Why Guessing an Infectious Disease/HIV Doctor's Political Affiliation Is Easy

October 9, 2016

Paul E. Sax, M.D.

Paul E. Sax, M.D., is director of the HIV Program and Division of Infectious Diseases at Brigham and Women's Hospital in Boston.

One of our medical school's most beloved teachers gives a wonderful lecture on how to give an effective presentation. He offers many invaluable tips for a successful talk, such as 1) Show up early; 2) Know your audience; 3) Don't read your slides; 4) Never include a slide that you need to preface by saying, "I know you can't read this, but ..."

He also cites certain "off limit" topics that could alienate you from your learners, hence best avoided if possible.

Here's the list:

  1. Sex.
  2. Politics.
  3. Religion.

Wise advice.

But to an ID/HIV specialist, Topic #1 is simply unavoidable. Sorry. And since we're less than a month from wrapping up one of the most bizarre presidential races in U.S. history, Topic #2 is front-and-center in everything we do these days, and where we're going to venture today.

The motivation is a New York Times piece published last week entitled, "Your Surgeon Is Probably a Republican, Your Psychiatrist Probably a Democrat".

Which prompted me to offer this observation (and lightly edited figure):


So if I might edit the title, it could be, "Your Surgeon Is Probably a Republican, Your Psychiatrist Probably a Democrat, and Your ID/HIV Doctor Probably Hasn't Voted Republican Since Lincoln."

(Actually, that's not quite true -- but you get the idea. And it's Psychiatry right above ID in the figure, obscured by the highlight I added.)

So now that I'm deep into these dangerous political waters, I'm wondering why we're at the bottom of this graph. Or at the top, if you flip the question.

Two quick thoughts inspired by the article:

  1. ID/HIV doctors support the "safety net" culture of healthcare. Think about our AIDS Drug Assistance Program (ADAP) and Ryan White Care Act -- arguably among the most successful national health programs in the country. (For the record, ADAP was the topic of the second-ever post on this site way back when, triggering all kinds of prickly comments. Glad the nice people at NEJM Journal Watch didn't pull the plug right then and there.) And consider organizations such as Partners in Health or Médecins Sans Frontières. Or the vast number of ID doctors who devote their energies to global health, or to emerging infectious diseases, or to life-threatening outbreaks, or to diseases that disproportionately strike the poor or disenfranchised (tuberculosis, malaria, HIV, HCV, cholera, parasitic diseases), or to working in "free" clinics for sexually transmitted infections. Somehow these efforts register as more Blue than Red, don't they?
  2. Money. Hey, this isn't the first time we ID/HIV docs have been at the bottom of a figure -- remember 2014, when we ranked last in salary? Things have improved for us since then, fortunately, but even with these salary gains, we're hardly in surgical specialty territory. So there's a strong correlation (higher salary, more likely Republican), but it's hard to argue that this relatively low pay directly causes Democratic leanings -- unless you conclude that highly paid doctors resent high taxes (which after all pay for those safety nets) more than we do.

But it's probably more complicated than just these two factors, so would be interested in your thoughts.

And just for fun, let's make it 3 for 3 on those prohibited topics ...

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This article was provided by NEJM Journal Watch. NEJM Journal Watch is a publication of the Massachusetts Medical Society.

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