The newest doctors in the House: Physicians become legislators

Reps. John Fleming, MD (R, La.), and Parker Griffith, MD (D, Ala.), at first seem to have little in common other than their medical degrees and the fact that they were both sworn in as first-time congressmen in January.

Dr. Fleming's solidly conservative platform, lack of political experience and reserved manner set him apart from Dr. Griffith, a high-energy former state senator looking for the right patch of moderate political ground.

But there are similarities. Both Dr. Griffith, a retired radiation oncologist, and Dr. Fleming, a family physician, ran for Congress largely because they believe the U.S. health system is failing to deliver enough preventive care. Both run small businesses in their districts, and both have similar advice for physicians: Become more politically active and sharpen your business skills.

Dr. Griffith and Dr. Fleming are two of the four new physicians who took seats in the U.S. House of Representatives in January. Voters also elected Bill Cassidy, MD (R, La.), and Phil Roe, MD (R, Tenn.), and re-elected nearly a dozen other doctors, putting the total number of physicians in Congress at 16.

American Medical News recently spoke with Dr. Griffith and Dr. Fleming. AMPAC -- the American Medical Association Political Action Committee -- donated the maximum possible amounts to both physicians' campaigns.

Parker Griffith, MD: A natural at politics

Dr. Griffith, 66, was beginning his second year as an Alabama state senator in early 2008 when the next perfect political opportunity came along.

Rep. Bud Cramer (D, Ala.), who represented the northern region of the state, decided his 18th year in the House would be his last. His friend and neighbor Dr. Griffith was a top choice to succeed him. Dr. Griffith has "a very dynamic, very aggressive personality," Cramer said.

Dr. Griffith came to politics after practicing radiation oncology for two decades. He thrived as the first board-certified radiation oncologist in the Huntsville area. But facing competition from larger hospitals and being forced to guarantee personally the purchase of increasingly expensive medical equipment, he was convinced to sell his clinic in 1992. "I decided that it might be a good time to change directions."

Although Dr. Griffith hasn't seen patients in more than 17 years, he maintains his medical license and is confident that he could get up to speed and practice again in six months if he chose to do so.

His family was repeatedly touched by cancer. An uncle had prostate cancer. His mom had breast cancer. Others had esophageal, bladder and colon cancer. "I could see that it was an area of medicine that was oftentimes neglected and misunderstood," he said.

Dr. Griffith was a driven medical student, according to Robert Baird, MD, a colorectal surgeon in Huntsville. They met in 1966 while attending the Louisiana State University School of Medicine in New Orleans. "On Saturday nights Parker would want to go over to Charity Hospital and see if we could work in the emergency room," Dr. Baird said.

Cramer said he's seen the new congressman bring that same level of energy to his political life. "He is extraordinarily enthusiastic and excited about what he's doing," said Cramer, an attorney who met Dr. Griffith in the early 1980s through business and social circles. Besides practicing medicine and politics, Dr. Griffith owns funeral homes and commercial real estate, and he has been involved with radio stations, restaurants, home health care and tire recycling.

Cramer said Dr. Griffith brings maturity and resiliency to the job. But the new lawmaker is going to have be careful not to say "yes" to too many individuals and groups who approach him with requests. "He's going to have to be very careful about spreading himself too thin," Cramer said.

When it comes to health system reform, Dr. Griffith sees the issue from a variety of angles. He estimated that 80% of the nation's public/private health system works well, but he noted that not everyone has access to it.

Dr. Griffith also pointed out that no free market exists in health care. Certain communities have hospitals that face no competition, For example, they may have the only pediatric oncologist or other specialist in town. "Health care in America really is a huge system of quasi-monopolies funded in large part by Medicare and Medicaid. The concept that it will work itself out if we leave it alone is wrong," he said.

Dr. Griffith is fully convinced that universal access is a key to America's physical and financial health. "We have to have a fundamental level of health care that will prevent a medical problem from becoming a financial disaster."

Fear of being uninsured keeps people from living up to their potential as entrepreneurs, he said. People stay in mediocre jobs for the health insurance instead of taking a risk and starting a business.

And people's lifestyle choices are literally killing them, he said. "If we took out smoking-related cancer deaths from cancer statistics, our death rate from cancer would be declining. We lose more people in Alabama every year to smoking-related cancers than we do to colon, breast and prostate cancer combined."

Congress faces tough choices if it is going to keep public programs such as Medicare solvent. "It's an emergency. I think the house is on fire," Dr. Griffith said. "We're going to have to confront some very hard issues, and some of us in the political world are going to have to take some votes that might cost us our jobs."

Still, he doesn't think that should discourage other doctors from seeking those political jobs. Physicians felt for years like they didn't have time to be politically active or didn't want to get roughed up in that arena, he said. "But I think more and more as they realize that there are going to be policies made that are going to affect their patients and their pocketbooks that they need to be involved."

Lawmakers have plenty of theoretical medical economists to advise them on health reform decisions, but they need more physicians, Dr. Griffith said. "Because only the physician on the ground and in the trenches can really see the devil in the details."

John Fleming, MD: The reserved outsider

Dr. Fleming, 57, is a relative newcomer to political life.

He has a more extensive background in business than in politics. He is founder of the Fleming Group, which owns 30 Subway restaurants as well as small shopping centers and commercial real estate in northwest Louisiana. The company also provides ongoing sales, support and training for more than a hundred UPS Store locations.

Mike Toland runs the Fleming Group's day-to-day operations. He's known Dr. Fleming for 20 years, since he coached the physician's children in baseball and basketball. In the 13 years they've worked together, Toland has never seen Dr. Fleming get flustered.

He has seen him keep a tight circle, which could be both a political weakness and a strength, Toland said. "John dedicated himself to his few close friends, his family, his church and his companies."

Dr. Fleming's interest in medicine began as a young boy. His grandmother, a hospital nurse, told him stories about her work. Although he no longer remembers many specifics, he recalls the tales as having a "soap opera" quality. His interest in science led him to ask many questions, such as why a patient was bleeding and what the doctors did to stop it.

"It seemed like the perfect match. You help people. You study science," Dr. Fleming said.

He enjoyed most medical specialties, with the exception of surgery, which he found confining because it required too much time in one room. Family medicine allowed him to balance his interest in all types of medicine and to relate more readily to people.

He plans to keep practicing in Minden, La., as his congressional schedule permits, to remain in touch with his patients. Developing relationships with patients and working with them to improve their health is probably what he enjoys most about being a family physician. "Over time, those patients tend to become friends," he said.

Dr. Fleming is staunchly conservative and anti-abortion. He firmly believes in the power of free markets, but he sees a health system that doesn't harness the full force of that power. That's a big reason why he decided to run for Congress.

"I really do not feel that Congress has ever really understood why our health care system -- at least our financing part of it -- is broken. They really seem unable to fix it," he said.

"One of the goals while I'm here is to try to get Congress to see where the mismatch of resources against the needs are and how we can get so much more for the money we spend."

Dr. Fleming recalls when the federal government froze maximum allowable charges for Medicare services in 1984 in an attempt to restrain cost growth. Physicians and hospitals simply increased their volume of services to make up the difference. That problem would be curtailed if physicians could band together to negotiate their pay with the government and private insurers, he said.

Dr. Fleming does believe in safety nets -- as long as they don't turn into entitlements. His family needed a safety net when his father died of a heart attack in 1969 at the age of 43. Dr. Fleming was 17 then, living with younger siblings and a mother disabled by long-term postpartum depression. Despite receiving a college scholarship and working in his spare time, his family needed public assistance.

Patients should have incentives to access primary care and medical homes where they can develop strong relationships with physicians, Dr. Fleming said. Patients who pay $20 for their primary care doctor should perhaps have to pay $100 for a cardiologist, he suggested.

"If every American has easy access to primary care and is given certain incentives to receive that care, preventive care and early diagnostic care, then the picture of disease down the road becomes much better," he said.

Dr. Fleming said physicians should participate politically in every level of government, build better business skills, and push for needed insurance and other health entity reforms.

"Physicians for a long time have had the mind-set that if we take care of patients, everything else will take care of itself. I don't believe that's true any longer," the new congressman said. "If we're going to be in a position to provide good health care and to be able to support our families, we're going to have to become more politically involved."