Physicians rate involvement in public roles as important

November 21, 2006

About two-thirds of physicians surveyed reported being actively involved in activities such as community participation, political involvement and collective advocacy, according to a study in the November 22/29 issue of JAMA.

There has been debate about the degree to which physicians should assume public roles, that is, their degree of social responsibility for addressing health-related matters beyond providing care to individual patients. Physician leaders, social commentators, and professional organizations' mission statements have often supported the physicians' assumption of public roles, according to background information in the article. Currently, little is known about practicing physicians' attitudes about, or the extent to which they participate in community, political, or advocacy activities.

Russell L. Gruen, M.B.B.S., Ph.D., of the University of Melbourne, Royal Melbourne Hospital, Melbourne, Australia and colleagues from Harvard Medical School, Boston, conducted a study to determine the importance physicians assign to public roles, their participation in related activities, and sociodemographic and practice factors related to physicians' rated levels of importance and activity. In this study, public roles were defined as community participation, political involvement, and collective advocacy.

The researchers analyzed data from the Institute on Medicine as a Profession's (IMAP) Survey on Medical Professionalism. The IMAP survey, conducted between November 2003 and June 2004, collected data about attitudes toward and participation in activities the previous 3 years related to physician professionalism from a nationally representative sample of 1,662 U.S. physicians in 3 primary care specialties (general internal medicine, family practice, and pediatrics) and 3 nonprimary care specialties (general surgery, anesthesiology, and cardiology)

The researchers found that more than 90 percent of the physicians who responded to their survey regarded public roles as important. More than half regarded community participation and collective advocacy to be very important, and more than one-third regarded individual political involvement to be very important. Approximately two-thirds of all physicians reported participating in at least 1 public role in the previous 3 years.

Nutrition, immunization, substance abuse, and road safety issues were rated as very important by more physicians than were access-to-care issues, unemployment, or illiteracy. Factors independently related to high overall rating of importance (civic-mindedness) included age, female sex, underrepresented race/ethnicity, and graduation from a non-U.S. or non-Canadian medical school. Civic mindedness, medical specialty, practice type, underrepresented race/ethnicity, teachers of physicians in training, rural practice, and graduation from a non-U.S. or non-Canadian medical school were independently related to civic activity.

"These results indicate a high degree of consensus and previously undocumented willingness of physicians to engage in addressing U.S. public health concerns," the authors write.

"... this study provides some important evidence for professional leaders and organizations, policy makers, and educators who may want to engage more physicians in public health and health policy concerns. First, the majority of physicians are supportive of such engagement through community participation, political involvement, and collective advocacy. Second, the perceived importance physicians assign to involvement in any particular issue appears to be, at least in part, related to how directly the issue concerns individual patients' health. Clarifying the evidence of such causative links may therefore be critical in influencing physician participation in public roles.

"Third, a variety of personal, professional, and practice characteristics may influence physicians' civic mindedness and civic activity. Confirming and understanding these potential influences could provide important guidance to leaders and policy makers who want to enlist the positive energy of physicians in promoting public health at a societal level," the authors conclude.
(JAMA. 2006;296:2467-2475. Available pre-embargo to the media at

Editor's Note: Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.

For more information, contact JAMA/Archives Media Relations at 312/464-JAMA or e-mail

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