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Dr. Tom's (uphill) Senate battle

When Oklahoma's Tom Coburn ran for the US Senate last year, he vowed, if elected, to continue his other job-a family physician who delivers lots of babies.

Senator Coburn, a Republican, sought to make good on his promise, until, that is, the Senate Ethics Committee told him to stop, giving him until this Sept. 30 to close up his medical shop. In justifying its decision, the committee cited Senate Rule 37, a conflict-of-interest safeguard that, among other things, prohibits members from receiving "compensation for practicing a profession which involves a fiduciary relationship"-a profession like medicine. Coburn responded by requesting that he be permitted to operate on a not-for-profit basis, as he had while serving for six years in the House of Representatives. But the committee, in their response issued in March, refused to budge.

Coburn would like to see the rule changed, specifically for doctors like him who want "to continue practicing and not make any money." To effect that change, he's asked another Senate body-the Rules and Administration Committee, chaired by Sen. Trent Lott (R-MS)-to clarify the rule's definition of "compensation." "It all hinges on that word," he says. "Am I being compensated if I don't take any money, yet have enough to pay for my rent, malpractice insurance, and nurses? As with many things in Washington, it's a hard concept for some people to see."

"Right now," says Coburn, "we preclude doctors from coming to the Senate because we say to them, 'You're going to have to quit being a physician when you come here.' That's not an easy thing to do, because you just can't walk away for six years and get back into it."

As for the potential conflict of interest that a rule change might portend, Coburn calls that "absurd." "No one comes to me to deliver a baby trying to influence my vote in Congress," he says.

While he waits for his colleagues to act-any change would require a vote by the full Senate-Coburn has begun to wind down his practice, as he promised the Ethics Committee he'd do. He's stopped taking new patients, opted out of a group partnership, and given up his separate allergy practice. He rents space and personnel from his former partners, and they cover his patients when he's out of town. He calculates that, if the rule change is enacted, he can continue in limited practice for about $200,000 in expenses annually, including malpractice insurance premiums.

Support from Senate colleagues, he says, has been "pretty good," on both sides of the aisle. Voters back home have also been in his corner for the most part, he says-as have his patients. But Oklahoma's newspapers have been less supportive. "Dr. Do-Little," the Tulsa World called Coburn earlier this year, urging him to focus on his Senate responsibilities.

To date, the Oklahoma State Medical Association, the AMA, and the AAFP haven't weighed in-and Coburn isn't pushing: "I don't want to be seen as the instigator who gets them to put pressure on members of Congress."

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Jennifer N. Lee, MD, FAAFP
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