Hey, doctors: Don’t be no-shows (again) on Election Day

Physicians do many things well. One thing they aren’t good at is showing up to vote. That bad habit starts early, and we believe it can — and must — be changed.

We don’t have data from recent elections, but studies from a decade ago show that physicians voted less often than the general population. (Lawyers, in contrast, were more likely to vote than the general population.) Given that health care accounts for almost one-fifth of the U.S. gross domestic product, and that new laws and regulations continuously alter the norms of medical practice, it is both curious and shameful that medical professionals fail to fulfill the basic civic responsibility of voting.

Several reasons have been tossed around to explain why physicians vote at such low rates. One is that doctors are so busy that it’s difficult to fit a trip to a polling place into an already packed day. Another explanation is that some physicians decide that the value of their single vote is too small to justify taking time away from patients in need. Low voting rates could also be part of broader disengagement from public life, consistent with evidence that physicians volunteer less often than other highly educated professionals and are less likely to donate to candidates.

But now more than ever physicians need to vote because the outcomes of elections are increasingly affecting their patients and their ability to care for them. Realizing this, many have called for more doctors to get politically involved. Although we’ve seen in recent years a swelling of physician advocacy on political issues, from repeal and replace the Affordable Care Act to “Dreamers” to gun violence, this engagement has largely taken the form of protests, marches, and social media campaigns. Far less energy has been invested into boosting the number of doctors who cast votes, the most fundamental form of civic engagement.

We believe that increasing voting rates among physicians requires a cultural shift in which they view voting as a natural extension of their obligations to their patients. Engineering this shift begins with promoting civic engagement among trainees — medical students, interns, residents, and fellows — because they are the future of the profession.

Good places to start are understanding and dismantling the barriers to voting and fostering an environment that encourages it.

To develop strategies to increase the turnout of trainees in November 2018, we surveyed medical students who were on their clinical rotations during the last election cycle. Those who didn’t vote during that election cited time, confusion about the process, and competing priorities as primary reasons for not voting.

Many said they didn’t have time to leave the hospital. As one student pointed out, “Voting opens at 7 am and I have to be at hospital before then. Voting closes at 8 pm and, if I’m on call, I get out after the polls close.” That sentiment was echoed by many trainees, who generally have demanding schedules. In addition to explicit scheduling demands, trainees also face implicit expectations from supervisors that foster a sense of guilt for taking time away from clinical responsibilities.

Giving trainees protected non-clinical time on Election Day — to be used explicitly for voting — could remove that barrier. Making this time mandatory, rather than “opt-in,” removes the fear that some trainees might have of appearing uncommitted to their clinical work. By adopting such a policy, institutions can take an effective and nonpartisan position that encourages physicians-in-training to fulfill their responsibility to vote. Early releases on Election Day for medical students, as Boston’s Beth Israel Deaconess Medical Center has announced for November 2018, is an important step in this direction. Following the medical center’s lead, Harvard Medical School announced last week early releases for all medical students at its affiliated hospitals for Election Day 2018.

Lack of basic knowledge about voting is another key barrier. Several students we surveyed who reported not voting during the previous election cycle said they didn’t know how or when to register to vote, change their residence, or apply for absentee ballots. The solution? Voter registration booths. They are simple, require few materials, and can be staffed by anyone.

In partnership with a nonpartisan student organization at Harvard Medical School, where we are students, Beth Israel Deaconess included a voter registration booth as part of its 2018 orientation day for new interns. Members of the student group set up and staffed the booth, a process that can be easily replicated at any academic medical center during orientations for trainees at every level. Dozens of trainees registered to vote in Massachusetts while waiting in line to pose for photos for their ID badges.

Some students in our survey simply forgot about voting or missed deadlines for registering. One lamented that clinical rotations take so much “mental energy” that less-pressing tasks inevitably fall by the wayside. In this era of electronic communication, reminding them is easy. Academic institutions and hospitals can support voting by emailing students, faculty, and staff with reminders about registering to vote before deadlines have passed and voting on Election Day. Including links to free resources like vote.org can be quite helpful. Such well-timed nudges can go a long way to getting more clinicians to vote.

Adding information about absentee ballots in these communications can help the many non-resident trainees, as well as those who know in advance they won’t be able to make it to the polls. Absentee voting, an underutilized option for clinicians at all levels, is straightforward, but takes planning and forethought. (Deadlines for doing it are approaching.)

Medical schools and hospitals can also promote online voting, an option for those from one of the 24 states that allow it, by making secure computers available on Election Day.

Even something like encouraging trainees to wear “I voted” stickers on Election Day can help establish social norms that motivate voting among peers.

Medical schools and hospitals don’t have to start from scratch. They can get ideas and resources from student-led initiatives like the MedOutTheVote Campaign, a joint initiative of the American Medical Student Association and Citizen Physicians.

As medical students, we are more than a bit embarrassed by the civic disengagement of the medical profession. We envision a culture in which physicians-in-training, as well as those who have been on the job for a while, treat voting as part of their responsibility to their patients and to the public, an unwritten but implicit line in the Hippocratic oath.

More doctors — and doctors-to-be — need to vote. Don’t be a no-show at the polls this November and beyond.

Suhas Gondi is a second-year medical student, Jonathan Kusner is a third-year medical student, and Yosef Berlyand is a fourth-year medical student, all at Harvard Medical School.