Political self-characterization of US women physicians

Erica Frank*

Department of Family and Preventive Medicine, Emory University School of Medicine, 69 Butler St., Atlanta, GA 30303, USA

Abstract

The political self-characterization of US physicians, especially including women physicians, has been poorly

described. We used data from the 4,501 respondents to the Women Physicians' Health Study (WPHS), a strati®edrandom sample of US women M.D.s surveyed in 1993±1994, to assess US women physicians' politicalcharacteristics. US women physicians were most likely to consider themselves politically moderate (36.6% of

respondents). More considered themselves liberal (28.4%) or very liberal (8.8%) than considered themselvesconservative (20.5%) or very conservative (5.8%). US women physicians predominantly bring moderate and liberalvoices to political discourse. Organizations that wish to attract US women physician members should consider

promoting less conservative policies. # 1999 Elsevier Science Ltd. All rights reserved.

Keywords: Physicians; Physicians, Women; Politics

Introduction

Although organizations such as the AmericanMedical Association are often considered to be politi-

cally conservative (McCormick, 1998), little is knownabout how American physicians politically characterizethemselves as individuals. Physicians' political beliefs

may be important, because they may a�ect their sup-port of issues relevant to medicine. To examine phys-icians' political self-characterization, the 4,501respondents to the Women Physicians' Health Study

(WPHS), a national, questionnaire based survey, wereasked ``Would you characterize yourself as politically:very conservative, fairly conservative, moderate, fairly

liberal, or very liberal?''

Methods

The design and methods of the Women Physicians'Health Study (WPHS) have been more fully described

elsewhere, as have basic characteristics of the popu-lation (Frank, 1995; Frank et al., 1997, 1998). WPHSsurveyed a strati®ed random sample of US women

M.D.s; the sampling frame is based on the AmericanMedical Association's (AMA's) Physician Master®le, adata base intended to record all M.D.s residing in theUS and possessions. Using a sampling scheme strati-

®ed by decade of graduation from medical school, werandomly selected 2500 women from each of the lastfour decades' graduating classes (1950 through 1989).

We over-sampled older women physicians, a popu-lation that would otherwise have been sparsely rep-resented by proportional allocation because of the

recent increase in numbers of women physicians. Weincluded active, part-time, professionally inactive andretired physicians, aged 30±70, who were not in resi-dency training programs in September 1993, when the

sampling frame was constructed. In that month, the

Social Science & Medicine 48 (1999) 1475±1481

0277-9536/99/$ - see front matter # 1999 Elsevier Science Ltd. All rights reserved.

PII: S0277-9536(98 )00454-7

* Tel.: +1-404-616-5603; Fax: +1-404/616-6847.

E-mail address: efrank@fpm.eushc.org (E. Frank)

Table

1

Politicalself-characterizationofUSwomen

physicians,a,b%

(S.E.)(�p

R0.05;��p

R0.01;��� p

R0.001;����p

R0.0001)

V.Conservative%

(S.E.)

Conservative%

(S.E.)

Moderate

%(S.E.)

Liberal%

(S.E.)

V.liberal%

(S.E.)

p-value

Total,n

269

939

1612

1194

364

±

Percent

6(0.4)

21(0.8)

37(0.9)

28(0.9)

9(0.5)

Age 30±39

5(0.8)

22(1)

36(2)

29(2)

8(0.8)

����

40±49

5(0.7)

17(1)

37(2)

29(1)

12(1)

50±59

8(0.9)

23(2)

38(2)

25(2)

6(0.9)

60±70

8(1)

24(2)

36(2)

24(2)

9(1)

Birthplace

����

US

5(0.5)

19(0.9)

34(1)

32(1)

10(0.7)

Other

country

8(1)

25(2)

43(2)

19(2)

5(0.8)

Ethnicity

����

Hispanic

15(3)

16(3)

42(5)

23(4)

5(2)

Black

2(1)

10(3)

47(5)

29(5)

11(3)

Other

5(3)

27(5)

40(5)

21(5)

7(3)

Asian

9(1)

31(2)

44(2)

13(2)

3(0.8)

White

5(0.5)

19(0.9)

34(1)

32(1)

10(0.6)

Maritalstatus

����

Unmarriedcouple

0.6

(0.6)

9(3)

35(5)

29(5)

26(5)

Single

5(1)

20(2)

39(3)

29(3)

8(2)

Widowed

12(5)

18(4)

48(6)

17(5)

5(2)

Separated/divorced

5(1)

20(3)

41(3)

24(2)

10(2)

Married

6(0.6)

21(0.9)

36(1)

29(1)

8(0.6)

Children

Yes

6(0.5)

21(0.9)

36(1)

28(1)

9(0.6)

NS

No

5(0.8)

21(2)

37(2)

28(2)

9(1)

Childcaretaker

�

Self

7(1)

15(2)

38(3)

29(2)

11(2)

Others

6(0.6)

21(1)

36(1)

29(1)

8(0.7)

Mother'seducation

���

RHighschoolgraduate

6(0.7)

21(1)

40(2)

26(1)

8(0.8)

Somecollege/collegegraduate

6(0.7)

20(1)

36(1)

29(1)

9(0.8)

Graduate

school

5(1)

19(2)

27(2)

35(2)

14(2)

Medicalschool

7(3)

22(4)

40(5)

26(4)

6(2)

Father'seducation

RHighschoolgraduate

6(0.9)

22(1)

39(2)

26(2)

8(0.9)

Somecollege/collegegraduate

6(0.8)

21(1)

35(2)

29(2)

8(0.9)

Graduate

school

5(0.9)

18(2)

35(2)

30(2)

12(1)

Medicalschool

5(1)

21(2)

37(3)

30(2)

7(1)

E. Frank / Social Science & Medicine 48 (1999) 1475±14811476

Table

1(continued

)

V.Conservative%

(S.E.)

Conservative%

(S.E.)

Moderate

%(S.E.)

Liberal%

(S.E.)

V.liberal%

(S.E.)

p-value

Incomeper

hour

����

US$0±36

4(0.7)

20(1)

33(2)

32(2)

11(1)

US$37±59

6(1)

18(1)

34(2)

32(2)

10(1)

>US$59

7(0.9)

23(2)

39(2)

25(2)

7(0.9)

Sexualidenti®cation

����

Heterosexual

6(0.5)

21(0.8)

37(0.9)

28(0.9)

8(0.5)

Bisexual

2(2)

2(1)

20(6)

50(9)

26(8)

Lesbian/gay

0.9

(0.9)

4(2)

22(5)

39(6)

34(6)

Other

2(2)

23(11)

16(7)

36(15)

24(11)

Specialty

��

Primary

care

5(0.6)

21(1)

35(1)

29(1)

11(0.8)

Specialist

6(0.6)

20(1)

38(1)

28(1)

7(0.7)

Specialty

����

Anesthesiologist

12(3)

26(3)

41(4)

18(3)

4(2)

Dermatology

9(3)

27(5)

32(5)

33(6)

0(±)

Emergency

medicine

4(2)

24(5)

43(6)

17(4)

12(4)

Familymedicine

5(1)

16(2)

32(3)

35(3)

13(2)

Generalpractice

8(3)

25(5)

42(5)

18(4)

8(3)

Generalinternalmedicine

7(1)

21(2)

36(3)

26(2)

10(2)

Med-subspecialty

5(2)

13(2)

40(3)

35(3)

7(2)

Neurology

6(5)

8(4)

33(8)

46(8)

6(3)

Ophthalm

ology

8(3)

36(6)

36(6)

18(5)

4(3)

Ob/G

yn

7(2)

22(3)

35(4)

27(3)

10(2)

Pathology

8(3)

23(4)

42(4)

25(4)

3(1)

Pediatrics

4(0.9)

22(2)

35(2)

30(2)

10(1)

Publichealth

5(3)

12(6)

27(6)

39(7)

18(6)

Psychiatry

2(0.7)

12(2)

36(3)

37(3)

12(2)

Radiology

6(2)

32(5)

41(5)

18(4)

3(2)

Surgery,general

6(4)

25(9)

31(10)

28(8)

10(4)

Surgery,subspecialty

10(4)

27(6)

36(6)

25(6)

2(2)

Other

5(2)

24(4)

38(4)

24(4)

9(2)

aChi-square

test

forprevalences.

bNumberswithin

atraitmayaddto

>100%

dueto

rounding.

E. Frank / Social Science & Medicine 48 (1999) 1475±1481 1477

Table 2

Odds ratios for variables associated with liberalism among US women physiciansa (�pR0.05; ��pR0.01; ���pR0.001;����pR 0.0001)

Odds ratio (95% CI) p-value

Age ���

60±70 1.3 (1.0±1.8)

50±59 1.3 (1.0±1.7)

40±49 1.6 (1.3±2.0)

30±39 1.0 (±)

Birthplace NS

US 1.3 (1.0±1.8)

Other country 1.0 (±)

Ethnicity ����

Hispanic 0.5 (0.3±0.9)

Black 1.1 (0.7±1.9)

Other 0.6 (0.3±1.2)

Asian 0.3 (0.2±0.5)

White 1.0 (±)

Marital status NS

Unmarried couple 1.0 (0.6±1.7)

Single 1.0 (0.7±1.4)

Widowed 0.7 (0.3±1.4)

Separated/divorced 0.7 (0.5±1.0)

Married 1.0 (±)

Mother's education ��

Medical school 1.0 (0.6±1.6)

Graduate school 1.7 (1.3±2.2)

Some college or college graduate 1.1 (0.9±1.3)

RHigh school graduate 1.0 (±)

Income per hour �

US$0±36 1.4 (1.1±1.8)

US$37±59 1.2 (1.0±1.6)

US>$59 1.0 (±)

Sexual identity ����

Bisexual 3.5 (1.6±8.0)

Lesbian/gay 4.5 (2.2±9.2)

Heterosexual 1.0 (±)

Specialtyb

Anesthesiology 0.9 (0.5±1.7) NS

Dermatology 1.2 (0.6±2.5) NS

Emergency medicine 1.0 (0.5±1.9) NS

Family medicine 2.1 (1.2±3.5) ��

General practice 0.9 (0.4±2.0) NS

General internal medicine 1.2 (0.7±2.0) NS

Med±subspecialty 1.7 (1.0±2.8) �

Neurology 2.9 (1.3±6.7) �

Ophthalmology 0.6 (0.3±1.5) NS

Obstetrics/gynecology 1.4 (0.8±2.4) NS

Pathology 1.2 (0.7±2.2) NS

Pediatrics 1.7 (1.1±2.8) �

Public health 2.7 (1.3±5.8) �

Psychiatry 2.4 (1.5±4.1) ���

Radiology 0.5 (0.2±1.1) NS

Surgery, general 0.9 (0.4±2.3) NS

Surgery, subspecialty 0.8 (0.4±1.8) NS

a Higher odds ratios connote a greater likelihood to be liberal.b Each specialty's odds ratio is a contrast of that specialty versus all others.

E. Frank / Social Science & Medicine 48 (1999) 1475±14811478

®rst of four mailings was sent out; each mailing con-tained a cover letter and a self-administered four-page

questionnaire. Enrollment was closed in October 1994(®nal n=4501).Of the potential respondents, an estimated 23%

were ineligible to participate because their addresseswere wrong or they were men, deceased, living out ofthe country, or interns or residents. Our response rate

is 59% of physicians eligible to participate. We com-pared respondents and non-respondents in three ways:we used our phone survey (comparing our phone-sur-

veyed random sample of 200 non-respondents with allthe written survey respondents), the AMA PhysicianMaster®le (contrasting all respondents with all non-respondents) and an examination of survey mailing

waves (all respondents, from wave 1 through 4) tocompare respondents and non-respondents regarding alarge number of key variables. From these three inves-

tigations, we found that non-respondents were lesslikely than were respondents to be board-certi®ed.However, respondents and non-respondents did not

consistently or substantively di�er on other testedmeasures, including age, ethnicity, marital status, num-ber of children, alcohol consumption, fat intake, exer-

cise, smoking status, hours worked per week,frequency of being a primary care practitioner, per-sonal income, or percentage actively practicing medi-cine.

Based on these ®ndings, we weighted the data bydecade of graduation (to adjust for our strati®edsampling scheme) and by decade-speci®c response rate

and board-certi®cation status (to adjust for our ident-i®ed response bias), allowing us to make inference tothe entire population of women physicians graduating

from medical school between 1950 and 1989. Analyseswere conducted in SUDAAN (Shah et al., 1991).

Findings

Demographic and personal characteristics

Self-characterizing as less conservative were phys-icians who were younger, US-born, black or white,

members of unmarried couples, non-heterosexual,themselves the primary caretaker for their children andhaving more educated (but non-physician) mothers.

Professional characteristics

More conservative specialties were anesthesiology

and general practice (both with a higher percentage ofphysicians born out of the country), dermatology, oph-thalmology, radiology and surgical subspecialists; more

liberal specialties were family medicine, medical sub-specialists, neurology, public health/preventive medi-

cine, and psychiatry. Physicians in primary care andthose with lower hourly incomes self-characterized as

more liberal.

Multivariate model

Physicians who were Asian or Hispanic were signi®-cantly less likely to be liberal. More liberal were phys-

icians: aged 40±49; with mothers who had attendedgraduate or professional (other than medical) school;homo/bisexuals; who earned less and who were family

physicians, medical subspecialists, neurologists, pedia-tricians, public health/preventive medicine specialists,or psychiatrists.

Discussion

US women physicians' political self-characterizationis diverse (Table 1). They are most likely to considerthemselves politically moderate, though more consider

themselves liberal or very liberal than consider them-selves conservative or very conservative.We found a number of interesting demographic

di�erences related to political self-characterizationamong these physicians (Table 2). Physicians aged 40±49, children in the politically liberal 1960s, were themost liberal physicians; physicians maturing in the

Reagan era were the most conservative. Some phys-icians complain about a decline in altruism amongrecent US medical school graduates. This may or may

not be true (data on this topic are scarce) but, if true,while some might ascribe such a change to the growthof managed care, it may be that this recent cohort has

more conservative values, and therefore may be lesssupportive of societal safety nets in healthcare andother areas. We also found that Asians and Hispanicswere signi®cantly less liberal than were Whites; this

was true even when adjusted for country of origin. Itmay be that more conservative members of minoritycommunities choose medicine as a profession or that

medical training and practice promotes conservatismmore among Asians and Hispanics than among Blacksand Whites. Finally, we found that family physicians,

preventionists (Frank, 1991) and psychiatrists (as wellas non-heterosexuals) were more liberal; such ®ndingsare unlikely to surprise most readers.

Physicians' political natures matter. Physicians' pol-itical inclinations may in¯uence such clinically-relevantdecisions as provision of care to Medicaid patients,provision of preventive services (Maheux et al., 1987)

or abortion (Nathanson and Becker, 1978), treatmentof alcoholism (Linn and Yager, 1989) or end of life de-cisions, as well as willingness to go on strike (Kravitz

et al., 1989), opinions regarding universal access tohealth care, and remediation of health-a�ecting social

E. Frank / Social Science & Medicine 48 (1999) 1475±1481 1479

inequities. Further, physicians are also often leaders intheir communities, and the directions of such leader-

ship may also be in¯uenced by their leanings.Few other studies have examined this issue. A 1986

British study found substantial variation among phys-

icians in political outlook, with surgeons being es-pecially conservative (this may be more true of menphysicians, 91% of those surveyed) and psychiatrists

being especially liberal (echoing our ®ndings)(Wakeford and Allery, 1986). A 1972 survey of 278Yale University School of Medicine students and

graduates (n=24 women) found that 49% self-charac-terized as liberal; this was especially true of youngerphysicians, those never-married and non-surgeons (es-pecially, again, psychiatrists) (Goldman, 1974). This

suggests that, at least in their selected population ofprimarily male physicians, liberalism was also notuncommon. A limitation of our study is that we do

not know if our ®ndings are true of men physicians; asmall (n=182) 1979 study of Detroit physicians foundfemale physicians (especially older female physicians)

more liberal than their age-matched male colleagues(Heins, 1979). Another serious limitation is that politi-cal characterization was self-de®ned and di�erent indi-

viduals may have inferred di�erent meaning of`political' character.Studies of political natures in the general population

have had variable ®ndings. Some have found that pro-

fessionals tend to be more conservative than are non-professionals (Phelan and Phelan, 1991), but othershave found that professionals have shifted away from

conservative social attitudes (Brooks and Manza,1997). As with the Detroit physician study, some havealso found an interaction with gender: white-collar

women may be more liberal than are white collar men(Smith, 1993).Many believe it to be part of physicians' obligations

to be politically involved (Masem, 1976; Jonsen and

Jameton, 1977; Callan, 1979; Eisenberg, 1986;Editorial, 1998). While some have found that phys-icians (especially older, more conservative physicians)

are more politically active than other Americans(Handberg, 1982), others have found that physicians'involvement, at least at the congressional or guberna-

torial level, has declined since the founding of the US(Jameson, 1983) and there are some other indications(Bohmfalk and Contreras, 1991) that US physicians

are not maximizing their potential political impact.Our data suggest that if women physicians were tobecome more politically involved, their in¯uence wouldgenerally be in a moderate to liberal direction.

Furthermore, as the somewhat conservative(McCormick, 1998) AMA seeks to increase its mem-bership, it might do well to consider that less conserva-

tive undertakings might be better received, at least bypotential women members.

Acknowledgements

I am grateful for our ®nancial support for thisresearch, which has come from the American MedicalAssociation Foundation, the American Heart

Association, an NIH (NHLBI) institutional NationalResearch Service Award (#5T32-HL-07034), theEmory Medical Care Foundation, and the Ulrich and

Ruth Frank Foundation for International Health. Iam also grateful for the advice and assistance of Ms.Lucia Cowan, Ms. Maxine Denniston, Ms. Lisa Elon,

Ms. Dorothy Fitzmaurice, Ms. Rebekah Johnson, Ms.Linda Markwell and Dr. Giselle Corbie-Smith and Dr.Randall White.

References

Bohmfalk, G.L., Contreras, F.L., 1991. The `incompleat'

physicians: community physicians' lack of knowledge of

medical socioeconomics and politics. Tex. Med. 87, 78±82.

Brooks, C., Manza, J., 1997. The social and ideological bases

of middle-class political realignment in the US, 1972±1992.

Am. Sociol. Rev. 62, 191±208.

Callan, J.P., 1979. Of physicians and politics. J. Am. Med.

Assoc. 241, 1498.

Editorial, 1998. Get involved. American Medical News, 19

October, p. 19.

Eisenberg, L., 1986. Rudolf Virchow: the physician as poli-

tician. Med. War 2, 243±250.

Frank, E., 1991. Osler was wrong: you are a preventionist.

Am. J. Prevent. Med. 7, 128.

Frank, E., 1995. The Women Physicians' Health Study: back-

ground, objectives, and methods. J. Am. Med. Wom.

Assoc. 50, 64±66.

Frank, E., Brogan, D., Mokdad, A., et al., 1998. Health-re-

lated behaviors of women physicians vs other women in

the United States. Arch. Int. Med. 158, 342±348.

Frank, E., Rothenberg, R., Brown, W., Maibach, H., 1997.

Basic demographic and professional characteristics of US

women physicians. West. J. Med. 166, 179±184.

Goldman, L., 1974. Factors related to physicians' medical

and political attitudes: a documentation of intraprofes-

sional variations. J. Health Soc. Behav. 15, 177±187.

Handberg, R., 1982. Isolating political activists among practi-

cing physicians. Free Inquiry Creative Sociol. 10, 207±214.

Heins, M., 1979. Attitudes of women and men physicians.

Am. J. Publ. Health 69, 1132±1139.

Jameson, M.G., 1983. Physicians and American political lea-

dership. J. Am. Med. Assoc. 249, 929±930.

Jonsen, A.R., Jameton, A.L., 1977. Social and political

responsibility of physicians. J. Med. Philos. 2, 376±400.

Kravitz, R.L., Shapiro, M.F., Linn, L.S., Froelicher, E.S.,

1989. Risk factors associated with participation in the

Ontario, Canada doctors' strike. Am. J. Publ. Health 79,

1227±1233.

Linn, L.S., Yager, J., 1989. Factors associated with physician

recognition and treatment of alcoholism. West. J. Med.

150, 468±472.

E. Frank / Social Science & Medicine 48 (1999) 1475±14811480

Maheux, B., Pineault, R., Beland, F., 1987. Factors in¯uen-

cing physicians' orientation toward prevention. Am. J.

Prevent. Med. 3, 12±18.

Masem, M., 1976. Our political responsibilities as physicians.

Minn. Med. 59, 135±137.

McCormick, B., 1998. Thrust into the spotlight: new AMA

EVP hits the ground running. American Medical News, 17

August, p. 22.

Nathanson, C.A., Becker, M.H., 1978. Physician behavior as

a determinant of utilization patterns: the case of abortion.

Am. J. Publ. Health 68, 1104±1114.

Phelan, T.J., Phelan, J., 1991. In search of a new class. J.

Polit. Milit. Soc. 19, 181±194.

Shah, B.V., Barnewell, B.G., Hunt, P.N., et al., 1991.

SUDAAN User's Manual, release 5.50. Research Triangle

Park, Research Triangle Institute.

Smith, R.B., 1993. The paradox of gender voting: exploratory

analysis. Qual. Quantity 27, 271±289.

Wakeford, R.E., Allery, L., 1986. Doctors' attitudes, medical

philosophy and political views. BMJ 292, 1025±1027.

E. Frank / Social Science & Medicine 48 (1999) 1475±1481 1481