There were 815 visitors to the SDN postings linked to the survey. Three hundred sixty-one unique individuals accessed the survey link, and 356 completed the first page to determine eligibility (based on attendance at an accredited U.S. medical school). Of 277 eligible participants, 240 completed the survey (view rate 44%; participation rate 77%; completion rate 87%).14 (Supplemental Digital Appendix 1)
Participant characteristics are shown in Table 1. Eighty-seven percent of participants were enrolled in MD programs. The majority was 25-34 years old (63%) and white (62%), and about half were women (53%). Participant gender and race were similar to characteristics of U.S. medical students overall.44 All geographic regions and years of medical school were represented, with slight overrepresentation of first-year students.
Interest and intentions around healthcare policy
Most participants in our study (181, 75%) were members of at least one medical organization addressing healthcare policy issues (e.g. American Medical Association, American Medical Student Association, American Medical Women’s Association). A large majority reported following healthcare policy in the news (82%) (Table 2). Eight-seven percent somewhat (28%) or strongly disagreed (59%) that healthcare policy will have little or no effect on their care of patients, with liberals twice as likely as conservatives to hold these views (p<0.001). Most also planned to become involved (80%) or take leadership (65%) in healthcare policy issues as physicians; liberals and those intending to enter primary care were 2 and 6 times likelier, respectively, than others to express strong interest in policy involvement (p<0.05).
Responsibilities around healthcare costs and access
The survey probed participants’ beliefs about physicians’ responsibilities around healthcare access and costs (Table 3). Three-quarters agreed it is very important for physicians to know the overall cost of the care they provide. A large majority (81%) believed that it was very important for physicians to provide necessary care regardless of the patient’s ability to pay, although liberals (87%) were more likely than independents (72%) and conservatives (57%) to hold this view (p<0.001).
Public roles: Collective, community, and individual
The survey assessed participants’ attitudes toward 3 forms of civic involvement by physicians: collective advocacy, community participation, and political engagement (Table 3). Most (76%) said that it was very important for physicians to encourage medical organizations to advocate for the public’s health. This attitude correlated with political identification, with 82% of liberals, 64% of independents, and 57% of conservatives holding this attitude (p<0.001). More than half (57%) reported that it is very important for physicians to provide health-related expertise to local community organizations. First- and second-year students and those intending to enter primary care were more likely than others to express this opinion (p<0.05). Fewer than half (45%) agreed that it is very important for physicians to be politically involved in health-related matters at the local, state or national level. Liberals were more likely than independents and conservatives to hold this view (p<0.001).
Issues of interest
The survey explored participants’ attitudes toward 18 public priorities (Table 4). Nearly all believed it was very important for physicians to individually or collectively advocate around drug addiction and treatment (83%), healthcare coverage for the uninsured (81%), and nutrition, obesity, and food safety (81%). Large majorities also strongly favored professional engagement around healthcare costs (78%), abortion laws and reproductive issues (75%), human rights (70%), disability rights (69%), Medicare, Medicaid, and Social Security (69%), and education (68%). Similarly, most rated physician advocacy on racial issues (62%), housing and homelessness (58%), and LGBTQ issues (55%) as very important. Lesser support was evident for physician engagement around environmental issues (47%), immigration (43%), economic issues (43%), crime and criminal justice (40%), transportation (36%), and military and national security issues (22%).
Overall civic-mindedness scores, averaging the strength of participants’ responses (using scores of 1 for “not important,” 2 for “somewhat important,” and 3 for “very important”) to all 18 issues, had a mean of 2.5 and median of 2.6 (IQR: 2.28-2.83). Medical scores, based on participants’ assessments of the 7 issues directly related to health and healthcare (healthcare costs, healthcare coverage for the uninsured, Medicare/Medicaid/Social Security, drug addiction and treatment, abortion laws/reproductive issues, nutrition/ obesity/food safety, and disability rights), had a mean of 2.7 and a median of 2.9 (IQR: 2.57-3.00). Social scores, based on participants’ responses to the 11 issues with indirect connections to or implications for health (education, housing/ homelessness, transportation, immigration, LGBTQ issues, racial issues, economic issues, environmental issues, human rights, crime/criminal justice, and military/national security issues), had a mean of 2.4 and a median of 2.5 (IQR: 2.00-2.82). (Table 4)
Regression analysis indicated that liberal participants had higher overall, medical, and social scores than conservatives (p<0.01). Nonwhite participants had higher medical scores than whites (p<0.05); they also had higher overall and social scores, although this trend was not statistically significant. Kruskal-Wallis tests showed women and those intending to enter primary care to have higher overall and social scores than other participants (p<0.05). However, our regression analysis did not find gender or intended future field to be a significant predictor, suggesting that political identification was driving these differences and capturing the variance in our model. (Table 5)