Election 2014: Why these ‘doctors in the House’ chose politics

As a physician serving in the Missouri House of Representatives, Republican James W. Neely, DO, makes good use of his medical background—and not always on legislative matters. Fellow representatives often seek his medical counsel, and he once persuaded a colleague who was having a heart attack in the state Capitol to get treatment.

“I said, ‘Let’s go to the hospital,’ and he didn’t want to go,” Dr. Neely says. “And I said, ‘Well, we are going to go.’ ”

Dr. Neely accompanied the man to the hospital, where he recovered.

Dr. Neely and the three other physicians in the Missouri state legislature also serve as a resource to other lawmakers on Medicaid, mental health and other health care matters. And this past term, which was Dr. Neely’s first in state office, he used his health care expertise to sponsor a bill to allow patients with terminal illnesses to access investigational medicines. Missouri Gov. Jay Nixon signed the bill in July.

“Not all patients with terminal illnesses have access to clinical trials,” Dr. Neely says. In addition, effective medications are pulled from pharmacies for arbitrary reasons, he notes, and this law will help patients access them.

Why physicians run

Missouri residents first elected Dr. Neely in 2012, and they re-elected him in November. Across the country, 10 DOs, including Dr. Neely, will serve in state legislatures next year. In the current term, eight DOs served; in the 2010-2012 term, just five DOs were in state office.

Nationally, Nevada constituents last month re-elected U.S. Rep. Joe Heck, a Republican who has served since 2011. Fourteen other physicians will serve in the 114th Congress alongside Dr. Heck. Sens. Rand Paul, MD, R-Ky., and John Barrasso, MD, R-Wyo., now comprise the physicians serving in the U.S. Senate next year, and Rep. Bill Cassidy, MD, R-La., will join them if he wins a Dec. 6 runoff election against incumbent Sen. Mary Landrieu, D-La.

DOs pursue political office for different reasons. Physicians in office don’t all align with the same political party. But these DOs bring medical expertise to their state—or the nation’s—capital, and they share a desire to improve public health and health care.

Dr. Neely says he first pursued elected office because he felt the federal government was too involved in health care and other issues that he perceived as the state’s jurisdiction. In addition, he saw evidence of child abuse when working in the emergency department and wanted to help children. That session, Dr. Neely helped increase funding for the state’s child advocacy centers, which provide treatment to victims of child abuse.

This year, Dr. Neely says he ran again because his time in office showed him how bureaucracy slows down progress, and he’d like to reduce it.

“We need to empower teachers to be teachers, and we need to empower doctors to be doctors,” he says. “The government is telling everyone what to do, and that’s not healthy.”

Although he’s on the national stage now, Dr. Heck also started his political career in state legislature. A stint working in the Washington, D.C., metro area fueled his interest in politics. Once he was back in Nevada, he decided to run for the state senate in 2003. His initial goal was to express his dissatisfaction with the incumbent. To his surprise, he won the race.

Seven years later, the candidate running for Dr. Heck’s future congressional district left the race at the last minute because of a family emergency. Although Dr. Heck wasn’t planning for a national political career at the time, his colleagues had other ideas.

“People came to me and said, ‘Joe, we need for you to step up, we need for you to run,’ ” he says. “The issues are health care, national security and the economy. You’re a physician, you own a company, you serve in the military and you’ve been deployed to Iraq. You’re the custom-made guy for this race.”

Dr. Heck won that race and the next two.

Other DOs, such as Missourian Keith J. Frederick, DO, run for office because they see a lack of physician voices in state government. Back in 2010, Dr. Frederick saw that the only physicians in the Missouri House of Representatives were going to be unable to run for re-election because of term limits.

“Had I not run that year, we would have had a House of Representatives with zero physician members,” says Dr. Frederick, a Republican who joined the Missouri House in 2011 and was re-elected in November. “I felt an obligation to step forward and bring a medical perspective to a House of Representatives that otherwise would not have had physician input.”

When Kelli M. Ward, DO, MPH, ran for office in Arizona in 2012, she says she chose the Senate because it had no physician members at that time.

“My senator had termed out,” says Dr. Ward, a Republican who was re-elected in November. “He actually said, ‘We need a conservative voice, especially during this time of so much turmoil with health care.’ “

Dr. Ward says she became more politically active after 9/11. She began following the news more closely, and she started expecting more from her elected officials. When she contacted them with requests and opinions, the response she received was usually minimal or nonexistent, she says, which made her wonder how she could have more of an impact.

“I threw my hands up and said, ‘Why don’t I do something,’ ” she says. “ ‘I have skills, I have talents, I have abilities to share to hopefully make things better for more than just my family or my patient population. I could maybe make a difference in the state of Arizona.’ ”

First-time Michigan state Rep. Edward Canfield, DO, has similar sentiments. A Republican, Dr. Canfield is the first DO, to his knowledge, to serve in Michigan state legislature.

“I tell my kids all the time, ‘We need to try to make a difference,’ ” he says. “I want to show my kids that sometimes you have to serve. It’s not just all about making a living.”

Dr. Canfield says he suspects many physicians his age—he’s 59—are drawn to politics or other endeavors because they are frustrated with electronic health records.

“I’m having trouble working in my job because of EHRs,” says Dr. Canfield, a family physician in private practice in Caro, a small city in eastern Michigan. “And there are all sorts of foibles and proprietary issues that come with EHRs. One system you might master, but then you move to another system and you can’t use it. It’s truly a different language. Many people in my age group have left medicine because they can, or they’ve decided to do something else. For me, that’s going to be politics.”

Democrat Alan C. Bates, DO, who joined the Oregon House of Representatives in 2001, ran for office because he felt the state legislature needed a physician representative to champion the Oregon Health Plan, the state’s revamped Medicaid program. As a volunteer on the state health services commission, Dr. Bates had assisted Gov. John Kitzhaber in setting up the program.

“I had been doing so much work,” says Dr. Bates, who moved to the Oregon Senate in 2005 and was re-elected in November. “I really felt that I needed to be inside the building and be a member of the Senate or the House to really solidify those gains.”

Back in 2001 when Dr. Bates began his political career, only a few other DOs were in state office. While Dr. Bates is encouraged by the recent influx of DOs into state government, he sees room for growth.

“I’m hoping more physicians are going to realize that we need leaders in our community to get involved,” he says. “If you look back, from Colonial times up to the turn of the last century, physicians commonly ran for office and were an integral part of state and federal government. We kind of walked away from that. It’s hard to be involved in politics. Serving is tough because you have to balance it with your practice.

“But physicians bring a unique ability to relate to the public because we see patients every day. Also, we have a lot to offer. We know the health care system better than anyone else, and that’s a big part of government now.”

Health care legislation

In the 2012-2014 session, Dr. Bates continued his focus on health care. He passed a bill to ensure autism patients receive private insurance or Medicaid coverage for applied behavior analysis, a treatment that helps patients learn new skills such as communication and self-care techniques.

In addition, Dr. Bates passed legislation directing state authorities to create a standard prior authorization form for prescriptions, which will make physicians’ lives easier. The law was tough to pass, he noted, because he had to get all the insurers to agree to a standard form.

In Missouri, Dr. Frederick also passed a law this year that will help physicians—in particular, those who didn’t match into residency—and inject health care professionals into the state’s underserved areas.

The law allows physicians who have graduated from medical school to go directly into practice in designated rural and underserved areas as an assistant physician working under the supervision of a fully licensed physician. The law is the first of its kind in the U.S. Some health care groups have voiced opposition to it, but Dr. Frederick notes that the state is in desperate need of physicians in rural areas. He expects more states to follow suit with similar laws in the coming years.

“Physicians who have graduated medical school but don’t get a residency really want to apply their medical skills,” he says. “We’ve gotten over 300 calls from doctors who are interested in coming to Missouri to practice under this program. It’s a way to address the maldistribution of medical care. I decided to write the bill so that physicians were required to go to an underserved area and to serve in primary care.”

Assistant physicians will be able to practice under supervision for as long as they would like to. To practice independently, they will still have to complete one year of postgraduate training, which is the state’s requirement for independent practice. Assistant physicians’ scope of practice will likely be similar to that of nurse practitioners, Dr. Frederick says, noting that rules and regulations are still developing. The state’s Board of Healing Arts will likely begin accepting applications in the spring, he says.

In Arizona, Dr. Ward passed legislation that she says protects direct primary care. Direct primary care is a retainer-based care model similar to concierge medicine. Patients pay a recurring fee in exchange for access to any primary care services they need, according to the American Academy of Family Physicians.

The state’s insurance department wanted to regulate small independent direct primary care practices in the same way they regulate large health maintenance organizations, Dr. Ward notes, which she says would place unnecessary burdens on these practices. Dr. Ward’s bill put direct primary care practices under the state’s business statutes instead of under its insurance statutes, which will allow the practices to operate without state insurance department regulation.

Dr. Ward also co-sponsored a bill requiring insurers to cover telemedicine in rural areas.

“In rural Arizona, we use telemedicine a lot,” she says. “We don’t have a lot of neurologists here, and stroke patients were able to use telemedicine through Mayo Clinic. We are able to have a neurologist at the bedside via telemedicine. It saves the system so much money. We don’t have to ship patients to Phoenix.”

Dr. Ward hopes to expand the law from rural areas to the entire state in the coming term.

Oklahoma state Rep J. Michael Ritze, DO, was instrumental in boosting state funding of the Oklahoma State University (OSU) Medical Center, the teaching hospital of the Oklahoma State University Center for Health Sciences College of Osteopathic Medicine (OSU-COM) in Tulsa.

“The OSU Medical Center is one of the only osteopathic institutions its size that’s still in existence,” says Dr. Ritze, who has served in the state House since 2008 and was re-elected in November. “We’re really proud of that.”

Last year, Dr. Ritze helped appropriate $13 million for the hospital to support its graduate medical education programs.

Some DOs would like to see the Affordable Care Act repealed. In Oklahoma, Dr. Ritze passed a law to make the ACA’s directives optional in the state, and he brought a bill to nullify the law in the state that is currently on hold pending the outcome of the upcoming Supreme Court case on state health insurance exchanges. In Missouri, Dr. Frederick introduced a bill that would require insurers in Missouri not to accept subsidy money from the federal government. His bill was still being processed when the legislative term ended, but he hopes to bring it forward again next year.

On a national level, Dr. Heck says he’ll first focus on changing aspects of the law that have support from both parties.

“There’s bipartisan agreement that certain pieces of the ACA have to go,” he says. “The quick wins are going to be to go after those things, whether it’s the medical device tax or the Independent Payment Advisory Board.”

Goals for the next term

While the Oklahoma state legislature has increased state funding of OSU-COM in recent years, in the next term Dr. Ritze also intends to sponsor bills to advance the school’s state funding even more so that it can increase class sizes.

“The new classes at the school are around 100 students each per year,” he says. “The goal is to get up to about 160 eventually. That will help fill in the need for the physician manpower in Oklahoma and help the osteopathic medical profession in general and provide more primary care physicians to our citizens.”

Noting studies that show the incidence of depression rises in medical students as they progress through school, Dr. Frederick says he wants to encourage medical schools to survey their incoming classes for depression and to offer students confidential mental health resources.

“By virtue of their profession and the expectations on them, medical students are often inhibited from accessing the support that may either keep them from diving deeper into depression or perhaps from attempting to take their own lives,” Dr. Frederick says. “We need to first identify the problem and then offer confidential resources to students that won’t impair their career and that they can feel comfortable accessing.”

In Michigan, Dr. Canfield says he’d like to introduce legislation to encourage more physicians to pursue primary care and to make the path of primary care physician more financially viable.

“Primary care physicians should be able to live in small towns and make a decent living,” he says. “The way things are right now in medical education, many students can’t make the choice to go into primary care because of extreme debt.”

Outside of health care, Dr. Bates says one of his chief goals for the next term is to raise Oregon’s minimum wage from $9.10 per hour to $10 or $11 per hour. Minimum wage hasn’t kept up with inflation over the years, Dr. Bates says, noting that many full-time workers earning minimum wage must use the Supplemental Nutrition Assistance Program, Medicaid and other social services to get by.

“That’s not the way to go,” he says. “You’d be better off paying people a higher wage and getting them off of these programs, which I would love to see happen. When you have a decent wage, you don’t need food stamps and you don’t need Medicaid. You can buy your own insurance.”

Advice

Has learning about these DOs’ work made you curious about running for office yourself? Make sure you have the support of your family first, Dr. Ward suggests.

“I could never do what I’m doing without my family,” she says. “My husband, our kids and our parents are all very involved in my being in the state senate. They are my biggest cheerleaders.”

Dr. Bates recommends starting at the local level.

“Get on the school board or city council and try it out for three or four years,” he says. “If you find it satisfying, then step up.

“In my 35 years in the DO profession, I’ve seen it grow from ‘What’s a DO?’ to ‘Oh, you’re a DO, that’s great!’ More DOs should step up and become better-known publicly. One of the best ways of doing that is by running for office.”