As Senator, Physician Also Wants His Practice

Is it good for the republic that serving in Congress must be treated as a full-time job?

Newly elected Sen. Tom Coburn of Oklahoma thinks not. And Coburn, who is also a physician, has already announced he will challenge a long-standing rule that bars him from continuing to practice medicine once he takes the oath of office Tuesday.

A conservative Republican, Coburn has always been a maverick in public life: During six tumultuous years in the House, where he served from 1995 to 2001, he cultivated an image as an angry renegade and a citizen legislator who scorned professional politicians.

But this time, he does not stand alone.

A significant number of conservative political thinkers agree that the country would benefit from a return to the tradition of the public servant who also remains a private citizen. That, it is argued, is the model handed down by the Founding Fathers.

George Washington continued to operate his Virginia plantation, Mount Vernon, while commanding the Continental Army and serving two terms in the White House. John Hancock, a wealthy Boston merchant, did not abandon his business interests because he signed the Declaration of Independence and worked to establish the new nation.

And Robert Morse, the New York financier, explicitly stipulated when he took over the challenge of financing the American Revolution that he would continue his private business dealings as well.

That is the pattern Coburn hopes to follow, and he argues that it will make him a better public servant.

“He does want to continue seeing patients while he’s serving in the Senate, and he is hoping to come to an accommodation with the Senate ethics committee,” said Michael Schwartz, Coburn’s chief of staff. The senator-elect was vacationing with his family and unavailable for comment.

“He believes he is a more effective legislator if he is able to relate to constituents in a nonpolitical context, if he is able to listen to what ordinary people are thinking,” Schwartz said of Coburn. “He believes that Congress is better off if we have citizen legislators.”

Seven new Republican senators are scheduled to be sworn in Tuesday. And neither Coburn’s critics in the Washington political establishment nor his admirers in conservative watchdog groups are surprised that he plans to begin his Senate career by challenging the rules.

Coburn said he delivered 400 babies while serving in the House, a feat accomplished by traveling back to his district to tend to patients nearly every weekend and during congressional recesses. To do so, he reached a compromise with the House ethics committee that allowed him to practice medicine, with the restriction that he could earn enough only to pay his medical malpractice insurance and his overhead.

Now, Coburn says, he will do the same in the Senate -- even if that means winning an exemption from Senate ethics rules and getting around a federal statute that forbids senators from practicing certain professions, including medicine, and limits the income they can earn at other professions.

Conservatives who agree with Coburn that full-time politicians are inimical to democracy are hoping his decision to buck the establishment, even if it fails, will at least raise the question of why serving in Congress should preclude holding down other jobs.

“I think Congress should change the law,” said Cleta Mitchell, a partner at the Washington law firm of Foley & Lardner who has represented members of Congress before both the Senate and House ethics committees.

Mitchell, formerly an activist for term limits, said she found it “abominable” that the unearned income of members of Congress was not limited, while earned income was held to less than $23,715 a year above the annual $157,100 salary.

The system, Mitchell said, favors millionaire lawmakers. “If you are a working stiff or a practicing physician, the law says you’re not supposed to be allowed to continue earning income” above the limit, Mitchell said. “What Coburn is trying to do is very laudable.”

But some watchdog groups said they found Coburn’s decision to challenge the work restrictions alarming and symptomatic of a willingness by Republicans -- who control the House and the Senate -- to try to bend the rules.

“My feeling is: The law is the law,” said Frank Clemente, director of Congress Watch for Public Citizen, a nonprofit organization. “If they are going to encourage people to be citizen legislators, there should be public hearings about it. He is paid a handsome salary to represent his constituents, and that should be his first priority.”

Some historians also challenge the comparison to the Founding Fathers.

“It is a false analogy to look at the world of 18th century America and say it ought to be the standard for 21st century America,” said John K. Alexander, a specialist in early American history at the University of Cincinnati.

“They lived in a different world,” he said, noting that even high government officials were often paid little more than expense money, and Congress was not the year-round enterprise it is today.

Although other members of Congress are physicians and surgeons, few have followed Coburn’s example.

In the Senate, Majority Leader Bill Frist (R-Tenn.), a transplant surgeon, occasionally performs surgery for free and pays his medical malpractice insurance out of his own pocket. In the House, Rep. Ron Paul (R-Texas), an obstetrician-gynecologist, keeps his license current by teaching for free at the University of Houston’s medical school.

Paul said that although he supported Coburn’s quest, “he’s struggling for something that is very, very difficult to achieve. I would say good luck, but my fight is to reduce the size and scope of government,” rather than to win the right to practice medicine.

Coburn sees work outside Congress as an antidote to what he describes as a disease infecting many members: careerism. It is a theme on which he elaborated in his book: “Breach of Trust: How Washington Turns Outsiders into Insiders.”

Coburn argued that Republicans had fallen victim to the desire to stay in power, and warned that ever-expanding government and career politicians posed a worse threat to American democracy than any foreign enemy.

Little wonder that much of the Washington political establishment breathed a sigh of relief when Coburn returned to Muskogee, Okla., in 2001, where he continued his work as a family practitioner specializing in obstetrics and gynecology.

Even some conservative groups acknowledged privately that they were dismayed when Coburn won election to the Senate in November, despite such campaign gaffes as advocating that physicians who performed abortions should receive the death penalty and alleging that lesbianism had become so widespread in southeast Oklahoma schools that “they’ll only let one girl go to the bathroom.”

“Just as Ted Kennedy is the poster boy for the right,” predicted an official with a Washington-based conservative organization that shared many of Coburn’s views, “Coburn will become a poster boy for the left.”

But the Senate provides Coburn with a far better forum for drawing attention to his issues -- freezing nondefense discretionary spending, making tax cuts permanent, restricting abortion and passing a constitutional amendment banning gay marriage -- than did the House.

“As a member of the House, he was known for being someone who was very principled and unwilling to go along to get along as is so common here,” said Paul Gessing, director of government affairs for the National Taxpayers Union.

With the higher visibility of a senator, Gessing said, “there’s a lot more in the way of potential for him to cause mischief for the establishment of both parties. He has a lot more parliamentary tools in the Senate.”

Most state legislatures do not restrict outside work, even those such as California’s that operate full time. But in 1978, after Watergate, Congress passed a series of ethics rules that restricted the outside income members could earn and forbade the practice of some professions.

Many conservatives have long regarded those restrictions as ridiculous, even dangerous, arguing that they help create permanent politicians who become captive to Washington and the lobbyists who haunt the halls of Congress.

But Betty K. Koed, assistant historian of the Senate, said the crushing workload of today’s members of Congress made it unlikely that many would choose to hold outside jobs, even if there were no restrictions.

“For a long time, Congress was a part-time job. It met only three months a year,” Koed said. “But since World War II, it has been extremely unusual to have outside employment.”

Serving in Congress, Koed said, “is very much a full-time job.”