Corporate health care entities that employ doctors often propose that they take “a middle path” in response to politically charged issues, prioritizing neutrality and effectively silencing a powerful group of patient advocates. | Getty Images Creative
A friend once asked me why more doctors don’t speak out against laws restricting health care access and delivery, like those imposed on abortion access and gender affirming care. This was a tough question for me. As someone who regularly speaks out against the enactment of these dangerous and restrictive laws, I was surprised at first – then I realized that they are right. Doctors are not being very loud in expressing their opposition to these proliferating laws limiting people’s bodily autonomy and doctors’ ability to provide quality, evidence-based care. This is not because we are not concerned — it’s because, too often, our employers discourage us from speaking out, even in our patients’ best interest.
Evidence shows that the vast majority of doctors are opposed to political attacks on health care. A recent study by University of Wisconsin – Madison’s Collaborative for Reproductive Equity found that more than 75% of surveyed Wisconsin doctors support access to abortion; virtually all of them displayed some level of concern over the impact of abortion restrictions on the doctor-patient relationship. In 2021, nine in ten doctors suggested that women’s health in Wisconsin would worsen with the overturning of Roe v. Wade.
Thankfully, some doctors are speaking up. In Wisconsin over 300 health care professionals signed a letter urging voters to support Supreme Court Justice Janet Protaziewicz when she was running for her seat, and in Michigan 2,000 voiced support for a constitutional amendment to protect abortion rights.
However, if so many are concerned about these emerging health care threats, why aren’t more speaking out? The answer is simple: the vast majority of doctors are employees who must answer to their employers. Unlike in the past when most were in private solo or small group practice, in 2020, 70% of doctors were employed by hospitals or corporations with only 15% in solo practice. The percentage of physicians as employees has steeply increased from years past, driven, in part, by the increasing federal regulations and documentation requirements as well as the pressures to contract with insurance companies making solo or small group practice impractical or even impossible.
As employees, doctors are subject to a set of behavior expectations in regards to the media, as anything can reflect on the corporate entity they work for. Corporations would rather keep stakeholders happy than rock the boat. Thus, administrators and leaders often propose that doctors take “a middle path” in response to politically charged issues, prioritizing neutrality.
Free speech remains legally protected so that private citizens may give their opinions, but employed doctors must clarify that they’re speaking as individuals and not for their employers when they give their opinion on public policy or legislation. Even with this attestation, many doctors fear their employer may be unhappy over their advocacy.
I have personal experience and knowledge of physicians being reprimanded by their employers for voicing their opinions about health care policy and legislation. We face immense pressure to keep our heads down and stay silent because of our concern that our employment will be put on the line if we speak out. Additionally, we lose some credibility as advocates when we have to hide our academic or work credentials when speaking with the media.
While HIPAA laws rightfully protect a patient’s privacy, doctors have witnessed ramifications for sharing stories that do not reveal any identifying information about their patients. An example of this is the experience of Dr. Caitlin Bernard, an Indiana obstetrician, who spoke to the media about the legal abortion care she provided to a 10-year-old victim of rape denied care in Ohio. She was censured and fined by Indiana’s state medical board as a result even though she did not violate HIPAA laws.
I applaud the courage of the doctors who are speaking out against the ever-growing threats to health care. But those who do speak up are not the outliers in their opinions. We represent a majority of physicians who hold similar views but cannot voice them. Doctors are trusted by our patients and our communities. We must be allowed to advocate for our patients and communities, and not be constrained by corporate neutrality.
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