71
of hospitals and health systems. Instead of
building their own patient bases, doctors
nowadays often receive fixed salaries. “What
that allowed physicians to do is basically look at
the system in a more altruistic way,” says Travis
Singleton, executive vice president of Merritt-
Hawkins. “It doesn’t mean the independent
physician 15 years ago didn’t care about every
patient who walked in the door. They simply
knew that if they didn’t control their payer
mix, then they couldn’t keep the doors open.”
Meanwhile, other macroeconomic shifts
have affected where doctors live, how they work
and who chooses to join the profession in the
first place. Beginning in earnest in the 1990s,
hospitals and medical groups began consolidat-
ing, pushing once rural and suburban doctors
into big cities. And as medical schools became
more expensive, aspiring doctors began tak-
ing on ever larger debt loads. In 2018, medical-
school graduates carried a median $200,000
in student debt, a burden heavy enough to re-
shape expectations. “If you want to make a lot
of money, maybe go into finance or business
consulting,” says Courtney Harris, a Chicago
medical student, who will have $300,000 in
student loans when she graduates.
As the economics of medicine have shifted,
so have the underlying demographics of the
profession. Over the past two decades, more
women and people of color have entered the
profession. Medical schools, meanwhile, have
expanded their curricula to include informa-
tion about gun violence, climate change and
how social determinants, like class and race,
affect people’s health. “These are not just our
patients, but our parents, our cousins, our un-
cles, our grandparents,” says Yoseph Aldras, a
medical student whose parents are Honduran
and Palestinian.
Singleton, whose firm conducts a biennial
survey of doctors’ opinions, says that while
there are myriad reasons for an uptick in po-
litical involvement, one of the most compelling
is simple: doctors see the dysfunction of the
health care system on a daily basis. As health
care costs ballooned and the private insurance
industry expanded, the job of being a doctor
changed. Instead of just treating patients, doc-
tors today must battle with insurance require-
ments, manage arcane reimbursement systems
and juggle enormous administrative costs, Sin-
gleton’s firm found. “We’ve heard so many hor-
ror stories from doctors who have come before
us about spending hours on the phone nego-
tiating with insurance companies,” says Scott
Swartz, a 28-year-old medical student in San
Francisco. “That’s not how we want to spend
our time.”
All these factors have combined to shift
doctors’ politics to the left. In 1994, 67% of
political campaign contributions by doctors
went to Republicans, according to research
by Adam Bonica, Howard Rosenthal and David
Rothman. By 2004, donations to Republicans
dropped below 50%. And by 2018, the ratio
had more than flipped: Democrats captured
more than 80% of physician donations last
year. “There is an absolutely notable shift over
25 years away from Republicans,” says Roth-
man, a professor of social medicine at Colum-
bia University’s Vagelos College of Physicians
and Surgeons. “And it’s persisting.”
A decade ago, many physicians’ groups sup-
ported the Obama Administration’s effort to
pass the Affordable Care Act, which aimed to
extend access to health insurance to nearly all
Americans. While the law failed to keep insur-
ance costs low for many Americans, Republi-
cans also failed to present a workable alterna-
tive to American voters. Though Republican
lawmakers maintained control of the House
and Senate in 2017, their attempts to repeal
or replace the flawed Obamacare failed, leaving
millions of Americans to continue to struggle
with sky-high health care costs. This fruitless
political maneuvering galvanized many in the
physician- activist community. It was clear
Jonathan
Rothberg
An ultrasound in
your pocket
There are more than
4 billion people globally
who don’t have access to
medical imaging—and
could benefit from Butterfly
iQ, a handheld ultrasound
device. Jonathan Rothberg,
a Yale genetics researcher
and serial entrepreneur,
figured out how to put ultra-
sound technology on a chip,
so instead of a $100,000
machine in a hospital, it’s
a $2,000 go-anywhere
gadget that connects to an
iPhone app. It went on sale
last year to medical profes-
sionals. “Our goal is to sell
to 150 countries that can
pay for it. And [the Gates
Foundation] is distributing
it in 53 countries that can’t,”
Rothberg says. For example,
the foundation is funding a
project bringing Butterfly iQ
to rural Uganda, to scan
children for pneumonia. The
device isn’t as good as the
big machines are and won’t
replace them in prosperous
parts of the world. But it
could make scanning more
routine. “There was a time
when the thermometer
was only used in a medical
setting, when a blood-
pressure cuff was only
used in a medical center,”
Rothberg says. “Democra-
tizing [health] happens on
multiple dimensions.”
ÑDon Steinberg
HEALTH CARE
I N N OVAT O R S
WIN MCNAMEE —GETTY IMAGES
