The author (at right) reflects on the value of holding office. His message to colleagues: Physician, involve thyself.
The author reflects on the value of holding office. His message to colleagues: Physician, involve thyself.
You may have heard the one about the derivation of the word politics. It comes from poly, meaning many, and from ticks, signifying blood-sucking parasites.
The joke always gets a laugh. But it's not trueand if it were, it sure wouldn't fit my experience. I'm in politics, now serving my fifth two-year term in the North Carolina General Assembly. My colleagues and I are nothing but conscientious individuals who try to write laws in the public's best interest. Far from being leeches, we sacrifice careers and family life to work for the public good. The same can be said about the majority of legislators everywhere.
I wish more doctors would become active in politics. Our way of thinkinglook, listen, diagnose, treatis highly applicable to public service. Four physicians signed the Declaration of Independence, hundreds have served in Congress, and thousands have been elected to state and local posts. Still, most physicians don't take the principles of the Hippocratic oath into the political arena.
It's time we got off our assets. Physicians should accept the challenge of running for officeor at least write a check or otherwise support those who do. It's imperative. We must be involved in the process that governs the way we practice. Isn't it better to be a player than a victim?
When I first ran for office, I had no idea what I was getting into. A patient took me aside one day, said he was retiring as county commissioner, and urged me to try for his seat. Until that point, I'd never been interested in politics. "What's a county commissioner?" I asked him.
Over the next eight years, I learned the duties of a county commissioner and the value of public service. Government policies that threaten the quality of health care are often developed by functionaries who aren't knowledgeable about medicine. By holding public office, I can defend our profession and protect the patient-doctor relationship.
Being a county commissioner was excellent training. I learned the art of compromise, built a constituency, and figured out how to raise funds. Physicians who want to go into politics need to get experience at the local level. Run for commissioner, or mayor, or even the school board.
In 1990, I won a state senate seat, and I was re-elected in 1992. In my subsequent senate races, I have been unopposed. And a good thing, too. Campaigning for a $12,000-a-year senate seat in North Carolina costs more than $100,000; some candidates have spent nearly $300,000. Because I haven't needed to run an expensive campaign since 1992, I reroute most of my supporters' contributions to the Republican Party or to fellow candidates.
The first bill that I sponsored in the senatewhich passedhad nothing to do with health care. At the request of some local law enforcement officers, I introduced legislation to outlaw the sale of flashing blue lights that could be mounted on the top of a vehicle like a police car's emergency signal.
Most of my other bills have been health care related. During my first term, I co-sponsored legislation, now law, that forces businesses to include coverage of mammograms and Pap smears in the health insurance they offer their employees.
My most controversial bill, which became law last January, mandates coverage of oral contraceptives in employee health benefit plans. The business community, which objects to mandates in general, and some religious groups opposed this legislation. As a compromise, I added a religious exemption, so that a Catholic church, for instance, doesn't have to offer contraceptive coverage as a benefit to its employees. And I hope businesses come to realize that it costs them far less to pay for contraceptive coverage than to cover the expenses of unwanted pregnancies.
Many of my other bills have affected medical practices in North Carolina. A primary care physician in an HMO can now write a referral for a chronically ill patient that's good for an entire year. An HMO's denial of coverage has to come from a physician licensed in our state, rather than one licensed elsewhere. (That gives the state board of medical examiners some influence over denials.) HMOs have to partially cover necessary prescription drugs that aren't on their formulary. Drive-through mastectomies have been outlawed. The state has set aside $l million to help low-income seniors pay for prescription drugs this year and next.
Politics is both satisfying and demanding. In North Carolina, legislative sessions are held on a biennial basis. One year the session lasts about six months, the next year about three months. During that time, I leave my practice in Stanley on Monday afternoons to drive to Raleigh, about 3 1/2 hours away. I return Thursday afternoon or evening so I can see patients Friday and Saturday and take weekend call.
Fortunately, by the time I became a senator my youngest children were in college. My wife was free to travel with meand she continues to do so. We have plenty of time to talk in the car, and we eat most meals together. The job would be more difficult if we had children at home.
Although I can be only a half-time doctor, I've managed to keep my solo practice. I contract with another family physician who works part time so she can be with her young children. We share all the patients in the practice. I don't maintain a hospital practice.
My patients are my most loyal supporters. Some of them have worked in my campaigns, handing out leaflets and bumper stickers and making phone calls. I don't think I've ever lost a patient because of my politicking. But I have gained some. In Raleigh, many of the legislators call on me to treat their illnesses. Although there's a dispensary and a doctor-of-the-day, most legislators prefer a deeper and more personal patient-physician relationship. And, I have to admit, having a little practice in the state capital doesn't hurt when I need support for a piece of legislation.
Fellow physicians are more reluctant than patients to back my political efforts. Doctors in general are poor financial contributors, and some worry about how a political stand would be received. One colleague, for example, told me he'd never put one of my signs in his yard for fear that it would offend his patients.
For me, two decades of being in politics has been nothing but rewarding. It's made my wife and meand our children and grandchildrenbetter citizens. We've learned to pay closer attention to the world around us. We've learned that accomplishments come from doing, not from complaining. We've learned that self-governing works so long as there are selves willing to work in government.
Physician, involve thyself.
The following essay was written for the first issue of Medical Economics, published in October 1923, by Royal S. Copeland, who was a physician, a mayor of Ann Arbor, MI, and a US senator from New York.
When we really consider the purpose of government, most of its vital problems have to do with things more familiar to the physician than to anybody else in society. There is a popular idea that lawyers are the natural statesmen. I hold no brief against the lawyers. Many of my most intimate friends belong to this inspiring profession. They will forgive me, I am sure, if I speak frankly of the lawyer in politics, as compared to what the doctor might accomplish in this field.
We have lawyers to formulate in legal language the conclusions reached by legislative bodies, but it does not follow that the lawyers originate the ideals expressed in the finished laws. In all modesty I contend that the doctor is better qualified to know the desires and the necessities of the human family than the lawyer, the engineer, and even the priest.
Who recognizes in the symptoms of his patient the lack of proper food? Who is so well able to testify to the lack of clothing, the want of proper housing, and the deprivation of heat? Determined as he is to seek ultimate causes, who is so well qualified as the physician to get at the bottom of the great social problems, the natural accompaniments of modern civilization?
I could go on indefinitely in pointing out the reasons why the doctor has an important place in politics. But the medical man is so devoted to his profession that he hesitates to leave it to take on the larger work of helping to heal the ills of a nation. However, when he does venture into this field, his education, his experiences, his human contacts, his broadened sympathies, and intimate knowledge of the endless needs of the human family must make him a useful and active agent for the good of the nation. He knows the heart of humanity.
Since the turn of the 20th century, 18 physicians have served as state or territorial governors. Three doctors currently hold the position. Internist Howard Dean, a Democrat, won election as state representative and lieutenant governor before succeeding to the office of governor of Vermont in 1991; he was elected to a full term in 1992, and has been re-elected three times. Emergency physician John A. Kitzhaber, also a Democrat, served in Oregon's house and senate before being elected governor in 1994; he was re-elected in 1998. Pediatric surgeon Pedro Rosselló, a member of the New Progressive Party, was first elected governor of Puerto Rico in 1992.
About 185 doctors and dentists occupy seats in state legislatures, according to the National Conference of State Legislatures. "In our 1995 survey, doctors and dentists accounted for 2.5 percent of the nearly 7,500 legislators," says a spokesman for the association. "The percentage is probably about the same today."
Among the 24 career types in the association's survey, physicians and dentists rank 12th. As you'd expect, lawyers hold the top spot (15.5 percent), followed by full-time public officeholders (14 percent) and business owners (12.3 percent).
James Forrester. Why politics--like medicine--is a noble calling. Medical Economics 2000;8:89.