Historically, say the Johns Hopkins investigators, the recent lack of physicians in Congress reflects a major departure from Congressional makeup in the nation's first century, when a much higher percentage of doctors held nationally elected posts. Records show that from 1789 to 1889, 4.6 percent of Congressional seats were held by physicians. Indeed, 10.7 percent of the signers of the Declaration of Independence were medical practitioners.
"There is real irony in our findings," said senior author Thomas Suarez, M.D., director of medical education at Sinai Hospital of Baltimore. "Health care issues are increasingly at the forefront of the presidential election debate, national health care spending is at an all-time high of 14 percent of GDP, and a record 45 million Americans lack health insurance. One could argue that the need for medical leadership has never been greater, yet few physicians walk the corridors of power in Washington, D.C., where major decisions are made."
In their study of national office-holders from the last 40 years, to be published in The Journal of the American Medical Association (JAMA) online Nov. 2, the Hopkins team conducted a review of the Congressional records for background information on every member who served between 1960 and 2004. The base year of 1960 was chosen for its proximity to the establishment of the nation's two largest health benefit programs, Medicare and Medicaid.
Nearly half the members reviewed were lawyers (44.6 percent). Individuals from the business sector (13.6 percent), public service (9.9 percent) and education (7.4 percent) represented the next largest groups in Congress. Physicians were tied for ninth place, behind professionals from military, banking/insurance, and media/entertainment backgrounds.
A majority of the 25 physicians were Republican (60 percent), and all but two served in the House of Representatives. Ranked by specialty, three were surgeons and three practiced obstetrics and gynecology. Several physicians had training in several disciplines, including two who were also lawyers. The average length of Congressional service by physicians was nine years.
The researchers suggested several possible reasons to explain the drop in physician representation in Congress, including training and a lack of significant financial incentive for public service. Physicians are trained to focus on patient care, not policy, they speculate, while lawyers are trained in law and have traditionally assumed roles in public service. Salaries in Congress are comparable to those in medicine, with the average family practitioner earning $139,000 per year, and the average rank-and-file member of the House and Senate earning $154,000 per year.
The researchers did not evaluate the influence of nonprofit health groups that practice government relations on behalf of physicians, especially the American Medical Association.
"Physicians, because of their unique and specialized training, need to be actively engaged as players in the legislative process of creating health policy, especially decisions about national funding for research and patient care," said lead study author Chadd Kraus, B.A., an emergency medicine researcher at Hopkins and graduate student at the Bloomberg School of Public Health. "Medical schools may need to broaden their curriculum to include an emphasis on the bigger picture of policy and government, when training the next generation of physicians, if they hope to have physicians shaping the direction of health care in the United States."
The eight most recent members of Congress who are physicians include Sen. Bill Frist (R-Tenn., cardiac surgeon); Del. Donna Christensen (D-U.S. Virgin Islands); Rep. Michael Burgess (R-Texas, obstetrician); Rep. Phil Gingrey (R-Ga., obstetrician); Rep. Jim McDermott (D.-Wash., family physician); Rep. Ron Paul (R-Texas, obstetrician); Rep. Vic Snyder (D-Ark., family physician and lawyer); and Rep. Dave Weldon (R-Fla., internist).