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Figure.  Marginal Estimated Probabilities and Risk Ratios of Voter Turnout Comparing US Physicians With the General Population, 2000-2020
Marginal Estimated Probabilities and Risk Ratios of Voter Turnout Comparing US Physicians With the General Population, 2000-2020

The analyses are based on data from the Current Population Survey Voting and Registration Supplement. To be consistent with the US Census Bureau’s approach, we classified nonresponses and responses of no or do not know to the voter questions as did not vote. All estimates provided in both panels were survey-weighted and adjusted for differences in demographic characteristics. Using a regression-based equivalent approach of standardization, these estimated risk ratios quantify the mean association between the physician occupation and voting participation in the overall population.

Table.  Common Reasons Why Eligible US Physicians Did Not Vote or Register in Presidential and Midterm Elections, 2000-2020
Common Reasons Why Eligible US Physicians Did Not Vote or Register in Presidential and Midterm Elections, 2000-2020
1.
Khullar  D. More doctors need to vote and get politically involved. Stat News. Published October 2016. Accessed June 5, 2021. https://www.statnews.com/2016/10/03/vote-doctors-politics/
2.
Grande  D, Asch  DA, Armstrong  K.  Do doctors vote?   J Gen Intern Med. 2007;22(5):585-589. doi:10.1007/s11606-007-0105-8PubMedGoogle ScholarCrossref
3.
Flood  S, King  M, Rodgers  R, Ruggles  S, Warren  JR. IPUMS, Current Population Survey: Version 7.0. IPUMS; 2020. doi:10.18128/D030.V7.0
4.
File  T. Characteristics of voters in the presidential election of 2016 population characteristics current population reports. United States Census Bureau; 2018.
5.
Gruen  RL, Pearson  SD, Brennan  TA.  Physician-citizens--public roles and professional obligations.   JAMA. 2004;291(1):94-98. doi:10.1001/jama.291.1.94PubMedGoogle ScholarCrossref
6.
Rovner  J.  US election 2020: how candidates will determine the shape of American health care.   BMJ. 2020;371:m3947. doi:10.1136/bmj.m3947PubMedGoogle Scholar
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    Research Letter
    Health Policy
    January 10, 2022

    Analysis of Reported Voting Behaviors of US Physicians, 2000-2020

    Author Affiliations
    • 1Harvard Medical School, Boston, Massachusetts
    • 2Department of Internal Medicine, Duke University Medical Center, Durham, North Carolina
    • 3Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts
    JAMA Netw Open. 2022;5(1):e2142527. doi:10.1001/jamanetworkopen.2021.42527
    Introduction

    Physicians’ engagement with the political process, particularly through voting, plays an important role in shaping public policy, affecting patient health and clinical practice.1 Historically, physicians in the US voted at lower rates than the general population in elections.2 However, physician voter engagement may have evolved, particularly given the changing political landscape and importance of US health care reform, as highlighted by the COVID-19 pandemic and differing policy proposals between the 2 major political parties. We assessed the trends in physician-voter turnout and reported reasons for not voting from 2000 through 2020.

    Methods

    This cross-sectional study was exempted from review and informed consent by the institutional review board at Harvard Pilgrim Health Care because of the use of publicly available, deidentified data. This study followed the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) reporting guideline.

    We used the US Census Bureau Current Population Survey Voting and Registration Supplement data.3 This survey is administered biennially to 60 000 households and collects information on voter participation and registration in the weeks following an election day. The response rates ranged from 79% to 92% in 2000 to 2020.

    We estimated marginal probabilities of voter turnout (ie, the proportion of eligible individuals who voted) in physicians and the general population in each election, respectively, using multivariable logistic regression and adjusting for demographic characteristics strongly associated with voting.4 We evaluated differences in voter turnout between physicians and the general population using risk ratios (RRs) and χ2 tests, both pooled and individually in each election. We examined the impact of sex, age, and availability of no-excuse mail-in voting on physician voter turnout. To examine barriers to voting among physicians, we calculated the proportions of eligible physicians who cited each reason for not voting and not registering to vote, respectively. All estimates were weighted to be nationally representative.

    All analyses were conducted in R version 3.6.3 (R Foundation). Tests were 2-sided, and a P value less than .05 was determined to be statistically significant. The study period was November 2000 to November 2020.

    Results

    Survey respondents from 2000 to 2020 included 4330 physicians and 1 438 809 nonphysicians. Among physicians, 1449 (33.5%) were female, 211 (4.9%) were Black physicians, 223 (5.2%) were Hispanic physicians, 3354 (77.5%) were White physicians, and 3598 (83.1%) were aged between 30 to 64 years. Physicians and nonphysicians differed in most demographic characteristics.

    Adjusted for demographic differences, pooled physician voter turnout was lower than the general population (57.4% vs 63.4%; RR, 0.91 [95% CI, 0.87-0.94]; P < .001). However, individual election results showed changes in this trend, especially in recent elections (Figure). Physicians had similar voter turnout as the general population in 2018 (RR, 1.00 [95% CI, 0.90-1.10]; P = .97) and higher turnout in 2020 (RR, 1.09 [95% CI, 1.00-1.18]; P = .03). Gaps in turnout between physicians and the general population were narrower in presidential elections than in midterm elections. Among physicians, voter turnout did not differ by sex but increased with age group with Generation X (born 1965 to 1979; RR, 1.25 [95% CI, 1.14-1.35]), Baby Boomer (born 1946 to 1964; 1.30 [95% CI, 1.17-1.43]), and Silent Generation (born 1925 to 1945; RR, 1.44 [95% CI, 1.09-1.80]) physicians more likely to vote than Millennial participants (born 1980 to 1994). Turnout was higher in states that offered no-excuse mail-in voting than those that did not (RR, 1.08 [95% CI, 1.03-1.13]; P = .003).

    Common barriers to voting cited by eligible physicians were not being registered to vote and being too busy or having a conflicting work schedule (Table). The most common reasons for not registering were not meeting the registration deadline and not being interested in politics.

    Discussion

    Voter turnout among US physicians has grown during the past 2 decades. Physicians were just as likely to vote as the general population in the 2018 midterm and more likely in the 2020 presidential election. These changes were likely multifactorial and may be related to health care reform and increased focus on physicians’ civic roles.5,6 Physicians in states that allowed no-excuse mail-in voting had a higher turnout. However, physicians still face barriers to voting, including registration and work schedule conflicts. Study limitations include potential reporting bias, overestimation of voter turnout by survey-based estimates, and limited representation of political participation with voting in nonprimary elections.

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    Article Information

    Accepted for Publication: November 11, 2021.

    Published: January 10, 2022. doi:10.1001/jamanetworkopen.2021.42527

    Open Access: This is an open access article distributed under the terms of the CC-BY License. © 2022 Ahmed A et al. JAMA Network Open.

    Corresponding Author: Xiaojuan Li, PhD, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, 401 Park Dr, Ste 401 E, Boston, MA 02215 (xiaojuan_Li@hphci.harvard.edu).

    Author Contributions: Mr Ahmed and Dr Li had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

    Concept and design: All authors.

    Acquisition, analysis, or interpretation of data: Ahmed, Li.

    Drafting of the manuscript: All authors.

    Critical revision of the manuscript for important intellectual content: Ahmed, Li.

    Statistical analysis: All authors.

    Administrative, technical, or material support: Li.

    Supervision: Li.

    Conflict of Interest Disclosures: None reported.

    Funding/Support: Dr Li was supported by grants R01HS026214 from the Agency for Health Care Research and Quality and R03AG070661 from the National Institute on Aging.

    Role of the Funder/Sponsor: The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

    References
    1.
    Khullar  D. More doctors need to vote and get politically involved. Stat News. Published October 2016. Accessed June 5, 2021. https://www.statnews.com/2016/10/03/vote-doctors-politics/
    2.
    Grande  D, Asch  DA, Armstrong  K.  Do doctors vote?   J Gen Intern Med. 2007;22(5):585-589. doi:10.1007/s11606-007-0105-8PubMedGoogle ScholarCrossref
    3.
    Flood  S, King  M, Rodgers  R, Ruggles  S, Warren  JR. IPUMS, Current Population Survey: Version 7.0. IPUMS; 2020. doi:10.18128/D030.V7.0
    4.
    File  T. Characteristics of voters in the presidential election of 2016 population characteristics current population reports. United States Census Bureau; 2018.
    5.
    Gruen  RL, Pearson  SD, Brennan  TA.  Physician-citizens--public roles and professional obligations.   JAMA. 2004;291(1):94-98. doi:10.1001/jama.291.1.94PubMedGoogle ScholarCrossref
    6.
    Rovner  J.  US election 2020: how candidates will determine the shape of American health care.   BMJ. 2020;371:m3947. doi:10.1136/bmj.m3947PubMedGoogle Scholar
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