patients who continue to struggle: those who negotiate to take one necessary medication over another because they can’t afford both copays. Or the ones who rotate through the emergency room time and again for preventable health problems.
These patients are why I entered medicine. The way they’re being treated is also why my faith in our political system is eroding. Frustrated by the difficult reality of caring for patients, I’ve felt more and more compelled to speak openly in my professional role as a physician. This came to a head when President-elect Donald Trump named Dr. Tom Price to lead the Department of Health and Human Services. Price has used his position as one of the few health care providers in public office to prioritize industry and physician gains over patient interests. He’s blocked efforts to limit doctor payments while denying health insurance expansion for poor children. He supports “balanced billing,” which allows physicians to charge patients excessive, unanticipated bills beyond what insurance reimburses. He worked at one of the country’s largest safety-net hospitals, Grady Memorial, but supports cutting funding to these very hospitals and the patients they serve, including a trillion dollars from Medicaid over the next decade.
The health care system is in profound need of fixing, but these actions are contrary to what I believe best serve my patients. The real tipping point came when the American Medical Association, the oldest and largest professional organizations for doctors, endorsed Price for the position. The AMA bills itself as an organization “dedicated to empowering the nation’s physicians to continually provide safer, higher quality, and more efficient care to patients and communities.” These are values that most health care providers share and that we ought to help one another uphold. I felt compelled to speak up and co-wrote an open letter sharing some concerns about the AMA’s endorsement.
Our letter quickly garnered more than 6,000 provider signatures and received responses from congressional staff and AMA leadership. The reaction made it clear that many doctors who have previously shied away from the policy fracas are rousing publicly on a different guiding principle: service to patients. Dr. Manan Trivedi, the president of the National Physicians Alliance, an organization whose motto is “patients over profit, profession over privilege,” told me that there’s been a significant recent uptick in membership. Our own nascent patient advocacy effort, called the Clinician Action Network, has grown its mailing list to more than 4,000 health care providers in just a few weeks. The silver lining of the policy proposals currently on the table seems to be that many more health care professionals are now eager to speak up for their patients. This will be good in the long term for health policy.
Naturally, we’ve also received words of reproach. We’ve been called disingenuous—physicians “don’t truly care about patients” and are “motivated by profit.” This sentiment is consistent with polls showing that public trust in the medical profession has declined sharply since the 1960s, likely due to dissatisfaction with the health care system, rising health care costs, and medicine’s transition from a service to a managed care business. But trust in the integrity of individual health care providers has remained high—Americans seem to still find their own doctors honest, principled, and ethical.
We’ve also been called partisan. In fact, health care has become so politically charged that even advocating for patients is subject to spin. But patient advocacy should not be a partisan issue. I’d argue that responsibility to our patients is actually what obligates us to advance policies that would improve the nation’s health. If more doctors were willing to take honest, public stances for their patients, we could reverse the negative image of medicine and re-establish it as a caring, altruistic profession. This would require physicians to overcome the uncertainty and discomfort that comes with being public advocates and help lead health care from a partisan value back to a patient-centered issue.
The AMA’s own code of medical ethics says that physician responsibilities should include seeking “changes in those requirements which are contrary to the best interests of the patient” and participating “in activities that contribute to the betterment of public health.” In other words, patients are not only at the center of our clinical activities, but they must be an obligatory focus of our public activities. And when we use our expertise for policy fights, this code dictates that we prioritize patients rather than self, political ideology, or party. As such, we should all get behind smart proposals that benefit patients, regardless of political authorship. Conversely, we all have a professional obligation to oppose policies that would do patients harm.
Republicans and Democrats don’t agree on much, but a whopping 84 percent of Americans—75 percent of Republicans and 91 percent of Democrats—believe that access to health care is a moral issue. Doctors and other clinicians have unique insight into issues of access, and we must engage collectively in efforts to protect care for all Americans. We need to mobilize to ensure that the health care system makes more patients better off. We need to share our knowledge with our communities and join organizations that align more closely with core professional values. We should run for office ourselves to infuse fresh ideas into government. And we will also need to develop new ways to make our voices heard.
We’d call it “abandonment” if a physician walked away from a patient during an illness. But we abandon patients just as profoundly if we don’t take our collective expertise and experience into the policymaking process, where the effects can be even more significant.