History repeats: Physicians face another 5.4% issue

AMA Leader Commentary. By Richard F. Corlin, MD April 15, 2002.

AMA LEADER COMMENTARY

A few words about current events in medical practice

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A message to all physicians from AMA President Richard F. Corlin, MD.

Fifty-six men signed a very special document in 1776. That document was, of course, the Declaration of Independence.

Three of those men -- or 5.4% of the total -- were physicians. Yes, 5.4%. It's the same number that gets physicians' attention today -- it's the cut we took this year on our Medicare payments, the cut we're asking Congress to rescind.

If today physicians were represented in Congress at the same level as they were in the signing of the Declaration of Independence, there would be 23 physician members of the House of Representatives and five physician-senators.

Unfortunately, the actual numbers today are only eight members of the House and one member of the Senate who are physicians.

Wouldn't a greater representation of physicians in Congress help amplify our voice and bolster medicine's messages?

The doctors who signed the Declaration of Independence in 1776 were activists as well as physicians. Dr. Benjamin Rush, of Pennsylvania, is the best known. He not only founded the Pennsylvania Hospital in Philadelphia but also served for 16 years as the Treasurer of the U.S. Mint and equipped the Lewis and Clark expedition with their medical supplies. Not as much is known about his fellow-physician-signers, Dr. Josiah Bartlett and Dr. Matthew Thornton, who both represented New Hampshire.

Although there has been a physician member in every Congress since the first Continental Congress in 1774, the numbers are not as high nowadays as they were in America's early years. Fewer and fewer physicians choose the life of public service.

It isn't that the legal profession or any other group conspired to steal the involvement and representation from physicians, but rather that we simply defaulted it away at all levels of government -- national, state and local. This lack of participation in public life isn't just in positions of high elected office, but in municipal offices and on all sorts of local boards and councils as well.

Why did it happen?

Let's first consider what weren't the reasons why it happened.

Physicians still have a contribution to make to public decision-making and government bodies. In fact, a physician, Dr. Samuel Freeman Miller, of Kentucky, served on the U.S. Supreme Court from 1862-1890. Many physicians have served as governors of states. Physicians are still regarded as worthy members of all those appointed and elected bodies. Physicians are still smart enough to handle those responsibilities.

We all recognize the important role physicians can play in public service, and the AMA has a number of programs that support that role. AMPAC, the AMA's political action committee, offers two different sorts of training to help physicians with their political aspirations.

The AMPAC Campaign School is an intensive five-day, bipartisan school taught by leading political consultants. Students learn the basics of political campaigns from developing strategy and message to targeting voters and conducting "Get out the vote" drives on election day.
In the AMPAC Candidate's Workshop, physicians who are planning to run for elective office spend a weekend learning whether it is the right choice and the right time to be running. Declared candidates and those contemplating a bid for public office find out what it takes to be a winning candidate.

AMPAC's training programs have plenty of active alumni -- including Rep. Greg Ganske, MD, (R, Iowa) and Michael Maves, MD, our new executive vice president and CEO, who recently urged a group of medical students and residents to start early in their political work, because even doctors have to pay their dues.

Maybe there are other ways, too, of encouraging us to get involved politically. Members of law firms, for instance, who return from public service to their practices find that they are regarded as having added value to the practice and can pick up their professional activity where they left off - or even better.

Members of a medical group who return from public service often find that they are simply written off as people who didn't carry their share of the overhead or meet productivity targets, or, if in solo practice or a small group, simply find their practice gone. How our colleagues react to public service can also change a physician's willingness to serve.

Given this pattern of behavior and lack of involvement, is it any wonder that we are considered outsiders by most of these appointed and elected groups? Is it any wonder that officials and staff members make decisions about issues related to all aspects of medical care without involving the physicians who have real experience treating patients?

Is it any wonder that so often we need to correct items that were simply positions taken by otherwise well-meaning people who didn't have medical input at the start?

Wouldn't it be better both for us and for our patients if we were involved from the start in these issues? I'm thinking of physician representation in public service in its broadest sense, including appointed as well as elected positions on school boards, planning commissions and other administrative bodies.

This involvement is not that hard to get. All we have to do is to recognize that, as physicians, we have a responsibility to participate in public life far more than we do today and to better regard our colleagues who choose to make this contribution.

We still would need to do what everyone else does: Start at the entry level and work up as far as we want to -- both for our own involvement and as workers and helpers in the campaigns of others.

Giving to our PAC is wonderful and needed, but working and participating in public life is even better. We need to keep it up at least until at all levels, physician involvement in boards, councils and commissions -- as well as in elected positions -- exceeds the 5.4% that we started with 226 years ago.

Because if we want our voices to be heard, it helps to be present at the discussion.

Note: Some historians say another signer of the Declaration of Independence, Lyman Hall, originally from Connecticut, but representing Georgia, was a physician, but his medical training has never been documented. If we include him, the percentage of physician-signers goes up to 7.0%. I prefer to use the attention-getting 5.4% to make my point. (Besides, "The Seven Percent Solution" has already been used as a title by Nicholas Meyer in his book about Sherlock Holmes's alleged addiction to cocaine.)

Dr. Corlin, a gastroenterologist in private practice in Santa Monica, Calif., served as AMA president during 2001-02.