Physician Politics: Does It Affect Care?

February 9, 2019 | Featured Articles

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The patient-doctor relationship is one based on trust—but we often think of that trust in terms of a caregiver’s competency and a patient’s openness about his or her symptoms and medical history. While looking for a primary care physician, patients seek competent providers with esteemed degrees, extensive medical backgrounds, and positive reviews. But at a first meeting, patients seek something more: doctors who instill confidence and put patients at ease.

So in today’s error of divisive politics, should patients be concerned about political differences resulting in insufficient care, or care misaligned with their values and beliefs? A 2016 survey of 233 physicians revealed that the difference between some doctors is not black and white—it’s blue and red.

The survey, designed to root out providers’ political affiliations and see if they affected healthcare responses and treatment, matched 20,000 primary care physicians in 29 states to a voter registration database. A sampling of Democratic and Republican primary care physicians were then asked to respond to nine hypothetical healthcare scenarios. To net the most honest responses, physicians were led to believe the survey was about how they administered social surveys at the start of patient-physician relationships.

Hypothetical scenarios in the survey all dealt with heavily politicized issues such as abortion, firearm safety, and marijuana use; and the physicians’ recommended treatments almost always landed within their perspective political party lines.

Republican doctors were far more likely to express concern over a patient with a history of abortions or recreational marijuana use than Democratic doctors. Most Republican physicians expressed concerns about mental health in the case of abortions, and illegality when it came to marijuana use. Doctors who identified as Democrats were much more concerned about firearm access in the home than Republican doctors, with the latter being inclined to advise on safe storage for weapons and the former recommending not having firearms in the home at all.

The data also revealed that political leanings might affect the field or specialty that a doctor chooses. The New York Times found that Republican physicians tend to “cluster” in the high-paying specialties: “In surgery, anesthesiology and urology, for example, around two-thirds of doctors who have registered a political affiliation are Republicans. In infectious disease medicine, psychiatry and pediatrics, more than two-thirds are Democrats.” At a glance, it’s not hard to divide these specialties under the categories of left or right-leaning political concerns: Healthcare issues that are closely linked to social or economic issues are more likely to appeal to Democrats.

It’s impossible with a survey of this size and scope to know whether other factors could be at play, such as gender or racial bias. Still, the patterns that emerge make a strong case for politics playing a role in care. Researchers from the study acknowledge that the survey’s results don’t provide definitive proof of bias; but Professor Hersh feels “Nothing predicts the outcome the way that partisanship does. I feel very confident that the results are real.”