October 9th, 2016

Why Guessing An ID/HIV Doctor’s Political Affiliation Is Easy

lincoln-portraitOne of our medical school’s most beloved teachers gives a wonderful lecture on how to give an effective presentation. He offers many invaluable tips for a successful talk, such as 1) Show up early; 2) Know your audience; 3) Don’t read your slides; 4) Never include a slide that you need to preface by saying, “I know you can’t read this, but …”

He also cites certain “off limit” topics that could alienate you from your learners, hence best avoided if possible.

Here’s the list:

  1. Sex
  2. Politics
  3. Religion

Wise advice.

But to an ID/HIV specialist, Topic #1 is simply unavoidable. Sorry. And since we’re less than a month from wrapping up one of the most bizarre presidential races in U.S. history, Topic #2 is front-and-center in everything we do these days, and where we’re going to venture today.

The motivation is a New York Times piece published last week entitled, “Your Surgeon Is Probably a Republican, Your Psychiatrist Probably a Democrat.”

Which prompted me to offer this observation (and lightly edited figure):


So if I might edit the title, it could be, “Your Surgeon Is Probably a Republican, Your Psychiatrist Probably a Democrat, and Your ID/HIV Doctor Probably Hasn’t Voted Republican Since Lincoln.”

(Actually, that’s not quite true — but you get the idea. And it’s Psychiatry right above ID in the figure, obscured by the highlight I added.)

So now that I’m deep into these dangerous political waters, I’m wondering why we’re at the bottom of this graph. Or at the top, if you flip the question.

Two quick thoughts inspired by the article:

  1. ID/HIV doctors support the “safety net” culture of healthcare. Think about our AIDS Drug Assistance Program (ADAP) and Ryan White Care Act — arguably among the most successful national health programs in the country. (For the record, ADAP was the topic of the second-ever post on this site way back when, triggering all kinds of prickly comments. Glad the nice people at NEJM Journal Watch didn’t pull the plug right then and there.) And consider organizations such as Partners in Health or Médecins Sans Frontières. Or the vast number of ID doctors who devote their energies to global health, or to emerging infectious diseases, or to life-threatening outbreaks, or to diseases that disproportionately strike the poor or disenfranchised (tuberculosis, malaria, HIV, HCV, cholera, parasitic diseases), or to working in “free” clinics for sexually transmitted infections. Somehow these efforts register as more Blue than Red, don’t they?
  2. Money. Hey, this isn’t the first time we ID/HIV docs have been at the bottom of a figure — remember 2014, when we ranked last in salary? Things have improved for us since then, fortunately, but even with these salary gains, we’re hardly in surgical specialty territory. So there’s a strong correlation (higher salary, more likely Republican), but it’s hard to argue that this relatively low pay directly causes Democratic leanings — unless you conclude that highly paid doctors resent high taxes (which after all pay for those safety nets) more than we do.

But it’s probably more complicated than just these two factors, so would be interested in your thoughts.

And just for fun, let’s make it 3 for 3 on those prohibited topics …

19 Responses to “Why Guessing An ID/HIV Doctor’s Political Affiliation Is Easy”

  1. Mimi Breed says:

    Paul, thank you for this video vignette from the 2016 presidential campaign.

    As to ID folks and their perennial last-place finish on the compensation charts… it’s been my observation over the past many many years (I’m pretty old now) that the people who have lots of money are often people who care a lot about money, who in fact care about money more than almost anything else. No aspersions on our friends in surgery, but this seems fairly consistent in my experience. And not that this observation is original with me. “Brian” seemed to notice it about AD 0 minus 20. But physicians who choose ID are, presumably, folks who, though intelligent, educated, and maybe even privileged, care about something else more than they care about money. Not for me to say whether caring a lot about money is good, bad, or indifferent. But there are lots of other things in life worth caring about.

  2. max voysey says:

    You missed out death . . . Don’t talk about sex, religion, money, politics and death.

  3. An ED Doc says:

    a couple thoughts on this very interesting topic:

    1) it looks like a full 1/3 of the docs they looked at were not registered with any party 19000 out of 55000… so that skews the conclusion somewhat about right-left leanings that they draw from the 36000 registered docs. I’d love to know more about this group of 19000 that is unregistered and is large enough to really push the left-right line in either direction.

    2) I have a hard time believing that 1/2 of my ED colleagues are politically conservative… but maybe I’m just colored by having worked in relatively left leaning states (MN, NY, CA). One of the reasons I went into EM and why a lot of us do it is to work at the safety net level… most people I’ve met who want to do this have at least some of the “liberal do-gooder” in them, and also recognize we need resources devoted to this level which is Dem policy for the most part.

    3) Two reasons I do see my colleagues get a bit jaded/cynical and perhaps slide to the middle/right:
    — abuse of the system / waste of resources. I think a lot of this abuse/waste is alas nearly impossible to erase i.e. the same patient getting admitted to the hospital for the 8th time in 3 months for the same untreated chronic medical problem. I see this wear on some people.
    — powerful nursing union. I personally have always supported labor but the degree to which I see the nursing union support nurses even when they are in the wrong ranges from irksome to disgusting. I want nurses to have a strong voice but the abuse I personally have witnessed on this front does lead some of my peers to question the need for unions in today’s world. (I still support them but wish to see some of their power tempered on some issues — one glaring example is that some nurses view sick days as vacation and use them as such. the union endorses this implicitly). I have more examples but won’t bore you.

    4) the money issues they bring up in the article I think apply as a generalization.

    my 2 cents
    look forward to hearing others

  4. PP says:

    Some interesting observations in this article:


    (For the record, I’m a surgeon.)

  5. IMS says:

    What surprises me are the OBs. I would have expected them–maybe foolishly–to be more Democratic because of abortion rights.

  6. Annie says:

    I’m an OB/GYN, and the doctors in my world are mostly decidedly liberal democrats.
    Medicine is in a state of flux – with growing pains with Obama Care as we attempt to more successfully financially cover healthcare and provide necessary care to all US citizens.
    And, this rapid growth will need to be studied and hopefully better implemented to ensure that Americans can have the kind of medical care they deserve and access to this care at affordable prices.
    We MUST protect women’s rights and clearly members of our dept are worried about the potential for disintegration of basic rights (shockingly we are finding that some insurance companies, for instance, are backing out of basic genetic screening for over 35 moms or denying coverage for procedures for discontinuation of ABNORMAL pregnancies….)
    So, it is a scary time and it is the obligation of healthcare providers to continue to advocate for their patients and ensure our elected officials understand the need to continue to protect these basic health care entitlements.

    • Alex R says:

      I am an Ob/Gyn and I don’t live in Annie’/ world.
      Every day you see women who live in a shelter or subsidized housing, have no stable partners and getting pregnant…with 5th child.
      They don’t use free IUDs, don’t use any contraception.
      Who is going to raise these kids to be successful citizens?
      I am doing abortions, and fiscally I am as Rebublican as it gets.

      Before we know it, everybody will be in line at a soup kitchen, but nobody to cook the soup.

      Our elites (from both parties) are destroying middle class and presiding at crumbling infrastructure.

      Where does money go–welfare, stock market and multimillion dollar condos

    • Candace Walkley says:

      My guess is that your “world” is created by whom you’ll tolerate in it. And I suspect you tolerate those Of like-mind. Hence, your experience is that the group is overwhelmingly democratic.

  7. Roger Felix says:

    Income alone would not explain why my specialty (family medicine) is so “red” politically and yet is even lower than ID in Medscape’s 2016 physician compensation report — we earn more than only peds and endocrine on their scale. I’m slightly politically to the left of most physicians I’ve met, but obviously my specialty is far to the right of that. Although it could be an urban/rural thing — maybe a lot of family docs come from more rural states and areas where more right-leaning thinking is just the norm. I don’t know…

    • Tim Beer says:

      Roger, I think it may be because a higher proportion of Family Practice physicians own their own practice (read: own their own business) than physicians in many other specialties… so they more frequently have the mentality of small business owners. I could be wrong about this, though.

  8. Adrienne Drake, MD says:

    I always felt that my Infectious Diseases colleagues were the deepest thinking, and kindest doctors I ever knew. Perhaps it is this deeper understanding of the important things in life that leads ID docs to be “stronger together.”

  9. J.M. Krick says:

    It seems like the liberal physicians are those who are employed and draw a salary from a hospital system. None of the millenial generation of physicians seems to have the backbone to be an independant small business owner. Perhaps socialized medicine has caused hospital employed phsicians to be oblivious to CMS and other goverment intrusions into the BUSINESS OF MEDICINE. I for one am a business owner and not a goverment social worker. It is possible to run a business with a social conscious without cowtowimg to goverment intrusion.

  10. Holly Gooding says:

    This confirms my feeling that when you actually spend time with those most vulnerable in our society – children, psychiatric patients, people with HIV/AIDS – you support the party that puts forward plans to care for the vulnerable. Or maybe only bleeding heart liberals are willing to go into these fields!

  11. Dan K. says:

    Makes sense.
    Everyone knows who the “smartest docs” are in the hospital. 9/10 physicians will say ID specialists are.

  12. I have memories of an HIV meeting (ACTG perhaps?) in DC during a presidential election, when as the meeting day/election day was ending, we stood on the balcony over the bar, watching the big screen in the bar below as votes came in, and was pleasantly surprised when my colleagues all wooped as Clinton (Bill not Hill) was declared winner in a key background state. The resounding cheer in part reflected more optimism that the programs and policies and research priorities vital to our at risk and HIV positive patients (and for children and youth for the pediatricians in the crowd) could continue and might improve.

  13. Bethany says:

    As a Family Doctor I am a registered independent. I leaned more to the left prior to training. After seeing so many people abusing the systems in place, I am totally disenchanted. Leaning right does not equal cold hearted/stupid/cruel as so many posters have implied. I currently work for a cash based practice that targets uninsured patients (who aren’t even supposed to exist). I’ve been known to pay drugs costs and lab fees out of my own pocket for patients who really needed them but no ‘safety-net’ existed. I’m tired of seeing able bodied and minded folks game the system, while others struggle just to get by. The solution is not to throw good money after bad.

  14. Candace Walkley says:

    Like the poster above, I am a conservative constitutionalist physician, but an even rarer breed, that of the Conservative ID physician. I can affirm that there are fewer of us than unicorns.

    That being said, it is a fallacy that compassion only comes from Leftists/”progressives.” I have spent many days and nights as the only person at the bedside of a patient dying of histoplasmosis, in delirium, covered in vomit and feces, and in an empty room. To me, it seems just plain sad that anybody should die alone, regardless of their choices. So I’ve sat, with people I didn’t know. Or I’ve discussed it with my team, and my medical students have sat, just so a patient doesn’t end his life scared and alone. The people markedly absent from these patients’ rooms at the very end, when there’s vomit and feces and screaming and delirium and cachexia and extreme ugliness are all the activists who encourage detrimental lifestyles of promiscuity and drug addiction. They are all gone. I find repeatedly that there are no parents, partners, community organizers, journalists, political commentators, health care policy advisors, and politicians. It’s whomever is willing to roll up their sleeves and get busy with the work and the sadness. And for me, my commitment comes from a respect for basic human life that comes from my beliefs in God, where I’m commanded to reflect God’s fruits of love, joy, peace, patience, kindness, gentlesness, faithfulness, goodness, and self control.

    • Daniela says:

      Thanks for your compassion, Candace.

      I’m unclear on the expectations, though. You want journalists and politicians to come into your hospital to clean up vomit and feces?

  15. I live in Texas so the conservative ID physician is not such an unexpected sight (although not as common as you might think, Dallas is a strange place). While I descend from a clan of liberal Democrats (Grandma said that paying high taxes was a way to take care of our neighbors 🙂 I love working with ID physicians with different viewpoints from me. I admire and honor your compassion, your strong faith and endurance in facing not only the challenges of caring for patients in our broken society, but those in which you face challenges with patients and other providers that you disagree with. For me, ID is a natural outgrowth of my progressive Christian faith and am glad to hear your faith leads you to the same place. I pray for your continued endurance and compassion, and hope you will also pray for us in Dallas (if for no other reason than this week’s lectionary passage from Luke 6:27 🙂

HIV Information: Author Paul Sax, M.D.

Paul E. Sax, MD

Contributing Editor

NEJM Journal Watch
Infectious Diseases

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