Advice on When and How Physicians Can Speak Out If Their Opinions Differ from Their Employer

by Linda Kossoff •

It’s very difficult to work in an environment where one’s personal values don’t line up with those of the hospital or institution; over time, the differences can lead to burnout. —Gopi Shah, MD

From this perspective, most, if not all, policy decisions by elected and appointed officials might be considered health related, and there would be plenty of overlap in the Venn diagram of politics and healthcare. “Climate change, immigration, gun control, welfare, subsidy—there are endless controversial topics,” said Dr. Wei, who, together with ASPO leadership, drafted a nonpartisan statement with a call to action to vote. “After the mass gun violence in Uvalde, Texas, and the overturning of Roe v. Wade, I believed strongly that we needed to send a message that would represent our majority and acknowledge our grief,” she said.

Some physicians believe that it is possible, and in fact, vital, to parse which aspects of a controversial issue should be considered health related and which would fall into the realm of political ideology. “For instance, you can be very much in favor of vaccines and yet not support mandatory situations,” said Bradford Holland, MD, an otolaryngologist based in Waco, Texas. “And I know that there are physicians who will disagree, but I think this relates to your opinion as to what the role of government should be, as opposed to not thinking the vaccine is a very good idea—which obviously it is. Is it okay for a physician who is pro-vaccine to say we shouldn’t have a vaccine mandate? I’m not sure those nuances in opinion were ever fully appreciated.”

When, Where, Why, and How to Speak

For physicians, attending to their fellow human’s healthcare needs is a daily reality that requires a neutral approach. “We are constantly in that place of exhibiting tolerance and understanding even as we’re trying to persuade a patient to put down the saltshaker,” said Dr. Holland. “We learn to do this in a way that’s effective but still withholds judgment.” As speaker of the house of the Texas Medical Association, he has found this aspect of a physician’s skill set highly transferable. “I’ve been in a position to work with our state’s medical political action committee, so I’ve become familiar with having to make policy statements that reach across the aisle.”

Gopi Shah, MD, a pediatric otolaryngologist in Dallas, has seen how an ideology-driven political point of view can spur changes that many physicians would consider detrimental to public health. “We have seen rapid policy changes in hospitals and other institutions since COVID-19, but a gradual evolution can also occur with changes in leadership and mission, and, ultimately, culture and values,” Dr. Shah said. “It’s very difficult to work in an environment where one’s personal values don’t line up with those of the hospital or institution. Over time, the differences can lead to burnout.”