As GOP views collide with science, doctors are in the crosshairs

WASHINGTON — It started with a tweet: A year-old, 43-second clip of Kevin Wang talking about how parents and teachers can help affirm and support a child’s gender identity, encouraging children to explore.

The vitriolic tweets were swift, and they snowballed. Right-wing influencers accused Wang, an unassuming Seattle physician, of “mutilating” and “destroying” children, though he did not discuss surgery in the clip. They made fun of his name and eventually even posted his workplace and contact details online, setting off enough red flags to convince his hospital’s security department to pull down his employee page.

“They are butchers not doctors,” tweeted Elizabeth Economou, a Seattle-based reporter for sites like Fox News.

The viral moment reverberated through the family physician and pediatrician community, as doctors across the country increasingly find their medical advice at odds with Republican political leaders across the nation. What was most baffling, Wang said, was that only other doctors who attended the event had access to the clip.

“It is definitely a dangerous time for many of my friends who provide care, especially in places which are more hostile,” Wang said.

Scores of practicing physicians and the national groups that represent them are increasingly at the center of a widening cleave between conservative America and science writ large. The gap has doctors young and old questioning how to navigate political landmines and limits in their communities — or whether they should at all.

The challenges only show signs of worsening as 2024 Republican presidential candidates make health care restrictions — and a deep distrust of science — tent poles in their campaigns. Limits and outright bans on abortion, and the very existence of gender-affirming care are already heated talking points in primary debates. Opposition to public health measures like vaccinations has also remained a key part of the conservative agenda this year. And as doctor networks and medical schools become increasingly vocal about diversity, equity, and social crises such as gun control, leading candidates like former President Trump, Florida Gov. Ron DeSantis and other Republican leaders have bucked those positions.

Physicians and advocates say the increasingly political environment could lessen the appeal of people going into the medical workforce, even as record retirements loom. On top of long hours and stressful environments — doctors are among the professions with the highest suicide levels — they now are defending what it means to do their job. STAT spoke to more than a dozen physicians across the country and multiple major doctors’ groups about the environment and found that the political climate is increasingly a major stressor among an already burned-out workforce.

“I feel like to be a provider of abortion care, gender-affirming care, is a political statement,” said Julie Burkhart, president of the only full-service abortion clinic in Wyoming, WellSpring Health Access, which was fire-bombed last year after news leaked that the U.S. Supreme Court intended to overturn Roe v. Wade.

A resident of the neighboring apartment complex heard the break-in and called 911, so first responders arrived before the fire spread out of control. That’s a lucky detail Burkhart still thinks about often — because the clinic sits next to a gas station.

“That still gives me nightmares,” said Burkhart.

But it is not only abortion providers, longtime targets for conservative ire, seeing attitudes towards the medical profession sharpen and shift. As Americans soured on the government’s pandemic response and doctors leading the work like Anthony Fauci, people increasingly have questioned medical experts more broadly — a noticeable reversal of public sentiment from the early days of the pandemic, when people would gather on balconies to applaud doctors and nurses.

“There’s this broad trend of disdain for medicine, science, evidence, expertise,” said Kellan Baker, executive director of the Whitman-Walker Institute, a network of LGBTQ-focused providers. “You hear it in conversations around Covid. It’s no accident that the same governors that are going after trans kids have also gone after mask mandates, have also gone after vaccines, are also peddling lies about what good medicine and good science look like.”

A coffee mug with a Black Lives Matter fist and Pride flag design on the desk of Kevin Wang. M. Scott Brauer for STAT

A changing profession

The challenging new political environment for physicians is coming at the same time as a wave of expected exits in the field, as boomers retire or others, burned out from the Covid-19 pandemic, leave their jobs.

That leaves medical groups and hospitals questioning whether new physicians and other young health care workers might self-select to work in less controversial fields, or choose areas of the country with fewer risks and limits to care, worsening disparities already present between urban and rural, red and blue states.

“It’s not only a concern, it’s real. We are seeing changes we don’t really fully understand, in terms of the types of residencies and specialties that our students are choosing to go into, as well as where they’re choosing to do their training,” said Jesse Ehrenfeld, president of the American Medical Association.

This year, the number of family medicine residency applicants by senior medical students declined 7.4% in states with abortion bans, according to an analysis by the American Academy of Family Physicians. Applications fell 3.6% in states where abortion is legal.

Another recent study from The Association of American Medical Colleges found that OB-GYN residency applications dropped 10.5% in abortion-banning states compared with a 5.3% decrease in legal states.

Gynecologists, family physicians, and pediatricians also experience some of the highest levels of burnout across medical specialities, according to AMA data.

AMA’s Ehrenfeld, who finished residency in Massachusetts in 2008, still advises students and medical school faculty on residency programs and training. “These pressures are very much on their mind,” he said of young physicians entering the workforce. “They see what their faculty, their attendings, are experiencing, which obviously is influential in their decision about how and where and when they want to practice.”

It’s not that doctors’ politics have changed, Ehrenfeld and other physicians argue — it’s that conservative politics have.

“There’s been a huge shift in the Republican Party in focus on social conservatism in just recent years. That has affected politics and medicine, with a very strong focus on abortion, transgender care, [diversity, equity and inclusion efforts] and medical education,” said Robert Blendon, a Harvard health policy professor who tracks Americans’ attitudes on health and social policy issues.

There has been a double-digit rise in social conservatism among middle-aged adults in the past two years according to Gallup polling this summer. While the biggest surge is among Republicans — 74% now identifying themselves as very conservative compared to 60% in 2021 — moderates also saw a 5% uptick in conservatism over two years.

Public health and providers increasingly found themselves in the crosshairs of that growing conservatism over the past four years, fueled first by Covid-19 frustrations and skepticism, then concerted GOP efforts to spark divides around transgender rights and care.

For instance, while dismantling federal abortion rights has been a long-held conservative priority, limits on transgender rights have had a rapid ascension in recent years. The words “transgender” and “gender” appear nowhere in the Republican National Committee’s 2016 platform, which it re-approved in 2020. (The platform does reiterate the party’s support for marriage “between one man and one woman,” abortion limits, and abstinence education.)

By comparison, the Democratic National Committee’s 2020 platform mentions the word “transgender” 15 times, mostly in the context of equity or anti-discrimination protections, but also twice in the context of protecting trans and nonbinary childrens’ wellbeing.

It’s hard to say whether and how doctors’ own politics are changing as the political environment shifts. There has been relatively sparse research about doctors’ political affiliations over time. A 2016 study from researchers at Yale found that more than half of doctors registered with a political party were Democrats, but that the numbers were heavily skewed by area of practice. For instance more than two-thirds of surgeons were registered Republicans, while most pediatricians, psychiatrists, and endocrinologists were Democrats.

Just over half of obstetricians and gynecologists were registered Democrats as well. Older OB-GYNs were mostly men and Republican, while younger doctors in that field were largely Democratic women.

The authors of the 2016 study, political scientist Eitan Hersh and psychiatrist Matthew Goldenberg, were more concerned with how those affiliations might impact care. For instance, while doctors from both parties ranked issues like obesity and alcohol use as serious, Democrats were far more concerned about firearms, sex work, and depression than Republicans, who instead rated abortion as very serious.

“Doctors are people and are influenced by the same forces that affect others in society, including political polarization,” Goldenberg told STAT. “We may want to believe that a doctor’s political beliefs and biases do not affect their practice, but evidence suggests that’s not the case.”

The implications for public policy

Conservative politicians’ increasing adversity to science isn’t limited to the campaign trail; it’s playing out in the halls of power in Washington, too. Republicans in Congress have launched investigations into the Biden administration’s Covid-19 response, into the origins of the coronavirus and into the social impacts of shutdowns. Conservatives continue to criticize the stances that medical groups and high-profile doctors took during the emergency, whether toward vaccines — and how they communicated about them — or social equity.

It’s not that doctors’ groups haven’t been involved in Washington before; AMA and others have not hesitated to throw their weight around on Medicare payment policy, nonprofit hospital regulations, and surprise billing disputes. It’s more that this string of battles has not revolved around who should pay for health care, but whether people should be allowed it all.

AMA and other medical groups have condemned limits on gender-affirming care and reproductive care. The doctor’s organization also expanded its gender-affirming guidance this summer, nodding to the wash of restrictions around the country.

Ehrenfeld, who is the AMA’s first openly gay president and one of its youngest, is quick to stress that the doctors’ group remains a nonpartisan organization even as they push to ensure that increasingly politicized care remains accessible.

“We’re able to bring together the house of medicine, to have those conversations in a respectful, sometimes difficult, but always open way, to set the best policy,” he said. “And there are just so few places where that actually can happen anywhere in the nation.”

Congress, for instance, has never been more divided.

Of the 17 doctors in Congress, 14 are Republicans and just two — Indiana Rep. Mariannette Miller Meeks, a Republican, and Washington Rep. Kim Schrier, a Democrat, are women. There are only four physicians in the Senate, and all are members of the GOP. That follows a general trend; most of the doctors who have served in Congress are Republicans.

In the House, Republicans are advancing a health spending bill that would bar using federal funds for gender-affirming care, a wide-ranging ban akin to the abortion-limiting Hyde Amendment that could force hospitals to sever some pediatric and family medicine services.

House Republicans also held a hearing in July titled, “The Dangers and Due Process Violations of ‘Gender-Affirming Care’” that brought in a woman who had detransitioned and a vocal opponent of transgender men competing in women’s sports, alongside medical experts.

Frank Pallone, the highest-ranking Democrat on the panel, called the hearing “an all-time low” and said he was “disgusted” by the Republican majority.

Doctors, of course, are not the only health care workers caught in the crosshairs as the debate in Washington and state capitals over gender-affirming care and reproductive rights builds.

“I’ve spent my entire career trying to help people, particularly children. That is what I do,” said one witness at the hearing, Myriam Reynolds, a Texas-based counselor with a transgender son. “And to be looked at as a child abuser, an indoctrinater, something like that — it’s just really painful. It just adds a whole other layer to this.”

Wang at Swedish Family Medicine First Hill in Seattle. M. Scott Brauer for STAT

For Kevin Wang, doing his job nowadays means staying off of social media and trying to educate other physicians on what gender-affirming care looks like, even if that means another leaked audio moment. He spoke at the same event this year that spawned the original viral clip.

He’s doing it because others can’t, Wang said. He works in a state, Washington, that has shored up rights to gender-affirming care. Nearby states including Idaho and Montana have passed bans on gender-affirming care for minors, spurring some to travel to Wang’s clinic and others in the state.

“What I feel is how most of us feel, regardless of how people perceive our recommendations, or our stances, on reproductive health services and LGBTQ-centered care,” he said. “Regardless of however you feel, and regardless of whether you agree with my positions or not, whenever you come into the clinic, or whenever you come into the hospital, I’m still going to do what I can to provide you the care you need.”

This story is part of ongoing coverage of reproductive health care supported by a grant from the Commonwealth Fund.

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