The Political Landscape for Ob/Gyns
Well, this is a fun, only slightly controversial topic.
The political landscape for Ob/Gyns is, unsurprisingly, complex.
The ACOG political action committee (PAC) is famously bipartisan. This inevitably causes angst among young Ob/Gyns who discover for the first time that the PAC donates to Republicans as well as Democrats. They wonder whether ACOG may have some hidden, nefarious anti-choice agenda, or perhaps simply doesn’t care about women, or Ob/Gyns, or anybody.
Now, I am far from privy to the inner workings of PAC leadership, but I am a longtime ACOG PAC donor, and from my perspective, the truth is more complex.
Mainstream obstetrics and gynecology is famously pro-choice. I remember being struck with pride in my profession by the 2013 “Statement on Abortion by 100 Professors of Obstetrics” published in the Grey Journal and signed by the chairs of virtually every academic, non-Catholic department of Obstetrics and Gynecology in the nation. I see now that it was reaffirmed in the Grey Journal in 2024 and signed by no fewer than 900 professors . The Democrats, of course, are the party of abortion access, and hence are the friends of Ob/Gyns on this issue.
Yet Ob/Gyns have 99 problems, and anti-abortion law is just one. Friends, we have a malpractice problem. Here in my state of Iowa, we have had hospital after hospital shut down its Labor and Delivery or declare bankruptcy often after an absurdly high-dollar malpractice verdict. Folks, the Democrats are not our friends on this issue.
The trial attorneys have their own ACOG, called the American Association for Justice, and they donate heavily to Democrats. Their grip over the Democratic party is strong– in part because the Democrats otherwise don’t have a ton of deep pockets supporting them. After all, venal capitalists find the Republicans more responsive to their concerns in general.
For example, for years, the Iowa Medical Society (essentially state-level AMA) struggled to pass malpractice (“tort”) reform. The situation in Iowa became increasingly dire as surrounding states passed malpractice reform, and out-of-state plaintiff’s lawyers set their sites on Iowa. A shocking number of high-dollar sign verdicts were returned . The consequences were severe. Practices were unable to secure malpractice coverage. Several family medicine residencies closed, in part because the residents were no longer insurable.
The Iowa Democrats had several physician members in state government. These physicians supported all the right things medically – accurate information about vaccines, abortion rights, etc. However, they could not bring themselves to support malpractice reform. There was great consternation among politically active physicians in the state – how could our own profession not support us when they knew our health care system was on the brink of falling apart due to these ridiculous malpractice verdicts?
Well, I learned from various insiders that, essentially, the trial lawyers association had threatened to "primary” any Democrat from a safe Democratic district who supported tort reform – that is, the plaintiff’s attorneys would find a more plaintiff-friendly Democrat to run in the next primary election and fund them well enough to unseat any incumbent. [Please note, this is essentially a rumor I cannot confirm directly – however, it has the ring of truth to it, and I cannot come up with any alternate explanation for perfectly intelligent physicians to drop the ball on their colleagues.] Ultimately, malpractice reform was signed into law in February 2023 by our Republican governor, having passed the Iowa Senate with 29 / 34 Republicans and 0/15 Democrats supporting it, and the Iowa House with 53/64 Republicans and 1 / 36 Democrats supporting it. That one lonely Democrat is a retired attorney.
There are other issues as well that we as Ob/Gyns need bipartisan support for, such as funding for maternal mortality review committees (MMRCs), Medicare and Medicaid reimbursement, funding for programs to support rural obstetrics, etc.
Essentially, Ob/Gyn concerns are bipartisan, and like it or not, we will certainly not achieve our political goals regarding malpractice reform, payment reform, and the overall survival of our profession if we only interface with one political party, even if that party is the clear partisan champion of reproductive rights.
Karla Solheim, MD, FACOG