By David Pittman

Doctors want more of their own to serve in Congress. But despite near-constant national debates over Obamacare, drug costs and how Medicare reimburses physicians, they're not having much luck.

The American Medical Association has run a school for prospective candidates since the 1970s that attracted about two dozen interested members this year. Some 350 physicians have passed through a similar venture started a decade ago by the American College of Obstetricians and Gynecologists.

And the ranks of doctors already in Congress have shrunk, not grown. There are now a little over a dozen physicians in the House and Senate, down by more than a third from just a few years ago. Although that was likely a high during modern times, the makeup of the legislative branch used to be quite different — more than 10 percent of the signers of the Declaration of Independence were physicians.

It's not for lack of trying. Scores of doctors have gone through multiday medical society training workshops and seminars, learning how to run successful campaigns in hopes of placing in power physicians of all political persuasions. Trial lawyers may be the only other group with similar programs to "seed the field." More than 200 attorneys serve in Congress.

The Congressional Research Service counts three physicians in the Senate and 10 in the House, plus a dozen related professions like nurses and psychologists.

The doctors caucus isn't linked in the public's mind with the kinds of medical issues that top polls — Obamacare provokes sharp responses, regardless of medical training. But physician-lawmakers have played a role on legislation important to their profession, such as MACRA and repeal of the Sustainable Growth Rate formula used to hold down Medicare payments to doctors.

“Just by the virtue that there aren’t many doctors in Congress,” said Rep. Ami Bera, (D-Calif.), "your colleagues are going to come talk to you about complicated health care issues.”

Physician organizations collectively pour millions of dollars into political campaigns to gain clout in Washington. Putting their own members in those seats would be cheaper and more effective.

“Why would we not have more members knowledgeable about health care, regardless if it’s Republican or Democrat or whatever?” said Ted Burnes, director of the American College of Radiology’s political action committee, which helps run the trainings.

Campaign strategists teach doctors about fundraising, communications and social media, polling and research, legal requirements, grassroots organization, advertising and how to work with a political party or committee.

Some political skills can be slow to develop. Doctors tend to be scientific and analytical, often lacking awareness of the complexities of campaigning.

“Obviously, these are very smart people,” Burnes said. “But advocacy is a very different animal, and they don’t really understand it.”

“The last thing we want our members to do is to quit their practice and then run an unsuccessful campaign,” said Stacie Monroe, who runs political advocacy for the American Association of Orthopedic Surgeons and helped start the ACOG school in 2009.

Texas, whose legislature is part-time, has the highest percentage of doctor-lawmakers in the nation (4 percent versus Congress' 2 percent), according to the Texas Medical Association.

In Congress, the number of doctors is down from as many as 20 between 2010 and 2014, and some of the higher-profile names are gone. Former Rep. Tom Price resigned to run HHS last year, before losing that job months later. Former Sen. Tom Coburn left for health reasons in 2015. Former Senate Majority Leader Bill Frist departed in 2007.

As many as 33 physicians have challenged for seats in Congress this year, although most who have competed in a primary have lost, according to an analysis. One winner: Democrat Kyle Horton, an internist from Wilmington, N.C., is seeking to defeat Republican Rep. David Rouzer in November.

A group called the Physician Women for Democratic Principles is trying to recruit liberal, female doctors to put their names on the ballot. At least eight female Democrat doctors are running for Congress this year.

The medical societies say they don’t keep track of whether their class participants win seats —or even run. Mostly they eye state legislative seats, and some never try.

Workshop speakers are both Democrats and Republicans. Doctors in Congress tend to be Republican white men, even as the profession itself is changing — one study showed physician attitudes shifting toward Democrats between 1991 and 2012, and the proportion of women has increased from about 10 percent in the 1970s to a third today.

When Sen. Bill Cassidy (R-La.) took the AMA course in 1993, attendees simulated a “fake election.” They divided into teams, were given data on potential voters and were forced to break the statistics down to devise a strategy.

“You learn how the numbers tell you which groups to target,” said Cassidy, who co-sponsored one of the failed attempts to repeal Obamacare last year. “You know who is going to vote for you, and you know who is going to vote against you, you know who could go either way. That’s where you need to focus your efforts.”

Tennessee GOP Rep. Phil Roe, who has spoken at both the AMA’s and ACOG’s classes, called them “intensive.” Attendees started early in the morning and went until 10 at night. At the end, they had to give a campaign-style speech.

“They say you’ve been at this all day long, working hard, we’re going to show you what a campaign’s really like,” Roe said.

Bera, the California Democrat, ran unsuccessfully for Congress in 2010, then took the AMA candidate training and won in 2012. He notes that health care legislation is complex, and often has unintended consequences.

Serving in Congress, you’re able to “sit there and say ‘that looks great on paper, but in reality, here’s what I would do if I were practicing medicine,’” Bera said.

Of course, the doctor lobbies who host the trainings get something in return: voices in Congress that are more sympathetic to their members' concerns.

“You need more than a textbook knowledge of health policy to understand what really works in the real world and what doesn’t,” said Rep. Andy Harris (R-Md.), an anesthesiologist.

“If we had over 200 health care professionals, health care policy would look very different,” Harris said.