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msJAMA
March 3, 1999

Physician-Legislators: Physicians Practicing Public Service

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JAMA. 1999;281(9):862. doi:10.1001/jama.281.9.862-JMS0303-7-1

Although some may consider physicians out of place in the halls of Congress, our nation has a long history of physicians as "citizen legislators." Four of the 56 colonists who signed the Declaration of Independence were physicians, 2 physicians signed the Constitution, and several physicians were members of the First Continental Congress.1 Currently 8 physicians serve in the US Congress: Sen William Frist (R, Tenn); Rep Tom Coburn (R, Okla); Rep John Cooksey (R, La); Rep Greg Ganske (R, Iowa); Rep Jim McDermott (D, Wash); Rep Ron Paul (R, Tex); Rep Vic Snyder (D, Ariz); and Rep David Weldon (R, Fla).

Dr Frist, a cardiothoracic surgeon, advocates strong physician involvement in health policy. He explains that "if we are to preserve all that is good and sacred about the practice of medicine, we physicians no longer can operate solely within the operating theater of our individual clinical practice. . . . We must bring all our values, ethics, and skills out of the operating and examination rooms and into the theater of public policy."1

Dr McDermott, a psychiatrist, became politically active during the time of the Vietnam war. His first experience with public office was serving in Washington's state legislature, where he developed the Washington Basic Health Plan, designed to provide insurance to the unemployed and working poor (J. A. McDermott, oral communication, May 1998).2

Dr Coburn, a family physician, ran for office because he grew disgusted with the House of Representatives being a "house of career politicians" that made decisions based on what motivated their own personal interests (T. A. Coburn, oral communication, May 1998). Dr Ganske, a plastic and reconstructive surgeon, sought congressional office when he lost confidence in the current welfare system. "I am here for a cause," Dr Ganske said in an interview after being elected in 1994. "I am here for a revolution. I believe that the welfare system needs to be replaced."3

Physician-legislators were featured quite prominently in many of the health care debates of the 105th Congress. Dr Ganske sponsored the Patient Right to Know Act, which would prohibit "gag clauses" that contractually restrict what information physicians can give their patients.4 Dr Coburn authored legislation to amend the Social Security Act to include specific protections to Medicare beneficiaries who enroll in Medicare managed care plans, including guaranteed access to out-of-network services.5,6 Dr McDermott, for the sixth consecutive year, introduced a bill to provide universal access to health care.7

However, congressional physicians are sometimes not involved in health policy initiatives. This can be attributed to physicians-legislators often not being in Washington long enough to gain the seniority needed for an appointment to those committees from which health policy bills originate.

Interestingly, these physician-legislators have different opinions as to how patient protection might best be achieved. Dr McDermott believes that Rep Charlie Norwood "put a finger on a real problem" with the "factory-like nature" of some health maintenance organizations. He argued that this should not be a "partisan issue" and joined Dr Ganske in co-sponsoring both early Republican8 and Democratic9 proposals (J. A. McDermott, oral communication, May 1998). Dr Weldon explained that his main goal was to "restore the doctor-patient relationship." He was therefore wary of supporting the Republican proposal8 because of language he felt would broaden allied health professionals' scope of practice beyond what is appropriate. He was also opposed to the Democratic proposal9 because of provisions that would lead to increased litigation, representing what he called a "field day for trial lawyers" (D. J. Weldon, oral communication, July 1998). In the end, Dr Weldon chose to support the Patient Protection Act, which provided an appeals process but did not extend the right to seek legal redress.

As legislators, physicians will continue to play key roles in the formation of health policy. In the words of Dr Royal Copeland, an ophthalmologist and US Senator from 1923 to 1938, who crafted the legislation creating the Food and Drug Administration: "we [physicians] have something of value to contribute and we dare not . . . shirk our obligation to render service to the Nation as a whole, so that the good we attempt to do to individuals may be magnified and multiplied."1 These physicians in Congress have certainly taken that sentiment to heart.

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Article Information
Submissions for the 1999 Frank Netter Arts Contest for Medical Students must be received by May 24, 1999. For detailed information, please refer to the February 3, 1999, issue of MSJAMA.
References
1.
Frist  WH Operating outside the clinical theater: a challenge for physician leadership. Today's Internist. 1998;3921- 25
2.
McDermott  JA Biography of Congressman Jim McDermott, 7th District, Washington. Available at: http://www.house.gov/mcdermott/bio.html. Accessed October 24, 1998.
3.
Pins  K Ready for Washington. The Des Moines Register. January1 1995;1A
4.
US House of Representatives, H.R. 586: Patient Right to Know Act. Available at: http://thomas.loc.gov/cgi-bin/query/z?c105:H.R.586. Accessed October 24, 1998.
5.
US House of Representatives, H.R. 66: Medicare Patient Choice and Access Act of 1997. Available at: http://thomas.loc.gov/cgi-bin/query/z?c105:H.R.66. Accessed October 24, 1998.
6.
US House of Representatives, H.R. 459: Senior Citizens' Access to Health Care Act of 1997. Available at: http://thomas.loc.gov/cgi-bin/query/z?c105:H.R.459. Accessed October 24, 1998.
7.
US House of Representatives, H.R. 1200: American Health Security Act of 1997. Available at: http://thomas.loc.gov/cgi-bin/bdquery/z?d105:h.r.01200. Accessed October 24, 1998.
8.
US House of Representatives, H.R. 1415: Patient Access to Responsible Care Act of 1997. Available at: http://thomas.loc.gov/cgi-bin/bdquery/z?d105:h.r.01415. Accessed October 24, 1998.
9.
US House of Representatives, H.R. 3605: Patients' Bill of Rights Act of 1998. Available at: http://thomas.loc.gov/cgi-bin/bdquery/z?d105:h.r.03605. Accessed October 24, 1998.
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