David Blumenthal, M.D., Russell L. Gruen, M.B.B.S., Ph.D., and Eric G. Campbell, Ph.D.
R. L. Gruen, E. G. Campbell, and D. Blumenthal, Public Roles of U.S. Physicians: Community Participation, Political Involvement, and Collective Advocacy, Journal of the American Medical Association November 22, 2006 296(20):246775
Physicians are naturally concerned with the health of their own patients, but to what extent are they also civic-minded? That is, are they concerned about social and economic issues that affect the health of their patients beyond the doors of their practices? Do physicians have a responsibility to advocate for public health issues and contribute to the society that grants them professional status?
The answer, according to physicians themselves, is yes. A new Commonwealth Fund–supported study finds that nearly all physicians believe they should play public roles, and two-thirds are actively involved in community activities, political work, or advocacy. In "Public Roles of U.S. Physicians: Community Participation, Political Involvement, and Collective Advocacy" (Journal of the American Medical Association, Nov. 22, 2006), lead author and former Harkness Fellow Russell L. Gruen, of the University of Melbourne, Australia, along with co-authors Eric C. Campbell and David Blumenthal, of Massachusetts General Hospital and Harvard Medical School, report findings from a survey to determine physicians' attitudes toward, and involvement in, the public sphere.
The researchers envisioned three types of public roles for physicians: community participation, political involvement in health issues (other than voting), and collective advocacy through professional organization. They conducted a mail survey between November 2003 and June 2004 of 3,504 U.S. physicians engaged in direct patient care (family practice, internal medicine, or pediatrics) or working in one of three specialties (anesthesiology, general surgery, or cardiology).
Nearly All Physicians View Their Public Roles As Important
Among the 1,662 survey respondents, more than 90 percent said that community participation, political involvement, and collective advocacy were important roles for physicians. To generate an overall score for civic-mindedness, researchers combined physicians' ratings for each of the three domains of public life. They found that 70 percent of respondents were civic-minded, with greater proportions among women, minorities, graduates of non-U.S. or non-Canadian medical schools, and those who had been in practice longer.
Type of specialty made a difference. For example, pediatricians and family practitioners were significantly more likely than internists and non–primary care physicians to rate community participation as being very important. Anesthesiologists and general surgeons were significantly more likely to rate political involvement as being very important than were cardiologists and pediatricians.
Health-Related Factors Seen as Very Important Topics for Advocacy
When asked to select from a list of factors, most physicians said it was very important to advocate for socioeconomic factors directly related to health, such as obesity, immunization, tobacco control, and substance abuse. More than half (58%) rated access to health insurance for the uninsured population as being very important, and 46 percent said ensuring the "cultural responsiveness" of health services in ethnically diverse areas was very important. Fewer respondents pointed to broader socioeconomic issues, such as literacy and air pollution, as being very important.
Most Physicians Participate in Civic Activities
Two-thirds of physicians (65%) had taken part in some type of community, political, or advocacy work in the past three years, with half (54%) providing health expertise to community groups, one-quarter (26%) taking political action on a health-related issue, and one-quarter (24%) encouraging a professional society to advocate for a public health issue. Not surprisingly, civic activity was significantly associated with scores on civic-mindedness. Minorities were significantly more active in community and political spheres than were white physicians. Rural physicians were more likely to take part in civic activities than those practicing in metropolitan areas.
Physicians seem to feel more responsible for issues directly related to health, such as obesity or smoking, than those less directly related, such as literacy or unemployment. Even though there is considerable evidence linking health insurance coverage to health status, fewer physicians said that advocating for expansion of insurance coverage was a very important issue for them—perhaps because they feel they have little influence in this area or because the issue has become politicized, the authors suggest.
Physicians' attitudes did not always predict action: 28 percent of physicians identified as civic-minded had not taken part in public activities in the previous three years. Conversely, more than half who had not been identified as civic-minded had taken part in such activities. Professional and practice characteristics, as well as sociodemographic factors, were related to levels of physician activity in the public sphere. "[A] variety of personal, professional, and practice characteristics may influence physicians' civic-mindedness and civic activity," the authors write. "Confirming and understanding these potential influences could provide important guidance to leaders and policymakers who want to enlist the positive energy of physicians in promoting public health at a societal level."
Facts and Figures