As Election Day approaches, some experts are calling for greater physician participation in the voting process, but not everyone expects that will happen.

In an article published online October 31 in the Annals of Internal Medicine, Katrina Armstrong, MD, MSCE, and David Grande, MD, MPA, both from the Perelman School of Medicine at the University of Pennsylvania, Philadelphia, highlight data showing that physicians vote less often than expected.

The most recent study on the subject, which analyzed data from the 1996 and 2002 elections, show that physicians vote at rates that are 9% lower than the general population and 22% lower than lawyers. Moreover, comparison to earlier studies show the rates have not changed much since the late 1970s.

"Physicians should try to make participation in the political process and public debates part of our professional lives. Elections and decisions by policymakers have a profound influence on the system physicians practice in and the opportunities patients have to access and afford care," Dr Grande said in an interview with Medscape Medical News.

In the article, Dr Armstrong and Dr Grande point out several reasons for low voting rates among physicians. Physicians are often highly engaged in their professional lives and may place lower social value on voting compared with clinical responsibilities. Long work hours, overnight call, and lack of clinical coverage may also create barriers.

Innate tendencies may also play a role, according to Eitan Hersh, PhD, an assistant professor of political science at Yale University, New Haven, Connecticut, who was not involved in the article.

"The main reason why doctors don't vote as much as lawyers is that general interest in politics is just lower among physicians. People who choose fields like law enjoy the political process and being part of it. People who choose fields like medicine are not particularly interested in politics," Dr Hersh told Medscape Medical News.

However, more can be done to encourage political engagement among physicians, according to Dr Armstrong and Dr Grande.

"As a profession we should prioritize voting: covering for colleagues, modifying schedules when appropriate, and encouraging other physicians to vote," Dr Grande suggested.

Hospitals and other healthcare institutions could implement policies that remove workplace barriers to voting, such as paid leave and improved clinical coverage. Other strategies include providing information on how to register to vote, sending reminders as Election Day approaches, and broader dissemination about early voting so that physicians can vote when their schedules permit.

In addition, improving health policy education in medical school might encourage greater social engagement among future physicians. Also, asking physicians to identify barriers to voting access among their patients, such as those with disabilities, may increase physicians' own awareness about the right to vote.

Finally, peer pressure, something about which many physicians may have intimate knowledge, can be very motivating. Simply knowing that their colleagues are voting, either by using social media or stickers such as the "I voted" stickers, may motivate others to do the same.

Of all these suggestions, Dr Hersh believes social pressure may most likely work.

"Social pressure and shame are the powerful motivators here," he commented.

Will the Current Election Be Different?

Whether physician voting patterns will be any different in the current election, which has many Americans on tenterhooks, is anybody's guess, according to Dr Grande.

"On one hand, healthcare has been a big part of political and policy debates over the last 8 years, which might increase physician interest in voting. On the other hand, the current election and political climate might cause some physicians to tune out even more. I hope that is not the case," he said.

However, if past years are any indication, those physicians who do turn out are likely to cast their ballots more liberally.

A recent analysis of campaign contributions for the 1991 to 1992 and 2011 to 2012 election cycles showed a shift toward Democratic affiliation among physicians, away from the predominantly Republican alignment of prior decades.

Physician voting patterns may also depend on what type of physicians are voting.

"Over time, physicians have become more liberal in their party affiliations. But it varies a great deal by specialty," Dr Grande pointed out.

Although more than half of physicians are registered Democrats, a recent study found that about two thirds of physicians in surgical specialties identify as Republican, whereas two thirds of those in infectious disease, psychiatry, and pediatrics vote Democrat. Experiences in clinical practice, initial self-selection as medical students, the changing demographics of physicians, and changing practice patterns may all play a role. Financial matters may also be involved. Fields, such as surgery, with higher average salaries tend to vote Republican.

Dr Hersh doubts whether physician voter turnout will be much different in this election than in the past, but he thinks voting choice may be.

"Republican-oriented physicians will be the kinds of Republicans who refuse to vote for Donald Trump. So I would bet that doctors will vote overwhelmingly Democratic this year," he predicted.

Dr Armstrong reports serving on the Portfolio Investment Board at GSK. Dr Grande reports that his spouse has received consulting fees from Pfizer. Dr Hersh has disclosed no relevant financial relationships.

Ann Intern Med. Published online October 31, 2016.

For more news, join us on Facebook and Twitter