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Health

Do doctors "look like America" (or not?)

Gene ExpressionBy Razib KhanApril 7, 2010 1:25 AM

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With the passage of health care reform, and the shift of the medical profession away from private practice and toward large institutions already, I wanted to revisit some data about the political orientation of medical students and recent graduates surveyed in the mid-aughts. One of the major issues among American elites has been the occupational bifurcation politically between liberals and conservatives, with the former concentrated in the professions which are often affiliated with the managerial state, and the latter within the business sector. Until recently I had assumed that medical doctors were an example of a profession which tended toward conservatism because of the bias toward private practice and the general lack of direct state involvement (as opposed to regulation) in their occupation, but this seems an older model. Political Self-characterization of U.S. Medical Students shows that medical students actually tend toward liberalism vis-a-vis the general population, and even young adults in their primary age group. No doubt this may change as they age, but I am skeptical of this because it looks as if medicine is going to resemble a public sector occupation more, not less, as we proceed. I reformatted table 1, removing a few rows which I felt were extraneous. Additionally, I added columns which show the proportions of medical students by ethnicity and religion (where they received close to 100% response) and the general population ~2008 (from the American Community Survey & Religious Landscape Survey).

There were a few religion categories which don't seem to map well between what was asked in the survey of medical students and the general population, so I omitted them. Specifically, it seems that many medical students are nominal Christians who simply selected "Other Christian," while in the general population this class consists mostly of heterodox groups such as Mormons, Jehovah's Witnesses and Christian scientists. The "Other" religious segment also seems inordinately large, and I suspect that they would be "Unaffiliated" in the Pew survey (if the question is asked so that "Atheist" is part of the category that will scare away a substantial subset of those who aren't members of organized religions but have some vague supernatural beliefs). Finally, it seems strange to me that they clumped "Native" and "Other" races together in the medical student survey, as it seems likely that many who didn't want to respond or were mixed-race are in this group, so I didn't compare it to anything in general population. No great surprise that pediatricians are more liberal than surgeons. Perhaps I'm employing stereotypes that people may find scurrilous, but I don't particularly care. Some of the trends among specialties are confounded with the fact that there are differences in sex ratio across them; specialists or those who wish to be specialists are more likely to be male than female, and females are more likely to be liberal than male. Correlations are not necessarily transitive, but I think that's what you're seeing here. The liberalism of Asian Americans is not that surprising, but notice that Hindus and Buddhists are even more liberal. The majority of young Asian Americans are now of non-Christian religions, or irreligious, but a significant minority are Christians, and often conservative ones at that. The higher proportion of conservatives among the whole Asian American group is probably a function of the fact that Christians are more comfortable with the conservative movement than non-Christians. If you are a racial minority being a non-Christian makes it very difficult to identify with the modern Republican movement; being a white person at least allows for racial solidarity, while being a conservative Christian allows for ideological solidarity. No matter the "family values" or high incomes of Asian Americans, those who are non-Christian are going to be deeply alienated from the party for reasons of identity for the foreseeable future (yes, I know there are secular libertarian Asian Americans who are Republican. When I was more politically engaged I was in that category). Interestingly, non-Hispanic whites are represented in proportion to their numbers in the general population among young doctors and medical students, though a bit overrepresented in proportion to their age bracket. As older individuals are more likely to need medical care, and these are more often non-Hispanic white, it will be common for non-white doctors to interact with older patients who grew up at a time when America was an explicitly biracial, and implicitly white, country. I have talked to young Asian American friends who recount experiences with very elderly patients whereby it is difficult for these individuals to grok that they were born and raised in the United States because these patients have an image of America which is derived from their youth. The prominence of ethnically Asian software engineers, or in scientific institutes, is a well known feature of the American landscape. But these are not occupations which require a great deal of interface with the general American public. Professions like medicine do require that interface, that is one reason that there is focus on getting underrepresented minorities into medicine, so that they can better serve their communities. When it comes to elderly white patients who are going through chronic illnesses at the end of their lives I think it is probably not practical or appropriate to expect too much consciousness raising in regards intercultural dynamics and sensitivity. Rather, I think the onus is going to be on young Asian American doctors to try and understand the perspectives of their patients and the America from which they came, an America which they and their parents have changed in fundamental ways by their very presence.

NConserv. %Mod. %Lib. %Students % Population %

Total4918263341

Female226018324946

Male265433343354

Mother's ed.

No HS diploma81174340

HS diploma240273538

Some college284333433

College625283835

Grad school549203546

Med school60173845

Father's ed.

No HS diploma79224038

HS diploma178223642

Some college163234036

College420303435

Grad school696253441

Med school296233938

Ethnicity

Asian932174142194

Black38893358812

Hispanic201153253415

Native/Other2422340375-

White31413231386466

Religion

Atheist/None879929631816

Buddhist789424921

Hindu2318415150.5

Muslim11921433621

Catholic11053035352224

Jewish32317265872

Other Christian81431412817-

Protestant11024530262250

Other235930615-

Ever married

Yes100239313020

No388523344379

Specialty

Primary care1423253343

Emergency338253441

Family med477312841

General internal366243541

Ob/gyn268162460

Pediatrics537213643

Psychiatry116172756

Surgery647343729

Other437273142

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