Aug. 1, 2007 Although most religious traditions call on the faithful to serve the poor, a large cross-sectional survey of U.S. physicians found that physicians who are more religious are slightly less likely to practice medicine among the under-served than physicians with no religious affiliation.
In the July/August issue of the Annals of Family Medicine, researchers from the University of Chicago and Yale New Haven Hospital report that 31 percent of physicians who were more religious--as measured by "intrinsic religiosity" as well as frequency of attendance at religious services--practiced among the under-served, compared to 35 percent of physicians who described their religion as atheist, agnostic or none.
"This came as both a surprise and a disappointment," said study author Farr Curlin, MD, assistant professor of medicine at the University of Chicago. "The Christian, Jewish, Muslim, Hindu and Buddhist scriptures all urge physicians to care for the poor, and the great majority of religious physicians describe their practice of medicine as a calling. Yet we found that religious physicians were not more likely to report practice among the under-served than their secular colleagues."
Physicians have many compelling reasons to avoid spending the bulk of their time caring for the poor. It can mean forgoing professional prestige, free time and academic opportunities. It often comes with reduced salaries, decreased support staff and constant bureaucratic interference.
But physicians who care for the under-served receive intangible rewards in exchange, such as a sense that they make a difference in society, have a positive impact on the lives of large groups of patients and have aligned their jobs with their altruistic aspirations.
To find out which religious, spiritual and personal factors were most often present in doctors who care for the under-served, Curlin and colleagues surveyed 1,820 practicing physicians from all specialties; 1,144 (63%) responded.
The survey contained questions about what the researchers called intrinsic religiosity--the extent to which individuals embrace their religion as the "master motive that guides and gives meaning to their life." Physicians were asked if they agreed or disagreed with two statements: "I try hard to carry my religious beliefs over into all my other dealings in life," and "My whole approach to life is based on my religion." They were also asked how often they attended religious services.
The survey also included questions about whether the physicians considered medicine a calling, whether their religious beliefs influence their practice of medicine, and whether the family in which they were raised emphasized helping those with few resources.
The researchers found that 26 percent of physicians reported that their patient populations are considered under-served. These physicians tended to be younger and were more likely to report working in an academic health center and receiving loan repayment in exchange for working where they do. Physicians who receive educational loan repayment are often obliged to work in under-served communities.
Physicians who strongly agreed that their religious beliefs influence their practice of medicine were more likely to report practice among the under-served. However, physicians who were more religious in general (as measured by their intrinsic religiosity or their frequency of attending religious services) were not more likely to practice among the under-served. Even the more religious physicians who reported that their families emphasized service to the poor and that, for them, the practice of medicine was a calling, were no more likely to practice among the under-served.
Curlin and colleagues also noted that those who identified themselves as very spiritual, whether or not they were religious, were roughly twice as likely to care for the under-served as those who described their spirituality as low. "Part of this divergence between religion and spirituality can be traced to a rift between Christian denominations in the late-19th and early-20th centuries," explained Curlin, who describes himself as an orthodox Christian in the Protestant tradition.
About a hundred years ago, he said, many of the mainline and liberal Protestant churches began "to emphasize efforts to right social injustices, while the more conservative churches tended to stress doctrinal orthodoxy. Research indicates that those who consider themselves spiritual but not so religious are more likely to be formed in the more liberal denominations."
Policy makers and medical educators hoping to increase the physician supply for under-served populations should take these results into account cautiously, said the authors. "No one knows how to select medical students in a way that would actually increase the number of physicians eager to serve the under-served," Curlin said, "but our findings suggest that admissions officials should ignore both the general religiousness of candidates and their professed sense of calling to medicine."
The Greenwall Foundation and the Robert Wood Johnson Clinical Scholars Program funded this study. Additional authors include John Lantos and Marshall Chin of the University of Chicago and Lydia Dugdale of Yale New Haven Hospital.
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