Most U.S. physicians believe that their responsibilities for matters related to health care extend beyond caring for their individual patients, according to a paper from the Massachusetts General Hospital (MGH) Institute for Health Policy. In the November 22 Journal of the American Medical Association, the researchers report results of a survey finding that more than 90 percent of physicians regard participation in health-focused community activities, political involvement and advocacy for health-related issues as important. Two thirds of respondents report actively taking part in such activities in the preceding three years.
"Unlike the common perception that doctors are small businesspeople focused on their own self-interest, we found that they are concerned about social and environmental causes of illness," says Russell Gruen, MBBS, PhD, of the University of Melbourne, Australia, the study's lead author who collaborated with the MGH researchers while a Harkness Fellow in Health Policy at Harvard School of Public Health. "Most doctors think it's important to work with their communities and be politically active on these issues in the public interest, but it seems that system factors can get in the way of their doing so."
The current study is part of the Institute on Medicine as a Profession Study, a 2004 survey sent to more than 3,000 physicians in six specialties – internal medicine, family practice, pediatrics, anesthesiology, general surgery and cardiology – randomly selected from the membership of the American Medical Association. Survey respondents were asked whether they thought it was important for physicians to provide health expertise to community organizations such as schools, to be politically active in health issues beyond voting, and to encourage their professional organizations to advocate for the public health. They also were asked whether they had personally participated in such activities and to rate the importance of 11 health-related issues, including health coverage for the uninsured, tobacco control, and reducing air pollution.
Among the almost 1,700 respondents, 70 percent were determined to be civic minded, based on their rating of the importance of physician community activity. Personal participation in at least one of the activities was reported by 65 percent. Respondents did seem to consider issues that directly impact patients' health – like access to immunizations, better nutrition, and tobacco control – as more important to address than broader influences like unemployment, literacy and air pollution.
"One result that we found surprising was that only 58 percent of respondents ranked universal health coverage for the uninsured as important," says Eric Campbell, PhD, of the MGH Institute for Health Policy, a study co-author. The team noted that political and ideological concerns may complicate attitudes about several of these issues.
"We also found that whether physicians become personally involved in these issues seems to depend on their work environment, as well as on characteristics such as age, where they received training and whether or not they belong to an underrepresented racial or ethnic group," says Gruen. "If medical schools, health policymakers and other leaders can focus on some of these public health issues, doctors could be a powerful voice for change in many areas."
David Blumenthal, MD, MPP, director of the MGH Institute for Health Policy, was the senior author of the study, which was supported by a grant from the Open Society Institute's Medicine as a Profession Program. Support also came from Harvard School of Public Health, Harvard Medical School and the Commonwealth Fund.
Massachusetts General Hospital, established in 1811, is the original and largest teaching hospital of Harvard Medical School. The MGH conducts the largest hospital-based research program in the United States, with an annual research budget of nearly $500 million and major research centers in AIDS, cardiovascular research, cancer, computational and integrative biology, cutaneous biology, human genetics, medical imaging, neurodegenerative disorders, regenerative medicine, transplantation biology and photomedicine. MGH and Brigham and Women's Hospital are founding members of Partners HealthCare HealthCare System, a Boston-based integrated health care delivery system
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