1. Public Roles among U.S. Physicians: Results of a Survey David Blumenthal, M.D., M.P.P. Opening Ceremony Sino-U.S. Center on Medical Professionalism Beijing, China October 20, 2008

2. Agenda  Describe evidence on physician attitudes toward and participation in public roles.  Discuss implications.

3. Definition of public roles: Community participation: providing health- related expertise to local community organizations. Political involvement: being involved (other than voting) in health-related matters at local, state or national level. Collective advocacy: encouraging a medical organization to advocate on an issue that is not directly related to physicians’ self-interest.

4. IMAP Professionalism Survey:  Random sample of physicians in six specialties Primary care  IM, Peds, FP Specialties  Cardiology, General Surgery, Anesthesia  1618 respondents (58 % RR)  Mailed/phone, Spring 2004  Results today from: Gruen et al: “Public Roles of U.S. Physicians.” Journal of the American Medical Association. July 10, 2007

5. Importance of/participation in public roles:  Proportion of physicians considering public roles important: Community participation: 95 Political involvement: 92 Collective advocacy: 24.  Levels of participation: Community Participation: 54 Political involvement: 26 Collective advocacy: 24

6. Predictors of support for participation in public roles:  Female gender  Ethnic/racial minority  Older age  International medical graduate No effect: specialty, practice type, rural/urban location, percent of patients uninsured.

7. Importance of topics:  Percent rating as very important: Direct socioeconomic influences on health:  Reducing obesity/better nutrition: 82  Immunization: 80  Tobacco control: 77  Seat belt use: 73  Prevention of substance abuse: 72 Access to care:  Health insurance for uninsured: 58 Broad socioeconomic influences on health:  Air pollution: 43  Increased literacy: 42  Unemployment: 23

8. Participation in public roles:  Participated at least one of three public roles: 65%  Predictors: Positive:  Civic-mindedness (rating of roles as important).  Ethnic minority.  Group practice/university-medical school/solo practice.  Preceptor of medical trainees.  Rural practice location.

9. Participation in public roles (cont.)  Negative predictors: International medical graduate. Anesthesiology (compared with family practice).

10. Conclusions:  Large majority of U.S. physicians consider participation in public roles important.  Participation is less common than support, but still, almost two-thirds involved in one public role in previous three years.

11. Conclusions (cont)  Physicians are most comfortable with advocacy when it involves a topic directly related to patient health and health care services: Obesity, tobacco, preventive services, seat belts.  Modestly comfortable when involves access to medical services: insurance.  Much less comfortable with broad societal issues that are less directly linked to personal health care services, even though their effects on population health are significant.

12. Conclusions (cont)  Participation is affected by personal, professional and practice factors: Personal: age, ethnicity. Professional: specialty, teaching Practice: setting of practice.  More research is needed to understand the reasons for these influences.

13. Implications  Overall levels of participation in public roles may be influenced by larger societal factors: Political stability. Economic distress. Levels of inequality.  Physicians mobilize individually and collectively in response to the suffering of the individual patients that they encounter in daily practice. Factors that increase that suffering will increase their participation in public roles.