More US Physicians Voted in 2020 Than In Last 4 Presidential Elections

Xiaojuan Li, PhD

More US physicians are participating in national elections now than in the last 2 decades, according to new research.

Results from a cross-sectional analysis of national survey data show that voter turnout for presidential election years among clinicians has increased at a greater rate than that of the general US population since 2000. In fact, physicians were 9% more likely to vote in the 2020 election than members of the general population (relative risk, 1.09; 95% CI, 1.00 – 1.18).

Led by Ahmed Ahmed, MPP, MSc, of the Harvard Medical School and Xiaojuan Li, PhD, of the Department of Population Medicine at Harvard Medical School and Harvard Pilgrim Health Care institute, the investigators sought to interpret the trends in physician voter turnout, as well as reasons given by the population for not voting, from 2000 through 2020.

As they noted, US physicians’ engagement in the political process is critical to the state of public policy, affecting factors including patient health and overall clinical practice. However, the population is historically lesser represented at the voting polls than the general population.

In an interview with HCPLive® regarding the findings, Li discussed the uniquely interesting data derived from the assessment, the history of physician voter turnout, the role of COVID-19 on decisions made during the pandemic on voter turnout, and future study of physician involvement in civic duties including voting.

HCPLive: What from your survey findings stood out to you as most surprising?

Li: Historically, physicians have been shown to vote at lower rates than the general population, after adjusting for important demographic characteristics associated with voter participation. Evidence suggests that it has been this way since the late 1970s. We thought the trend would continue, which we did find in the pooled analysis for the entire study period (2000-2020). But when we separated out presidential elections and midterm elections, it became clear that the biggest gaps in turnout were in the midterm elections with physicians voting consistently at much lower rate than the general population.

The 2018 election showed a large shift in this, so it will be of interest to see if turnout continues to improve in midterm elections for physicians. In comparison, in presidential elections, the voting rate were more similar between the 2 groups, and there was actually a general uptrend in turnout among physicians.

Based on the suggestion of factors that may play a role in the growth of physicians participating in US elections, would your team anticipate that election participation may continue to increase among physicians in future years?

We believe it may for a few reasons. First, more and more states have begun to adopt no-excuse mail-in voting, which our study showed is associated with increased turnout for physicians. Second, through social media efforts (e.g., posting "I Voted" stickers), social campaigns like #MedOutTheVote, offering voter registration in hospital emergency rooms, and other grassroots efforts, the social pressures to vote have grown over the years - and research has shown this increases turnout.

Finally, the COVID-19 pandemic and the diverging visions for American health care may spark more physicians to want to politically participate, as both their clinical practice and patients' health outcomes continue to be shaped by policy.

What role do you believe the COVID-19 pandemic and the fallout from it may have played (if causative) in the turnout of physician voters in the 2020 election?

The largest increase in presidential election voting for physicians occurred in 2020, up about 12 percentage points from 2016, despite pandemic challenges. While our study can't tell us if the COVID-19 pandemic caused this boost—it was not designed to examine this question—several efforts and policy changes taken in light of the pandemic may have contributed to such a large shift. For example, many states took extraordinary steps to increase voting by mail in 2020, in an effort to minimize in-person contact and virus transmission risk during the pandemic.

The findings identify barriers including voter registration, busy schedules, and conflicting work schedule for physician non-voters. Is there opportunity for follow-up research into the demands of physician workload and likelihood of their civic participation?

This is an important question that necessitates further investigation. The daily workload for a physician is high, and additionally, it varies depending on one's level of training and their specialty of practice. This can certainly constrain what one is able to make time for—as we saw in our study for those unable to vote due to work schedule conflicts. It would be interesting to see if reducing the time demands, or even providing protected time-off to vote or civically participate, boosts physicians' civic engagement.

Where else do you see opportunities for follow-up research?

While our research gives a bird's-eye view on physician voting behavior, it's important to get more granular and understand physicians by level of training and specialty. The demands of the job evolve at different stages and within each specialty, so better understanding those subgroups and their civic engagement is a good first step. From there, we can begin to investigate tailored solutions for each group, such that they too have a fair chance at having their voices heard in the political process.

The study, “Analysis of Reported Voting Behaviors of US Physicians, 2000-2020,” was published online in JAMA Network Open.