Physicians have Many Civic Duties and Voting is One of Them

From the 10/30/2020 newsletter
 
Director’s Corner
 
 
Physicians have Many Civic Duties and Voting is One of Them
 
 
Adina Kalet, MD MPH
 
 
This week Dr. Kalet explores why physicians have a stake in the enfranchisement of our patients and, despite being very busy people, must vote.…
 
 

My dear friends, your vote is precious, almost sacred. It is the most powerful nonviolent tool we have to create a more perfect union.
- US Representative John Lewis

 
 
Did you know that physicians vote at a lower rate than the general population? Would you have guessed 14% lower? In a recent study, over half of physicians were not even registered to vote. This is especially perplexing and striking when compared to other educated, wealthy Americans who typically vote at much higher rates than average citizens. I have heard many physicians say that they prefer not to mix “politics” with health care (more on that later) or that as physicians, we just do not have the time to vote. This is not inspiring news about what many physicians understand about the importance of politics to the lives of their patients.
 
 
This attitude starts early. Many medical students and resident physicians, who were registered voters earlier in life, don’t prioritize registering or voting as they relocate. This break in the habit of civic engagement is noxious. By not encouraging and enabling voter registration of students and residents, we silently condone the view that we are just too “busy” doing very important things to vote. But few things are as important.
 
 
There are always barriers to voting for busy people. For instance, the annual national meeting of a large medical education organization regularly takes place on and around US election day, requiring the thousands of American citizen attendees to go out of their way to request absentee ballots. I must admit, I myself have missed voting in a midterm election because I did not plan ahead. Television coverage routinely shows long lines, even for early voting. This year, there should be no excuses.
 
 
Simply put, politics is the way we make decisions as a group about how to distribute shared resources. The majority of funding for health care is publicly funded. The regulations and codes that determine how we deliver health care are legislatively based and can end up being debated in the Supreme Court. The complex machinations of the electoral college aside, in the US, we govern ourselves by voting as individual adults. But typically, just over half of Americans regularly exercise this right and responsibility by voting. Many recent consequential elections have been ultimately decided by a small number of votes. This must change, at least for physicians.
 
 
Social issues and political advocacy are “in our lane”
 
Social determinants of health (SDoH) – affordable housing, food security, high quality education, access to health care, stable loving communities all shaped by political, economic and social policies – are increasingly acknowledged as within the health professionals’ medical obligations. SDoH are associated with race- and wealth-based disparities in health, particularly for Milwaukeeans. These are things we should care about. And while we cannot personally act to address all these issues, we can vote for the people we believe will.
 
 
There are so many examples of why physicians have a professional obligation to care about public governance. Without nationally organized preparation and response to disasters – such as the COVID-19 pandemic or gun violence – the negative impact of SDoH are exaggerated. What if pediatrician Mona Hanna-Attisha, MD MPH hadn’t been activated to do research and conduct the advocacy needed once she realized that many of her patients had elevated blood lead levels – a potent neurotoxin – associated with a switch in the source of Flint’s water supply? Physicians make a difference every day, even though many opportunities are missed.
 
 
So, why don’t we vote?
 
There is no doubt that voter participation and health are linked. Places where few low-income voters turn out have much less generous social welfare systems. This is not surprising, since elected representatives, looking to the next election, prioritize the needs of their voters and donors. Non-participants risk being disenfranchised.
 
Not voting, as individuals or groups, means less influence on elected officials. This is why health care professionals should vote and help patients register, as well. Of course, it is unethical for physicians to coerce patients or anyone to embrace a certain political view but that is not the same as enabling voters to register.  Enabling registration can be done without favoring differing political views or party affiliation.
 
As my husband, Mark Schwartz, MD, pointed out in his guest appearance in this space on October 7, 2020, it is common to hear the following explanations for avoiding civic engagement “We can’t fight big money,” “Science and politics don’t mix,” and “It’s not my job.” See his column for a deeper dive into why those responses are “wrong-headed.”
 
All this makes it even more perplexing as to why some physicians are unlikely to vote.
 
 
Getting and staying involved
 
Physicians, as well as society, must heed the lessons of a traditional civics education in order to protect democracy itself. Across the continents and centuries, the profession of medicine and physicians have not fared well when societies ceded power to autocrats. Consider how medicine was corrupted in Mao’s China or Hitler’s Germany. Physicians acquiesced and were stripped of their ability to protect patients and their profession. Medical “experimentation” led to horrific abuses, genocide, and eugenics.  As has been pointed out, autocracies are insidious because, at first, they make life easier for the educated and affluent, but ultimately physicians cannot assume we will be protected by our ancient traditions, our highly respected place in society, or our valuable knowledge.
 
As I have argued many times in this space, physicians need to be prepared to understand, how local, state and federal law influences how health care is organized and financed. We need to be “good citizens” of the systems in which we work while prioritizing our individual patients and the communities we serve. We must educate ourselves as effective advocates and understand the public health system and structure.
 
Physicians have no defensible excuse for being passive. Democracy is too delicate to leave untended. One in four physicians didn’t vote in any of the last three presidential elections. Let’s change that calculus. Society needs to hear our voices.
 
 
 
 
Adina Kalet, MD MPH is the Director of the Robert D. and Patricia E. Kern Institute for the Transformation of Medical Education and holder of the Stephen and Shelagh Roell Endowed Chair at the Medical College of Wisconsin