A plague on both your houses

When you walked into the voting booth on Tuesday, November 6, did you do so with a feeling of calm certainty that the man who would get your vote for President was unquestionably the best choice, or even the only possible choice?  Did you feel confident that your candidate’s political party fully supports your political views as well as your personal values?

For many physicians, I suspect that the answer to those questions was not a resounding “yes”.  Perhaps more so than in any previous election that I can recall, there were elements in each party’s platform that many thoughtful physicians might have a hard time accepting.  The extreme left and right wing contingents within the Democratic and Republican parties argue for wildly different policies, but does either of them truly represent the best interests of our profession or our patients?

First, the Democrats

To take a closer look at this question, let’s start with the Democratic Party. Many physicians greeted the passage of the Affordable Care Act (ACA) with at least some sense of optimism.  After all, none of us want to deny care to patients who need it.  All of us have endured capricious and unjust denials of payment by insurance companies, and everyone understands the calamity that can result to a patient from the loss of a job and insurance coverage.

But even while the ink was still damp on the thousands of pages of fine print within the ACA, it became clear that it contained far more of a threat to the practice of medicine than many anticipated.  In essence, it aims to make health care cheaper by allowing non-physicians to practice medicine.  A secondary aim is to devalue physicians’ judgment by imposing “standards” and “protocols” of unproven merit.  This philosophy was perfectly summed up in a recent address by AMA President Jeremy Lazarus, who said, “It once made sense for physicians to value autonomy, independence, and self-sufficiency. But the game has changed.”  Another ACA apologist, Dr. Ezekiel Emanuel, advocates shortening medical education so that new physicians will “become comfortable with group decision making, standardization of practices, task shifting to non-physician providers”—in other words, making sure new physicians won’t have the scientific background to inform their decisions, and will seek the protection of group-think.

If all this wasn’t bad enough, many physicians failed to appreciate the critical moment when President Obama chose not to appoint a physician to succeed Dr. Donald Berwick as acting head of the Centers for Medicare and Medicaid Services (CMS), and instead appointed a nurse administrator, Marilyn Tavenner.  It should come as no surprise that CMS recently gave nurse anesthetists the right to bill Medicare directly for pain management services, over the strenuous objections of the ASA. Nationwide independent practice for nurse anesthetists and nurse practitioners is fast becoming a done deal.  A vote for President Obama implicitly endorsed this agenda.

Next, the Republicans

Yet there are so many reasons why a physician, male or female, might have been embarrassed to disclose to friends an intention to vote Republican in this election.

Sarah Palin and her equally ill-informed colleague in Congress, Michele Bachmann:  You’ll remember Mrs. Bachmann, at one point a GOP presidential candidate, who stated that the HPV vaccine causes mental retardation, and that “The Lion King” could influence children as propaganda for gay rights.

Todd Akin, the Missouri Congressman and unsuccessful Senate candidate, who opposes abortion in nearly all circumstances, and stated that rape rarely causes pregnancy because “the female body has ways to try and shut that whole thing down.”

Rick Santorum, another erstwhile GOP presidential candidate, who believes contraception is “harmful to women” because “it’s a license to do things in the sexual realm that is counter to how things are supposed to be.”

I could go on. But even setting aside the obvious targets, it’s all too easy to find reasons why many physicians were unable to support the Republican cause.  Certainly staunch Republican physicians like Maryland’s Representative Andy Harris, the first anesthesiologist in Congress, and ASA President John Zerwas, who serves in the Texas State Legislature, support physician interests tirelessly.  But it’s hard for their influence to outweigh the negative impact of the Tea Party zealots who tolerate no compromise on contentious social issues.

Here’s where I’m still confused.  I thought that conservatives and the Republican Party believed in fiscal stewardship, limited government, and the freedom of each individual American to chart his or her own destiny.  Yet the Republican candidates of 2012 seemed all too eager to have their influence extend into the most personal and intimate matters in people’s lives, issues that might better involve the counsel of a physician or a member of the clergy than a politician.

In fact, the Republicans didn’t conceal their disdain for a lot of different groups of people in America.  But it wasn’t a clever move to alienate anyone with sympathy for feminism, for immigration reform, or for people who lack health insurance, and it certainly didn’t end well for the GOP.

I’m no expert on immigration policy, but weren’t nearly all of us immigrants at some point?  As the granddaughter of Polish immigrants and the great-granddaughter of an O’Sullivan who (according to family lore) left Ireland one step ahead of the hangman’s noose, I can only be grateful that my ancestors got here before anyone started talking about building a wall to keep immigrants out.  Governor Romney’s talk of “self-deportation” of illegal immigrants was annoying and irrelevant, and it’s hard to understand why he didn’t make better use of New Mexico’s Governor Susana Martinez and Florida Senator Marco Rubio in his campaign.

When we look around our hospitals, it becomes clear how much immigration has benefited American medicine.  The doctors’ lounge and nursing stations look like the United Nations, and it’s lucky that we have physicians and staff who can speak Spanish, Farsi, Chinese, Russian, Armenian, and Tagalog with our patients from around the world.  Can we really criticize people of Hispanic or Asian descent, or anyone else for that matter, who didn’t vote Republican?

Do we need a new American political party?

Here’s my wish list.  I’d like to be able to vote for a candidate who truly believes in limited government and free enterprise.  I believe that there is a role for government in the coverage of trauma and catastrophic illness, but that patients should expect to budget for routine health care, pay their physicians, and pay for routine medications just as they pay for food, shelter, cell phones, automobiles, and legal advice.  I wish everyone would simply let Roe v. Wade stand as settled law, and leave the rest to individual conscience. I support civil unions for consenting adults with rights and responsibilities to be defined by state government, and marriage as a sacrament to be defined privately by religious institutions according to their traditions.  I’d like to keep on practicing medicine as an honorable profession with a proud history, and not live in fear of violating “protocols” set in place by federal government administrators who know little of what we do.

Is that too much to ask?  Can either political party reinvent itself to be a party that physicians could enthusiastically support, maintaining loyalty to the profession as well as to their personal values?  Or do we need a new American political party altogether?  We have just under four years to figure it out.


a reader

Hi! I have been enjoying your recent articles! I have some questions about anesthesiology and I was wondering if you could give me some insight. I’m an MS2 interested in the field…

1) I was wondering if you would still advise interested students to go into anesthesia considering all of the CRNA issues? I wouldn’t be averse to doing a fellowship if that was necessary–if I did one it would probably be in peds.

2) I’m a pretty social person (like a lot of people in medicine) and one of my concerns is whether anesthesia will be social enough for me. I’m thinking it will be nice to connect with patients and their families before surgery (though I’ll often be following the same “script”), there is definitely some shop talk during surgeries between the surgeon, nurses, and anesthesiologist (though I suppose this can vary a lot depending on the case), and I assume there will be some downtime to chat with my colleagues socially between cases. But one of the things I’ve enjoyed about my previous jobs is the social interaction between myself and my coworkers and I’m not sure if I should expect a lot of lonely hours in the OR? Don’t get me wrong, a super chatty patient in primary care clinic can often be too much for me, but I don’t want to feel lonely or isolated in my job either.

Thanks so much!!



Dear dmfinn,

Thank you so much for writing. You pose thoughtful questions which don’t necessarily have easy answers.

Many specialties are going to face problems with undercutting and competition from lesser-qualified advanced practice nurses. This was evident as soon as President Obama nominated a nurse instead of a physician to head Medicare for the first time in history. This administration is granting unprecedented powers to advanced practice nurses in a misguided attempt to control the cost of health care. We in anesthesiology are no different in this regard from family practitioners, pediatricians, and internists. Your best bet in terms of job security is to become as highly trained and specialized as you can in whatever field you choose, so that you can truly define yourself as able to provide unique, valuable service that cannot be equaled by a nurse.

The practice of anesthesiology takes many different forms; read up on the “anesthesia care team” for more information. One good resource is the American Society of Anesthesiologists’ website. I practice in a large group but am typically in an operating room caring for one patient at a time. This suits me very well. I interact with all the surgeons and nurses during the case, and see anesthesiology colleagues at other times. In other hospitals, the attending anesthesiologist may supervise more than one OR at a time, working with residents, nurse anesthetists, and/or anesthesiology assistants. This type of work environment provides a great deal of personal and social interaction–perhaps too much on some days!

One drawback of anesthesiology (along with radiology and emergency medicine) is the lack of longitudinal care of any patient, and the lack of long-term relationships with patients over the years. Some people find this a deal-breaker. You certainly won’t get the patient accolades that the surgeons do, no matter how important your role in the success of the mission. It’s just as well to recognize this up front. On the other hand, you’re hardly ever the physician that has to break the news of a cancer diagnosis or a bad outcome. So every field has its advantages.

The most important thing for you to do as you go through your clinical rotations is to keep an open mind, and not choose a specialty prematurely. Eventually you’ll see what you really love and want to do.

All the best, and please let me know how you are doing as your medical school years progress.

Karen Sibert


a reader

Thank you so much for the thoughtful insights! I’m excited (but nervous!) about starting third year soon and I hope it will bring me some answers that I crave about what I want to do with the rest of my life. 😉




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