Practice Economics

Doctors' political giving starts to shift from Republicans

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Physicians can leverage political power with unity

Dr. Bonica and colleagues are careful not to extrapolate much beyond their findings. Their data show a recent shift toward the Democrats in the traditional physician support of Republicans, and they believe that this shift is likely to continue. However, these data may not be representative of the rank and file of physicians.

Predictions of how physicians will behave in the future are at best uncertain. We simply do not know how most physicians will react to the problems that will probably emerge as the Affordable Care Act plays out.

Physicians have the unique power to reshape the medical care system. But if they never unite to press for major reform, the future of health care in the United States will indeed be bleak. We will end up with either a system controlled by blind market forces or a system entangled in complicated and intrusive government regulations. In either case it would be impossible to practice good patient-centered medicine, and the quality and effectiveness of our health care system would sink even lower among the ranks of developed countries. It is up to the medical profession to see that this does not happen.

Dr. Arnold S. Relman is retired from the department of medicine at Brigham and Women’s Hospital in Boston. His comments were adapted from an editorial (doi:10.1001/jamainternmed.2014.509) accompanying Dr. Bonica’s study. He reported no conflicts of interest.



A gradual shift in physicians’ contributions from Republican candidates and organizations – and to their Democratic counterparts – has accompanied the increasing numbers of female physicians and physician employees in the workforce, Adam Bonica, Ph.D., and his colleagues reported June 2 in JAMA Internal Medicine.

The researchers used publicly available data from the Federal Elections Commission and the Database on Ideology, Money in Politics, and Elections for the 1992 and 2012 election cycles. Doctors were identified using the National Provider Identified public use file from the National Plan and Provider Enumeration System and the Unique Physician Identifier Number database (JAMA Intern. Med. [doi:10.1001/jamainternmed.2014.2105]).

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The biggest contrast in contributions was by specialty, and showed increased polarization during the study period.

A total of 140,423 physicians contributed at least $200 to a candidate or organization (including super political action committees) during at least one election cycle in that time, Dr. Bonica of Stanford (Calif.) University and his colleagues reported.

In the 1992 election cycle (spanning 1991 and 1992), 2.6% of physicians made $20 million in political contributions; by the 2012 cycle, 9.4% of physicians donated $189 million. The authors calculated the percentage of total contributions that went to Republican candidates or organizations during those 2 decades.

During the entire study period, an average 57% of male physicians and 31% of female physicians contributed to Republicans; however, the overall percentage of physician contributions to Republicans began decreasing in 1996. In both the 2008 and 2012 election cycles, less than half of political contributions from physicians went to Republicans.

The gender gap in contributions also increased over time. In the 2012 election cycles, twice as many men (52%) as women (24%) donated to Republicans. The gap was similar between doctors practicing at for-profit (53%) versus nonprofit (26%) organizations.

The biggest contrast in contributions was by specialty and also showed increased polarization during the study period. Although 66% of surgeons and 33% of pediatricians contributed to Republicans in the 1992 election cycle, that gulf widened to include 70% of surgeons and 22% of pediatricians in 2012.

Much of this gap appeared to be explained by average earnings by specialty: As average earnings by each specialty increased, the percentage of physicians in that specialty contributing to Republicans also increased.

The authors reported no conflicts of interest.

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