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cian donors contributed to Republicans, including 45% of previous donors and 44% of new donors; when the percentages were weighted by the amount of the contributions, the comparable percentages were 50%, 50%, and 46%, respectively. Nearly all physicians contribute exclusively to 1 of the 2 major parties. Few physicians ever switch parties, so shifts in contributions reflect the exit of previous donors and the entry of new donors. The Figure shows the percentage of physician campaign contributions to Republicans by sex, for-profit vs non-profit employment status, and surgeons vs pediatricians. In all groups, there was a small uptick in the Republican direction in the 2013-2014 election cycle; however, the shift toward the Republicans was less than in the 2009-2010 cycle, when Congress debated and voted on the Affordable Care Act during President Obama’s first term. In all groups, the percentage of physician campaign contributions to Republicans was less than in the 2005-2006 election cycle, when the Democrats gained control of the Senate. In the 2013-2014 cycle, there were far fewer new physician donors than in the 2009-2010 cycle, when the Affordable Care Act was under consideration (5737 vs 14 724); the total amount of physician donations also decreased ($57.5 million in 2013-2014 vs $81.6 million in 2009-2010). In the 9 states where the Republicans gained Senate seats in the 2013-2014 cycle, physician contributions were equally split between Democrats and Republicans, with 49% of previous donors and 51% of new donors contributing to Republic ans (Table). When the percentages were weighted by the amount of contributions, Republicans secured the majority of funds: 57% from previous donors and 60% from new donors.

The Political Alignment of US Physicians: An Update Including Campaign Contributions to the Congressional Midterm Elections in 2014 We recently reported that between 1991 and 2012, the political alignment of American physicians shifted from predominantly Republican toward the Democrats. 1 In 2014, the Republican surge changed party control of Congress: the Republicans gained 9 Senate seats and became the majority party there, and the Republican majority in the House of Representatives increased to the largest since 1928. To determine if the political alignment of physicians also shifted toward Republicans, we studied their campaign contributions to federal elections in 2013 and 2014. We found that physicians’ campaign contributions did not shift to the Republicans, in contrast to the change in the public’s voting behavior. In general, the shift in campaign contributions toward the Democrats that prevailed in 2011 to 2012 and earlier election cycles continued, even in the 9 states where the Republicans gained Senate seats. Methods | Our methods, including how we identified physicians, measured their campaign contributions, and analyzed the data, have been previously described.1 We grouped 2013 and 2014 contributions by the 2-year congressional election cycle and calculated the percentage of physicians who contributed to Republicans for all donors, previous donors, and new donors, both unweighted and weighted by amount of contribution, and the total amount of physician contributions. Results | The Table lists physicians’ contributions in each 2-year election cycle from the 1993-1994 cycle through the 20132014 cycle. In the 2013-2014 election cycle, 45% of all physi-

Table. Physician Contributions to Federal Election Campaigns by Election Cycle Contributing to Republicans, % Donors Weighted by Contribution Amount

Unweighted Donors Election Cycle

Total Physician Contributionsa

Donors, No.

All

Previous

New

All

Previous

New

Previous

New

All Donors

1993-1994

69

63

72

65

61

71

5121

9722

22.7

1995-1996

72

72

72

67

65

70

8446

10 100

30.6

1997-1998

68

69

66

63

63

64

8785

6808

23.3

1999-2000

65

67

61

61

61

61

12 105

9844

41.0

2001-2002

68

66

69

65

64

69

13 275

11 978

37.6

2003-2004

58

65

53

56

58

51

21 071

25 594

92.6

2005-2006

55

55

54

56

56

56

22 957

11 618

56.0

2007-2008

44

50

37

47

50

37

34 953

28 404

124.3

2009-2010

56

53

63

53

52

63

33 563

14 724

81.6

2011-2012

45

48

40

63

64

50

47 534

22 514

148.0

2013-2014

45

45

44

50

50

46

29 538

5737

57.5

51

58

57

60

3163

724

All US States

9 US States That Shifted to Republican Senate Seatb 2013-2014

49

49

NA

Abbreviation: NA, not applicable.

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a

Reported in millions of dollars and adjusted to 2012 dollars; single contributions greater than $1 million, including $43 million from Miriam Adelson in 2012, are excluded from the totals.

b

Alaska, Arizona, Colorado, Iowa, Louisiana, Montana, North Carolina, South Dakota, West Virginia.

JAMA Internal Medicine July 2015 Volume 175, Number 7 (Reprinted)

Copyright 2015 American Medical Association. All rights reserved.

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Figure. Percentage of Physician Campaign Contributions to Republicans A Sex

Campaign Contributions to Republicans, %

100

75

Male

50 Female

25

0 1992 1994 1996 1998 2000 2002 2004 2006 2008 2010 2012 2014

Election Year B

Adam Bonica, PhD Howard Rosenthal, PhD David J. Rothman, PhD Author Affiliations: Department of Political Science, Stanford University, Stanford, California (Bonica); Department of Political Science, New York University, New York (Rosenthal); Center on Medicine as a Profession, Columbia College of Physicians and Surgeons, New York, New York (Rothman).

Employment 100

Campaign Contributions to Republicans, %

salaried physicians, who typically ally with the Democrats, in contrast to surgeons, who typically ally with the Republicans, our findings suggest that the medical profession will be challenged to achieve consensus on health policy issues. The profession is unlikely to speak with one voice on questions such as the provision of health insurance or controlling the costs of medical care. The polarization among physicians, however, may spur both political parties to work harder to maintain and increase physicians’ support. Thus, the political divisions among physicians may have the unintended effect of enhancing the political standing of the medical profession.

Corresponding Author: David J. Rothman PhD, Center on Medicine as a Profession, Columbia College of Physicians and Surgeons, 622 W 168th St, PH15-25, New York, NY 10032 ([email protected]).

75

Published Online: April 27, 2015. doi:10.1001/jamainternmed.2015.1332. For−profit

50 Nonprofit 25

Conflict of Interest Disclosures: None reported. Additional Contributions: Kristy Blackwood, BA, Center on Medicine as a Profession, provided exceptional editorial and administrative assistance for this article. She was not compensated for her contribution beyond her normal salary. 1. Bonica A, Rosenthal H, Rothman DJ. The political polarization of physicians in the United States: an analysis of campaign contributions to federal elections, 1991 through 2012. JAMA Intern Med. 2014;174(8):1308-1317.

0 1992 1994 1996 1998 2000 2002 2004 2006 2008 2010 2012 2014

The Course of Functional Impairment in Older Homeless Adults: Disabled on the Street

Election Year C

Specialty

Campaign Contributions to Republicans, %

100

Surgeons

75

50 Pediatricians 25

0 1992 1994 1996 1998 2000 2002 2004 2006 2008 2010 2012 2014

Election Year

Discussion | Although the results of the 2014 congressional midterm elections in the United States may have constituted an important political shift toward the Republicans, the majority of physicians continued to be aligned with the Democrats. Of physicians who contributed to federal campaigns in the 2013-2014 election cycle, 55% contributed to Democratic candidates, 45% to Republican candidates. Political divisions among physicians will almost certainly persist. Given the increasing numbers of women physicians and jamainternalmedicine.com

During the past 25 years, the proportion of the homeless population aged 50 years or older has increased, from 11% in 19901 to 50% today.2 Older homeless adults experience the early onset of age-related conditions compared with the general population, including difficulty performing basic self-care activities that are considered essential for independence, such as bathing and dressing.3 Such functional impairment occurs in 30% of homeless adults in their 50s and early 60s—a prevalence exceeding that of housed adults who are 20 years older.3 However, it is unknown whether functional impairment among older homeless adults is transient or persistent and thus what types of interventions are needed to address these deficits. We examined the persistence of functional impairment in homeless adults aged 50 years or older and identified risk factors for persistent or worsened functional impairment. Methods | We conducted a 12-month prospective study of 250 older homeless adults recruited from 8 homeless shelters in Boston, Massachusetts, from January 25 to June 30, 2010.3 Eligibility criteria included age 50 years or older, current homelessness, and ability to communicate in English. We interviewed participants in person at baseline and at 12 months. The institutional review boards of the participating universities approved the study; all participants provided written informed consent and received financial compensation. (Reprinted) JAMA Internal Medicine July 2015 Volume 175, Number 7

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The Political Alignment of US Physicians: An Update Including Campaign Contributions to the Congressional Midterm Elections in 2014.

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