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Physicians are less likely to make campaign contributions to Republican candidates than they were 2 decades ago but are increasingly more politically polarized by sex, employment status, and specialty, according to a study published online June 2, 2014, ahead of print in JAMA Internal Medicine.

Political Participation on the Rise

Physician campaign contributions increased nearly 10-fold, from $20 million to $189 million in inflation-adjusted 2012 dollars from the 1991-1992 election cycle to the 2011-2012 cycle; the growth surpassed the overall population’s 6.5-fold increase over the same period (from $716 million in 1991 to $4.64 billion in 2012). In addition to monetary increases, the number of physicians who donated money also jumped from 2.6% of active physicians (n = 11,801) to 9.4% (n = 67,852).

Moreover, over the study period, more physicians (57% of men and 31% of women) contributed to Republican candidates or super political action committees than to Democrats.

After controlling for other variables, there was a 16% gap between male and female physicians in the percentage of contributions to Republicans. Across all 50 medical specialties analyzed, female physicians were more likely to contribute to Democrats than Republicans than male physicians. In addition, physicians working for small for-profit organizations were the most likely to contribute to Republicans and those working for large nonprofits were more likely to give to Democrats. The difference between these groups’ likelihood of contributing to Republicans amounted to a 17% gap on multiple regression analysis.

James C. Blankenship, MD, of Geisinger Medical Center (Danville, PA), told TCTMD in a telephone interview that he was not surprised by the relationship between where a physician works and his or her political leanings.

“You don’t go into an academic or nonprofit environment to maximize income,” said Dr. Blankenship, who serves as vice president of the Society for Cardiovascular Angiography and Interventions. He added that there are often other incentives at play including the education of new physicians and research into new technologies and techniques to improve patient care, both of which can correspond with Democratic leanings.

In the current study, political partisanship of the surrounding congressional district (determined by the majority of the presidential vote in the district) also positively predicted physician political contributions.

Specialty, Income Behind Partisanship

Physician specialty was strongly associated with contributions to the Republican Party, with a 30% gap in contributions between the extremes on either side of the political spectrum—Democrat-leaning pediatric infectious disease doctors and Republican-leaning orthopedic surgeons. In 2011-2012, for example, 75% of surgeons contributed to Republicans, while only about 25% of pediatricians did.

Annual salary also played a part; an increase in income from $200,000 to $600,000 corresponded with an estimated 3-fold increase in percentage of donations to Republicans. Dr. Blankenship pointed out that cardiologists appear to lean more toward Democrats than other specialties at similar income levels, noting that only 2 of the 9 equivalent specialties were less likely to contribute to Republicans.

Data were not available for interventional cardiologists specifically, but based on their income and sex, Dr. Blankenship predicted the group would tend to support Republicans.  This tendency, however, might be partly mediated by the fact that cardiologists as a whole contribute less to the Republican Party than would be expected at their income level, he added.

Progressively Less Republican

Peak support for Republicans came in 1996, when approximately 70% of contributing physicians gave money to the Republican rather than the Democratic Party. After 1996, however, such loyalty began waning, with the lowest proportion of contributors in 2008, the year of President Barack Obama’s initial election (~43%).

Physician contributions to Republicans fluctuated according to election cycle, though they showed a steady downward trend similar to that seen among the general population. The decline was only interrupted during election cycles when healthcare reform was being federally debated (eg, 1994 and 2009-2010). Here, the amount of contributors to Republicans jumped, regardless of physician characteristics.

Similar to US voters as a whole, physicians have become more polarized. In 1991-1992, 5.9% of physicians split their contributions between political parties, whereas only 2.7% did so in the 2011-2012 cycle. Meanwhile, “the gap between the percentage of contributions to Republicans for surgeons and pediatricians widened considerably, as did the gaps between physicians working in for-profit and nonprofit organizations and, to a lesser extent, between male and female physicians,” Dr. Rothman and colleagues write.

Repercussions of Change

The spikes in financial support to Republicans during national debates over healthcare reform stemmed from apprehension about change, suggested Dr. Blankenship. “People who will be adversely affected by change will fight it hard; those who benefit from change tend to support it softly,” he elaborated. “Physicians generally have a lot to lose and not much to gain financially with the [Affordable Care Act].”

Though political participation through campaign contributions has been on the rise, he reported, “some experts suggest that if physicians were as politically active as hospitals or drug companies, then Congress would not have limited increase in reimbursements to physicians to [nearly nothing] over the past 10 years.”

Where patient interest and reimbursement are at stake, however, cardiologists have been more involved and influential, Dr. Blankenship said, highlighting physician efforts to lobby the Centers for Medicare and Medicaid Services for TAVR and the Washington State Health Care Authority for coverage of DES.

Rather than focusing on self-interest or party ideology, Dr. Blankenship suggested, physicians can play an important role in educating local, state, and national policymakers and advocating for the welfare of their patients.

In the paper, Dr. Rothman and colleagues acknowledge that it is hard to predict how politicians would respond to greater physician presence. For now, they say, “all that is certain is that in political terms, the profession is in play.”

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