As high earners, you’d think that doctors would be more likely to contribute money to Republicans than Democrats. But it turns out that isn’t true. A new analysis in JAMA Internal Medicine shows that merely well-off doctors—your allergists, your pediatricians, your pulmonologists—favor Democrats. It’s only when you get into the territory of medical royalty—your surgeons, your urologists, your radiologists—that political contributions start to heavily favor Republicans. Even within one of the best paid professions in the country, there’s a class divide, with the haves favoring Republicans and the have-nots favoring Democrats. That’s fairly remarkable.
I think a sub-component of this split is practice composition. The basic providers (primary care physicians, pediatrics, cardiology etc) have been under significant pressure in the past fifteen years to move away from the solo or small group practice model towards an employment model. The NIH has shown this shift:
The percentage of physicians in groups of more than fifty increased from 30.9 percent in 2009 to 35.6 percent in 2011. This shift occurred across all specialty categories, both sexes, and all age groups, although it was more prominent among physicians under age forty than those age sixty or older….
The New York Times in 2010 noted this pattern as well:
As recently as 2005, more than two-thirds of medical practices were physician-owned — a share that had been relatively constant for many years, the Medical Group Management Association says. But within three years, that share dropped below 50 percent, and analysts say the slide has continued…
The move towards Accountable Care Organizations, coordinated care and bundled payments in PPACA has pushed the generalists and PCPS towards more risk bearing and more capital intensity. The private practices with only a handful of docs usually don’t have the money to upgrade electronic medical records or participate in the risk of patient population management. So the smaller practices are being bought out by either large hospital based physician groups or banding together to form regional co-ops. From here, the shift from being owner to employee is rapid, and class interest comes into play. The high end specialists have not had that degree of pressure yet, so the combination of being very high income, typically older than average and still working as owners may be coming into play here.