Study finds public health issues not addressed by physicians lobbying Congress

November 26, 2000

Physicians are frequent and effective lobbyists on Capitol Hill, but their lobbying efforts do not generally address public health issues, according to a new study that appears in the November 27 issue of the "Archives of Internal Medicine."

Conducting the study were Steven Landers and Ashwini Sehgal of CWRU's School of Medicine and MetroHealth Medical Center.

Based on surveys of congressional legislative assistants, the study found that physician lobbying focuses on Medicare reimbursement (mentioned by 80 percent of legislative assistants), managed care reform (75 percent), and biomedical research funding (25 percent).

By contrast, public health issues, such as access to care for the uninsured, tobacco control, abortion rights, and violence prevention are rarely discussed, according to the study.

"This is the first known study to systematically look at how physicians lobby members of Congress," said Sehgal.

The researchers randomly selected 84 members of Congress and then surveyed the legislative assistants who work on health care legislation and meet with constituents and lobbyists on behalf of their senator or representative. Based on their responses, the researchers estimate that more than 29,000 meetings occur each year between physicians and congressional staffers.

The congressional staffers rated physicians as very effective lobbyists, but wanted physicians to provide input on a broader range of public health issues. One staffer said, "Physicians should be aware of the impression that their main concern is reimbursement rates." Another commented that physicians should "convey passion ... and recognize the power they have to influence Congress."

"Like any other group, physicians have a right to inform legislators about issues that affect their livelihood and working conditions," said Landers, a medical student at CWRU. "But because of their unique qualifications, physicians also should educate members of Congress about how legislative decisions affect patient care and public health."

Sehgal said, "Policy makers told us they want more input from physicians about public health issues. We urge both individual physicians and physician organizations to work with legislators to improve our health care system."
Landers began this study as a medical student while taking the course Activism and Medicine at CWRU, which Sehgal teaches. Landers is now on leave from CWRU, working on a master's degree at the Johns Hopkins School of Public Health.

Sehgal is an associate professor of medicine, biomedical ethics, and epidemiology and biostatistics at the medical school and a member of the Division of Nephrology at MetroHealth Medical Center.

Case Western Reserve University

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