Back at the old stomping ground

Before I took my current job, I worked at a medium-sized hospital-owned practice in mid-Maine.  So I found this recent article in the New York Times about doctors’ supposedly shifting politics intriguing.  (Hat tip: you know who you are.)

AUGUSTA, Me. — With Republicans in complete control of Maine’s state government for the first time since 1962, State Senator Lois A. Snowe-Mello offered a bill in February to limit doctors’ liability that she was sure the powerful doctors’ lobby would cheer. Instead, it asked her to shelve the measure.

“It was like a slap in the face,” said Ms. Snowe-Mello, who describes herself as a conservative Republican. “The doctors in this state are increasingly going left.”

It does not fill my heart with joy to know that a conservative Republican assumed that the state’s doctors would be de facto supporters.  (I’d rather not be taken for granted by either side, but if I had to choose I’d at least prefer an affiliation with politicians whose politics I actually support.)

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 from Maine as well as South Dakota, Arizona and Oregon, according to doctors’ advocates in those and other states.

That change could have a profound effect on the nation’s health care debate. Indeed, after opposing almost every major health overhaul proposal for nearly a century, the American Medical Association supported President Obama’s legislation last year because the new law would provide health insurance to the vast majority of the nation’s uninsured, improve competition and choice in insurance, and promote prevention and wellness, the group said.

Because so many doctors are no longer in business for themselves, many of the issues that were once priorities for doctors’ groups, like insurance reimbursement, have been displaced by public health and safety concerns, including mandatory seat belt use and chemicals in baby products.

Even the issue of liability, while still important to the A.M.A. and many of its state affiliates, is losing some of its unifying power because malpractice insurance is generally provided when doctors join hospital staffs.

“It was a comfortable fit 30 years ago representing physicians and being an active Republican,” said Gordon H. Smith, executive vice president of the Maine Medical Association. “The fit is considerably less comfortable today.” [emphasis added]

Little gets me as exercised as the lazy assumption that the AMA actually represents the broad opinions of doctors in this country.  The AMA would love for you to believe that, but it’s not true.  I’ve had a hard time finding hard numbers regarding the percentage of physicians who are AMA members, but this blog item seems consistent with most of what I’ve pieced together, with estimates ranging between 1/8 and 1/3 of physicians in practice.  In either case, most physicians aren’t members of the AMA.

For my part, I have never been a member of the AMA.  The reason why is highlighted above.  I have never felt a “comfortable fit” with being an active Republican, and I’ve never wanted to be a part of an organization that does.  I’m also not entirely comfortable with how they compile information about physicians and how that information is shared.  What this article really describes is the interests of doctors who choose to join the AMA.  While there is doubtless some shift in physicians’ politics as more and more become employees instead of business owners, conflating the views of the AMA with that of the medical community writ large does the former’s work for it.

But doctors in Maine have abandoned the ownership of practices en masse, and their politics and points of view have shifted dramatically. The Maine doctors’ group once opposed health insurance mandates because they increase costs to employers, but it now supports them, despite Republican opposition, because they help patients.

I find this paragraph just incredibly lazy.  I support mandates because I don’t see how one can have universal health care coverage without them.  But I wonder if the Maine Medical Association doesn’t have motivations that are a wee bit more complex.  “Because they help patients” feels like it was cut and pasted from an MMA press release.

Representative Sharon Anglin Treat, a powerful Democrat who was first elected in 1990, said that she and Mr. Smith were once bitter foes. “But Gordon’s become like a consumer activist,” she said with a big smile. “I’ve seen him more times in the last few years than I can count.”

Full disclosure — I used to live in Rep. Treat’s district, and she was a friend and neighbor.  (I think it’s great that she’s getting quoted in the Times.)  I’ve worked with her on some advocacy issues, sometimes at cross-purposes with the MMA.  She has been a fierce defender of patient rights for years.  It does signal a notable shift (to those who happen to follow Augusta politics [all nine of us]) that she and Mr. Smith are more frequently allies these days.

Dr. Kevin S. Flanigan, a former president of the Maine Medical Association, described himself as “very conservative” and said he was fighting to bring the group “back to where I think it belongs.” Dr. Flanigan was recently forced to close his own practice, and he now works for a company with hundreds of urgent-care centers. He said that in his experience, conservatives prefer owning their own businesses.

“People who are conservative by nature are not going to go into the profession,” he said, “because medicine is not about running your own shop anymore.”

And there you have it.  Dr. Flanigan makes no bones whatsoever about the MMA’s historical ideology.  Why on earth would physicians like myself who are aware of this bias ever choose to join the MMA in the first place?  Whatever my financial interests as an employed physician vs. partner in a private practice, my own personal politics would almost never overlap with a “very conservative” organization, so why would I ever choose to support it?  Most left-of-center doctors probably have felt similarly in the past, with little change recently.  This article tells us a little bit about the interplay between the financial interests and the politics of a relatively small number of physicians, and little more.