Best of 2024: Physician politicians: Why doctors choose to serve -- and how you can too

Editor's note: 2024 has been a year of innovation in primary care, from advancements in artificial intelligence to the growing role of value-based care. As we close out the calendar year, our "Best of 2024" series highlights Medical Economics' coverage of the past year's health care trends that have paved the way towards better patient care.

Listen to the accompanying episode of the "Off the Chart with Medical Economics" podcast: The physician's guide to running for office.

Physicians who run for elected office say they’re proud to serve patients in ways that go beyond the individual contacts in the examination room. This fall, doctors will appear on the ballot with other political candidates seeking public office. They are a small group relative to the total number of physicians or elected leaders in the nation. However, they said their experiences in medicine are great preparation for serving in office, and they spoke to Medical Economics about the process of campaigning and why more doctors need to get involved in politics.

Physicians in politics

Physicians were more prominent in the federal government in the first 100 years of the United States, but that has waned over time. Physicians have always been involved in politics, but lawyers have dominated Congress since 1960, which was the start of Medicare, Medicaid and federal participation in health care payment and policy, according to “Is There a Doctor in the House? … Or the Senate? Physicians in U.S. Congress, 1960-2004,” a 2004 study by Chadd K. Kraus, D.O. , Dr.PH., M.P.H., and Thomas A. Suarez, M.D.

As of July 2022, there were 17 federal physician-legislators making up 3.1% of 541 members of Congress; at the state level, 86 physicians made up 1.1% of the population among 7,552 lawmakers. Doctors were 0.3% of the American population then, so, numerically, physicians were overrepresented in federal and state legislatures, according to a 2022 study by Tanvee Varma, M.D., and Matthew Goldenberg, M.D., MS.c.

Physicians may be overrepresented in Oregon, where state Sen. Elizabeth Steiner, M.D., is running for state treasurer. Her current state Senate district encompasses two state House districts, both represented by physicians: state Rep. Lisa Reynolds, M.D., a pediatrician who is seeking reelection; and state Rep. Maxine Dexter, M.D., a pulmonologist who is seeking election to the U.S. House of Representatives. “We have quite the gamut, but mostly primary care,” said Steiner said.

In contrast, in 2022, when Bill Hauter, M.D., emergency and anesthesiology specialist, won his seat in the Illinois House of Representatives, he was the first physician elected to that chamber in 30 years.

Staying off the ballot

Why don’t more doctors get involved in politics? Largely because of a lack of time and money, according to lawmakers. Medical school, residencies and fellowships last for years in a period of life when new physicians also may be starting families, practices or both, which are all huge commitments. For newer or established doctors — whether employed or in independent practice — the hours are long.

“The practice of medicine doesn’t offer a lot of spare time. It’s an occupation that robs a lot of your time away from your family and other things that probably would be important to be involved with,” said Ken Moore, M.D., elected mayor of Franklin, Tennessee. “So they guard that free time pretty hard.”

Medical school also costs a lot of money, and doctors have to repay those debts. They generally earn more than elected officials. Most members of Congress earn $174,000 a year, with more for leadership roles. Legislators in California and New York earn six-figure salaries, but some states pay much less, and local positions such as city councils or school boards may have minimal or no pay.

“My running joke is that I get paid $32,000 a year to run the $33-billion biennial budget. But that’s OK,” said Steiner, who has become one of her state’s spending experts.

Attitude can also be a factor. “I think sometimes [some physicians] think it’s below them to be involved in politics,” Moore said.

The politics of medicine

Regardless of history or contemporary influences, the physicians agreed that more doctors need to be involved in politics. Health care is a huge part of the U.S. economy, and it is intensely personal to every American — whether they vote or not and whether they are in good health or not. It is intensely public, as evidenced by the COVID-19 pandemic. It is also governed by lots of “well-meaning, very smart people,” who are not physicians, Hauter said. “They don’t understand the reality of medicine,” he continued. “A lot of their prescriptions or solutions are not going to work in the real world of medicine.”

“We have to certainly be more involved, because medicine and politics are completely intertwined now,” said Minnesota state Sen. Alice Mann, M.D., M.P.H. “They are one and the same. The care I provide for my patients has a direct correlation to what’s going on in local and federal politics. People who have never touched a patient … are making laws about how I practice medicine. If we don’t become more involved, the system is just going to get worse and worse.”

Do no harm and be a good listener

The physician lawmakers agreed that doctors have the potential to make competent elected leaders because of their medical training. “I’ll tell you this, and people don’t normally think about it: You’re a doctor, you’re in your lane. Political office is in another lane over here, and the two really don’t intersect. But, in fact, they do,” said Rep. Michael C. Burgess, M.D. (R-Texas), who is now the longest-tenured physician in Congress.

A skill that physicians and lawmakers have in common is being able to sift through large volumes of information, understanding it quickly and then asking the critical questions. “Preparing for a committee hearing is like an all-nighter before a major midterm exam in medical school,” Burgess said.

In both arenas, a lot of information comes from listening. “You’re not a good doctor if you’re not a good listener, and you’re not a good political representative if you’re not a good listener,”
Burgess said.

Rep. Ami Bera, M.D. (D-C.A.), agreed. “We’re taught to listen and to gather information, but we also, as doctors, have to make a decision, implement it and then learn from the outcome of that decision,” he said. “That’s how I approach Congress. I’m not here to judge my colleagues, whether they’re Democrats or Republicans. I’m here to try to understand their perspective, which is what we do with our patients. That really does come from listening to one another, and we could use more of that in politics today.”

Why run for office?

Calling the office of an elected official is one thing, but feeling the call to become an elected official is another. The elected physicians described their motivations as spurred at times by personal and professional reactions to large-scale public events.

Burgess had a successful OB/GYN surgical practice when the attacks on Sept. 11, 2001, shocked the nation. “For me, it was 9/11. The events surrounding 9/11 were pretty jarring. They caused me to ask: Am I doing what I’m supposed to be doing with my life, or should I be doing something else?” he said.

Bera made his first run for Congress in 2010, on the heels of former President Barack Obama’s election.

“I knew he was going to work on health care, so I could either sit on the sidelines or try to get in the game and shape what this looks like,” Bera said. He lost the race in 2010 but was elected to Congress in 2012.

U.S. Rep. Kim Schrier, M.D. (D-W.A.), who has publicly disclosed that she has type 1 diabetes, said she was inspired by national legislative attacks on the Affordable Care Act and Planned Parenthood, an organization she supports. “A friend suggested to me that as a physician with a preexisting condition, I might be the perfect voice to speak up for health care,” she said. She added that she lives in a 50/50 “flip-able” district, so she ran for the seat, won it and has since kept it.

For Steiner and Moore, running for office evolved from advocacy through their respective state medical organizations. Eventually, people suggested they become candidates. Hauter and Jasmeet Bains, M.D., California State Assembly member, cited the COVID-19 pandemic as part of their inspirations.

In Illinois, the legislature had lawyers, business owners, teachers, farmers and activists but no physicians to make decisions in a public health emergency, Hauter said, who first served as an elected member of the Tazewell County Board. Mandatory closures and vaccinations felt authoritarian, he said, “and I just felt really compelled to run for state representative.”

When the pandemic hit, physicians were lauded and then cast aside, Bains said, who is a specialist in family medicine and addiction medicine. When people lost their jobs due to the economic conditions, they also lost health insurance. Elected leaders made decisions out of fear. At the same time, the opioid crisis was devastating families, and political, community and law enforcement leaders needed medical guidance, she said. “Those were the reasons why I decided to run for office, because you saw a physician who was at the end of her rope trying to come up with solutions at the level of being a community doctor,” Bains said.

Mann said she developed a gnawing desire to find ways to help patients struggling with health care access and affordability. “I feel like I’m working in a system that keeps putting up barriers in front of patient care, so I ran for office,” Mann said.

In 2020, because of the COVID-19 pandemic, Mann did not seek reelection and instead returned to medicine full time. “We were getting bombarded in the emergency department (ED). I thought: ‘Someone can replace me in the Minnesota House [of Representatives], but we don’t have extra physicians lying around to replace me in the ED,’” she said. When redistricting in 2022 put her in a district without a senator, she returned to the campaign trail and won the election for Minnesota Senate.

Campaigning and serving

The elected doctors said running for office and serving in office are two related jobs but are sometimes very different jobs.

“I think campaigning is fun,” Moore said. “The part of campaigning that is not so much fun for most politicians is asking for money. And to run a campaign, you’ve got to have money.”

When seeking contributions, the elected physicians said they are not asking for handouts but for financial pledges toward a common cause.

Hauter raised about $150,000 to run for state representative, with donations from family, friends and supporters. He also credited the Illinois State Medical Society for help. He spent $135,000 and said he did not want to have to keep asking people for money. However, a political adviser emphasized that continual fundraising to build the “war chest” shows that a candidate has a base of support by people who want to fight for their families, homes and values, and to change Illinois for the better. Hauter said that it also signals to potential opponents that “I’m effective enough that there’s people who support me. If you want to take me on, this is my backing.”

When beginning her run for office, Schrier said she felt she needed to cram about world leaders, economics and foreign policy. “My team who is charged with getting me elected wanted me to sit on the phone and ask people for money to support my campaign,” Schrier said. “I’ve never asked for anything in my life. Even with my parents, I was pretty timid about asking for things, so it was very weird to call people.

“I felt like I was spinning my wheels and wasting my time,” she said. Her team’s advice was that “nobody is going to know what you think or how much you know if you can’t afford to say it to them, and it’s a really good point,” Schrier said.

Growing up in the family auto sales business, Bains said she was used to cold-calling people and the disappointment of rejection. “It is hard to ask people for money, but when you’re passionate and you have the right reasons to run for office, it’s not that hard,” she said. “Because when there’s a question, you have the answer to it, and you are giving them examples for why it is that you need to be elected to office. If you don’t have a reason to run for office other than you want to climb the political ladder, then it will be difficult. But if you have a real passion and there are things you want to change … all you’re doing is calling to get people to believe in your vision. That’s the first step of being a leader.”

Time in office

Once elected and sworn in, doctors generally follow the same daily routines as other lawmakers. When the governing body is in session, days include committee hearings, debates, votes and meetings with aides, other lawmakers, regulators and visitors. Evenings can include fundraisers, nonprofit events and dinners with other legislators of the same or opposing party.

Back home, there are staff meetings, but there is much more work with constituents. This can range from town hall meetings to visiting area farms, businesses, factories or schools to appearing at local government meetings, campaign kickoffs, community events or fundraisers.

Burgess, Bera and Schrier crisscross the country by airliner, flying in for sessions, flying home for weekends and using time in the air to read or sleep. The local elected physicians generally have less travel, which allows for greater flexibility to practice medicine, though Bains said she had to scale back some duties due to the five-hour drive between Delano and Sacramento, California. Steiner, Hauter and Mann get to return home every night. “There’s a zero percent chance I could do this job if I could not live at home with my kids,” Mann said. Moore lives where he serves as mayor, so he is well traveled in Franklin.

In session or in the district, the doctors don’t necessarily walk in lockstep with each other or with every voter, but they said they try to reach out to colleagues on both sides of the aisle for the health of the body politic. “There’s no way that all doctors are going to hold the same political beliefs,” Schrier said. “But some of my favorite partners in both parties are physicians, because we speak a common language. We all did residency, and we all had practices of one sort or another, so we work together. Even though we may disagree on plenty of issues, we all bring that spirit of a physician — listening, finding common ground and working together for the greater good.”