With the White House and Republican leadership in both houses of Congress intent on repealing the Affordable Care Act (ACA), as well as funding for Planned Parenthood and foreign aid programs on the chopping block, doctors and other frontline clinicians are speaking out publicly about their concerns.
A lot is on the line. The House has passed legislation to replace the ACA in the American Health Care Act (ACHA), and the Senate is working on its own repeal bill. Funding for women’s health programs and protections for people with preexisting conditions are at risk of being cut or eliminated. The president’s budget would slash Medicaid by more than $600 billion. And Trump’s executive order on immigration threatens to curb the supply of foreign doctors.
Doctors are speaking out against the administration's policies in public media, in protests, through petitions and in direct conversations with lawmakers, either in Washington or during town halls in their districts. For the most part, their employers support them. Doctors are careful to separate their patient contact from their political activity, but many view protesting as not only a right, but also an obligation.
In an opinion piece in the Washington Post, Dr. Dhruv Khullar urged Congress and the White House to ensure that no one with health insurance today would lose coverage in the future. “My patients can’t wait for policies that appeal to this political lobby or that political base,” he wrote. “Any lapse in insurance coverage affects the care they get — or don’t get — right now.”
When it was learned the Dana-Farber Cancer Institute had scheduled fundraisers at Trump’s Mar-a-Lago Club, scores of Harvard Medical School students and faculty signed a petition pressing the center to relocate. Cleveland Clinic’s planned fundraiser at the Palm Beach, FL, resort, also sparked protests.
First do no harm
Doctors must toe a fine line in balancing political advocacy and their responsibilities to patients.
The American Medical Association’s (AMA) Code of Medical Ethics encourages doctors to “stay well informed” about proposed healthcare policies and “work toward and advocate for the reform and proper administration of laws related to healthcare.” However, it draws a line against mixing politics with patient care. According to Section 2.3.4, physicians should “be sensitive to the imbalance of power in the patient-physician relationship” and “refrain from political conversations during the clinical encounter.”
The American College of Physicians (ACP) encourages its members to take a stand on issues affecting healthcare. “We have been advocating very, very strongly in support of the ACA and against the AHCA,” Dr. Jack Ende, president of the ACP, tells Healthcare Dive, adding that the college focuses on policies and not political parties or politicians. “If the evidence shows that the public is better served with one program, that’s the program we support,” he says.
While health systems and other employers typically refrain from activism, most seem to support medical professionals’ right to protest policies they feel harm patients, so long a they do it on their own time.
“Intermountain Healthcare encourages caregivers to participate in and speak out about matters important to them,” Daron Cowley, senior communications director, tells Healthcare Dive in an email. “The only restriction is that they cannot say or imply they are speaking on behalf of Intermountain Healthcare.”
Care through a broader lens
For many physicians, the Trump era has sharpened the realization that staying in their office isn’t enough and that larger contextual issues play as important a role in a patient’s health as the treatments doctors prescribe.
“If somebody does not have health insurance, you can treat their diabetes until the cows come home,” says Ende. “If they can’t afford medication, if they’re not able to find a primary care doctor, if they don’t have access to care, then what you’re doing is futile.”
Dr. Manik Chhabra, a primary care physician in Philadelphia, agrees. “I think there had been an assumption that the way care was provided to patients, especially those who are the most vulnerable, was going to continue and continue to improve in a lot of ways,” says Chhabra, admitting he was surprised when Trump won the November election. “But with a lot of the policies that are being proposed by this administration, and especially given the recent legislation that was passed by the House, I think a lot of providers are really beginning to understand that these policies are a direct threat to the patients we serve.”
To influence the debate, Chhabra and some colleagues formed Clinician Action Network. The group now numbers about 70 physicians, many working in health policy and serving underserved populations, and studies the impact of policy decisions on patients to effectively advocate on their behalf. One of their first public positions was against the AMA’s support of then Rep. Tom Price for secretary of HHS, on grounds that his policies would be harmful to patients.
Obligation to speak out
Ende sees the increased activism as a reflection of a current trend to teach medical students and residents to be sensitive to problems in their workplace. If a hospital system doesn’t provide adequate nursing support or doesn’t address issues about patient experience, doctors have an obligation to speak out and try to push positive change. Speaking out on healthcare policies at the state and federal levels is a natural and logical extension of that trend.
With passage of the ACHA in the House, the ACP is turning its attention to the Senate. ACP members are fanning out across Capitol Hill on Wednesday to share their concerns about ACA repeal and argue on behalf of patients, especially the most vulnerable.
Doctors still command a certain respect, Ende notes, and that puts them in a unique position to influence systematic change. “It is difficult to know the kind of impact you can have,” Ende says. “We’re certainly giving it our best efforts.”
Chhabra says he believes that many providers are wary of putting their name on an op-ed or otherwise stepping up on politically charged issues for fear of pushback from employers or the communities they serve. But it is vital that they speak out honestly and armed with facts, he tells Healthcare Dive.
“What we’ve been telling providers is talk to people in your institution, find out what they would like you to do, but don’t let that actually silence your voice,” he says.