Drawn to a cause: Doctors find a political voice

For most of his career, Richard B. Jennett, MD, kept his involvement in politics to a bare minimum. "I voted -- that's about it," said the president and CEO of Jefferson City Medical Group, one of the largest physician-owned groups in Missouri.

Like many in medicine, Dr. Jennett was satisfied to leave the rough-and-tumble of politics to others, believing that politicians would generally do the right thing.

But his thinking began to change in 2003, when Missouri's then.-Gov. Bob Holden, a Democrat, vetoed a medical liability reform bill that was heavily supported by physicians.

The Legislature's failure to override the veto provided the initial spark that ultimately led Dr. Jennett into politics. His frustration with the liability crisis moved him -- as it has moved untold numbers of doctors in Missouri and across the country -- from political disinterest to political engagement. "I had to get involved," he said.

By the time Holden vetoed liability reform a second time in 2004, the same year the governor was up for re-election, Dr. Jennett had thrown his support to a challenger, Republican gubernatorial candidate Matt Blunt. Although generally a swing voter and without party affiliation, Dr. Jennett felt he could strongly get behind Blunt, who had announced at the start of his campaign that he favored the type of liability reform that Holden twice vetoed.

Soon after contacting Blunt's campaign, Dr. Jennett agreed to chair a statewide fundraising committee called "Health Care Providers for Blunt." The committee raised nearly $100,000, mostly through donations from physicians, he said.

Dr. Jennett sent fundraising appeals to doctors statewide, held press conferences and hosted fundraising events on Blunt's behalf. He did it all in the hopes that it would lead to liability reform in Missouri.

"It was a real black-and-white issue for physicians," said Tom Holloway, director of government relations at the Missouri State Medical Assn. Overall, the state's physicians contributed upwards of several hundred thousand dollars to Blunt's campaign, he said.

They were not disappointed by the results. Blunt won the governor's office. Then signing a comprehensive, physician-backed tort reform bill into law was one of his first actions as governor earlier this year.

The bill-signing was a sweet victory for Dr. Jennett, who stood beside Blunt during the ceremony and received a copy of the signed legislation as a tribute to his efforts.

Reflecting on his first experience with a political campaign, Dr. Jennett said he "thoroughly enjoyed the whole thing."

He is hardly the only physician who has undergone a significant -- and unexpected -- political awakening during the past few years.

The pressure of skyrocketing liability premiums has prodded a number of doctors out of their examining rooms and into their state capitols to rally, lobby and testify before legislative committees.

"I think the sleeping giant has been awakened," Dr. Jennett said. "Doctors are much more politically tuned in now than they were two or three years ago."

Politics as part of the job

Few doctors ever expected to become as deeply engaged in politics as many have become, said Maureen Callaghan, MD, a neurologist in Olympia, Wash., and the 2002-03 president of the Washington State Medical Assn.

"When we went into medicine, we had no idea that [politics] would become an important part of our lives," Dr. Callaghan said.

But with liability reform now a "make or break" issue for many doctors, they have been pushed to get over their reticence about political involvement. In Washington state, physicians have held a series of rallies in various locations to draw attention to the impact that rising liability premiums have on their ability to practice.

"Physicians didn't choose to become placard-carrying demonstrators, but they're angry about the liability issue," Dr. Callaghan said.

Anger undeniably fuels the activism of many physicians these days.

"I'm angry and I'm passionate," said Ruth Schulze, MD, an obstetrician-gynecologist in Ridgewood, N.J., who was propelled from apathy to activism while president of her county medical society in 2002-03, when the liability crisis was erupting in New Jersey. "All of a sudden, premiums went crazy, I got pulled in through the county medical society, and my whole world changed."

Only a few years ago, Dr. Schulze felt detached from politics. "I was ill-informed and still thought my government was working for me," she explained. But that is no longer the case.

Dr. Schulze now sits on the Medical Society of New Jersey's board of trustees. She also chairs a New Jersey-based, grassroots organization called Coalition for Accessible Physicians. CAP sponsored a rally in Washington, D.C., in April that brought busloads of doctors from nine states to urge Congress to cap noneconomic damages awarded in medical liability cases. Dr. Schulze was among the speakers at the Capitol Hill rally, along with other physicians and several members of Congress.

For many doctors, the decision to get involved in politics is not made lightly, and some still hesitate to jump into the fray.

One reason is that the political arena is outside their traditional comfort zone, Dr. Callaghan said.

"It's not something we're used to doing, so it requires a cultural shift in many respects," she said.

Often physicians feel they lack the necessary knowledge or experience to step into a highly charged, partisan environment. They also are keenly aware that the debate over liability reform pits them against trial lawyers, for whom politics is familiar ground. "Doctors would prefer to do what they're trained to do, which is medicine," Dr. Schulze said. "Unfortunately, they're not schooled in [politics]."

Another challenge is overcoming what may be a longstanding distaste for politics. Donating money to political candidates "is not something that comes easily to physicians, whereas it seems to come easily to business groups and other interest groups," Dr. Jennett said.

Trial attorneys, for example, "have been very active in raising money, supporting candidates and getting their point of view out there," he said. "For some reason, physicians have been reluctant to do that."

Some doctors worry that they might alienate patients or other doctors by taking a public stand on issues or by supporting a political candidate.

Dr. Jennett said he realized before getting involved in the Blunt campaign that he would have to be careful about how his political activities would reflect on the medical group he leads.

"Since we are in the state capital and we have patients from both political parties, we didn't want to become totally partisan," he said. "So we made it clear that I, at least, went with the Republican candidate this time because he was strongly in favor of tort reform and because the issue is so vital to health care."

Sticking with it

Doctors' increased political involvement doesn't appear likely to subside any time soon, according to physicians AMNews interviewed, as well as American Medical Association Trustee Rebecca J. Patchin, MD.

"I think for many physicians, this is going to be sustained," she said.

One reason is that the struggle for liability reform is ongoing in many states and at the federal level, Dr. Patchin said. "We're in it for the long haul, and we're not going to give up just because we've been at it for a few years."

Even in states such as Missouri where liability reform legislation has been enacted, physicians realize that is not the end of the struggle.

"We understand that we won a battle, but we haven't won the war," Dr. Jennett said. "Certainly the trial attorneys are going to come back and try to turn back tort reform."

But Dr. Jennett's interest in politics now goes well beyond the struggle for medical liability reform. He's discovered a deep conviction about the active role that citizens must play in a democracy and has even had thoughts of running for office some day.

"I think the day is past that physicians can passively sit there and be happy with whatever happens," he observed.

Now Dr. Jennett is a dyed-in-the-wool political activist. In addition to staying involved in politics himself, he said he is on a mission to get fellow doctors mobilized as well. "Physicians need to step up to the plate and get involved in politics," he said. "It's an extension of their obligation to patients and society to do the right thing."

For Dr. Schulze, politics has become just as personal. Her advocacy for liability reform is directly linked to her desire to keep practicing as an obstetrician, which is currently threatened by the pressure of liability premium costs.

"My group is going to give up OB in the next two years unless there's a solution" to the liability crisis, she said. "And I'm probably going to get out in January."

She also worries about the future availability of obstetricians, particularly as the mother of three young daughters who may want to have children themselves one day.

"I don't know what kind of quality delivery they're going to get," she said. "So even though I get frustrated and part of me says I should pull back, I'm going to keep going forward."