Rejected by JAMA in 2004.
To the Editor:
Mr. Kraus and Dr. Suarez (1) provide facts and commentary about physician membership in Congress that should be viewed with care.
The authors calculate that non-physician members of Congressional serve a mean of 3 statistically insignificant years longer than physician members. Yet, a tenure difference of 2 years can be highly significant legislatively because committee chairmanships, from where power in Congress emanates, are few in number and are traditionally determined by strict party seniority. Statistics related to long-duration memberships would therefore tell a more important story, but applying measures of statistical significance to Congress must always be done with restraint. The only true measure of legislative significance is votes.
The speculation on why physician representation in Congress has dropped since 1889 is hopelessly incomplete. The authors discuss workforce levels, salary, duty, time, morale, and role models, but omit power, pride, passion, idealism, ego, drive, connections, expense, and, most startlingly, the electorate and its changes over 115 years. Perhaps 20th century physicians have merely heeded Osler’s comment that “Politics has been the ruin of many country doctors” (2). Given the innumerable factors contributing to electability, one might as well explain the surprisingly large proportion of gynecologists among current physician Congressmen by citing Richard Asher’s half-serious observation that gynecologists typically wear “an expression of refinement and sympathy” (3).
The authors suggest it is advantageous to have physicians in Congress to bring health care expertise to bear on health-related issues. This is a narrow view. Among the reasons not to have physicians in office is: we are a socially homogenous and privileged group functioning in a professional environment that does not generally foster development of leadership skills.
Indeed, the greatest benefit carried by medical training would not be narrow expertise on health care, but would be skepticism and the habit of asking good questions. An exception might have been the ninth President of the United States, William Henry Harrison, who was a medical student first in Richmond then Philadelphia (under Benjamin Rush, no less) before leaving to join the Army and follow the path that would take him to the White House. He is chiefly remembered now for dying of pneumonia one month after not having the medical good sense to wear an overcoat or hat while delivering his hour and forty-minute inaugural address on a very cold Washington day (4).
(1) Kraus CK, Suarez TA. Is there a doctor in the House? ... or the Senate? JAMA. 2004;292:2125-2129.
(3) Asher R. An Asher Miscellany. London: British Medical Association, 1984; 86.
(2) Bryant CS. Osler: Inspirations from a Great Physician. Oxford: Oxford University Press, 1997; 179.
(4) Bumgarner JR. The Health of the Presidents. Jefferson, NC: McFarland & Co., 1993; 59-63.