Politics and Your Practice: One Senator Takes on the System

Tom Coburn, a first-term U.S. senator, travels home to Muskogee, Okla., almost every weekend to treat high-risk pregnant women in his private, nonprofit medical clinic.

An unusual way to stay in touch with constituents?

Coburn says it is critical to remaining a “citizen-legislator” and not falling prey to Washington’s “culture of corruption.” Such remarks sting his colleagues but are not unusual for a polarizing political figure, described alternately as a single-minded hothead and a highly principled leader.

He is one of a handful of senators trying to curb federal spending by attacking “earmarks” - the Senate practice of dropping expensive pet projects of questionable national value into the federal budget. According to the Congressional Research Service, the number of earmarks has grown from about 100 in 1987 to more than 15,000 last year.

So it is ironic that his peers insist the best way for Coburn to remain pure is for him to become purely political.

Coburn has been fighting the Senate Ethics Committee’s order, issued more than 18 months ago, demanding he quit his job as a physician in order to conform to the institution’s long-standing rule barring most forms of moonlighting. The reasoning: Senators who have jobs back home are more subject to the influences of dishonest lobbyists than those who remain in Washington with the lobbyists. This has been the conventional wisdom since the discovery, 20 years ago, of a scheme involving lobbyists who “hired” members of Congress.

Coburn, for his part, finds this preposterous. “It is absurd to think that I have a conflict of interest [like a lawyer],” he says. “None of my patients come to see me and ask me to deliver their baby in order to influence my vote in Congress. Let’s get real.”

Although the rule is intended to limit corruption by reducing temptation, Coburn says it has the opposite effect because it turns all senators into career politicians. Congress would be more responsible if members were allowed to follow his example: keep their day jobs, at least part time, spend less time fundraising, and make their stays in Washington temporary. When legislators can be re-elected in perpetuity, they are motivated to place their constituents’ parochial interests ahead of broader national concerns.

Coburn, a conservative Republican, is a former member of the House, winning a seat in 1994 with a pledge to return home after six years. He then stunned the political world by keeping his promise. When a Senate seat opened in 2004, he jumped at the chance to run, pledging this time to remain only two terms.

By returning to Oklahoma one weekend a month to treat pregnant women and deliver their babies, Coburn says he learns more than he does from any Senate hearing.

There seems little chance that the rule will be eliminated.

But it should be more flexible.

It should envision professionals - physicians, engineers, scientists - who cannot easily return to their careers after long hiatuses, as lawyers typically can. And it should allow for professional activities that have little risk of inviting corruption.

Should the Senate make exceptions to its rule on moonlighting? Or would that invite corruption? Write to me at kkarpay@physicianspractice.com. The views expressed here are my own and do not necessarily reflect those of Physicians Practice.

This article originally appeared in the July/August 2006 issue of Physicians Practice.