When a doctor wins a seat in the US House of Representatives, health policy tends to move. Physician lawmakers sponsor more health bills than their colleagues, see more of them pass, and score 66% higher on a standard measure of legislative effectiveness in health, according to a new analysis of five decades of congressional records.
The study was written by Alexandra Fountaine of Akron Children’s Hospital, Michael E. Shepherd of the University of Michigan School of Public Health and Daniel Skinner of Ohio University’s Heritage College of Osteopathic Medicine. It was published online in Legislative Studies Quarterly on November 8, 2024.
A small group with outsized influence
The authors coded every member of the House and Senate from 1921 to 2023 as a physician or not, using official congressional biographies. Over that period 62 members were doctors. All but six were men, and 72% were Republicans. Ron Paul served the longest, 38 years.
Their numbers have grown fast. For most of the 20th century there were one or two physicians per Congress; the 116th Congress had more than 20. Across 1973 to 2021, about 2% of House members were doctors, close to the share held by the largest racial and ethnic minority groups.
The team merged these records with bill sponsorship, passage rates and the Volden and Wiseman legislative effectiveness scores for the 93rd to 116th Congresses, comparing physicians with other members of the same Congress.
More bills, more passed, but only in health
Physician members sponsored on average 2.8 more health bills per Congress than other members. That gap is about 1.7 times the well documented gender gap in health bill sponsorship.
They also had 0.23 more health bills pass the chamber per Congress, against an overall average of 0.07 per member. Their health effectiveness score was 66% higher, even after controlling for the usual predictors of legislative success.
The advantage did not extend to other subjects. Doctors were not more effective overall, and if anything were less likely to pass bills outside health. Committee seats did not explain it either: physicians who sat on no health committee were still more effective on health than non-physicians who did.
A conservative, pro-industry slant
Moderation was not the secret. Physician members were more conservative than their own party colleagues, with voting scores about half a standard deviation to the right of other members, and the pattern held among both Republicans and Democrats.
The authors also coded all 802 health bills sponsored by House physicians and compared them with a random sample of 800 health bills from other members. About 30% of the doctors’ bills were explicitly pro-industry, such as expanding physician autonomy or limiting regulation, and only 14% were pro-consumer or focused on population health. For other members the split was almost the reverse: about 20% pro-consumer and 9% pro-industry.
Republican physicians in the House, about 2% of the chamber, accounted for 26% of all attempts in either chamber to repeal the Affordable Care Act. Physicians on health committees also received four times more campaign money from health professionals, hospitals and nursing homes than other members of those committees.
The authors note that what counts as a “health” bill follows the Comparative Agendas Project coding, which they flag as a limitation. With educators making up about 20% of Congress, they suggest the same test could be run on teachers and education policy.
Study Details:
- Title: Physicians in congress: Professional backgrounds and legislative effectiveness
- Authors: Alexandra Fountaine, Michael E. Shepherd, Daniel Skinner
- Journal: Legislative Studies Quarterly
- Publication Date: November 8, 2024
- DOI: 10.1111/lsq.12482