While most groups that get in the independent expenditure game are strongly ideological and issue oriented — think climate change, gun rights and violence prevention, and overall conservative versus liberal — one group of big spenders in the 2014 elections has a more pecuniary interest: medical and specialty doctors’ groups.

Our return-on-investment (ROI) analysis shows 14 medical groups spent $50,000 or more on independent expenditures, a total of $6.9 million on general election candidates. Ten of them earned an ROI of 70 percent or higher, meaning that most of the candidates they supported won and those they opposed lost. (The medical groups’ ROI is likely to go higher, as Republican William Cassidy is heavily favored to unseat Sen. Mary Landrieu, D-La., in a Saturday runoff election.) The medical committees got involved in hotly contested races and supported both Democrats and Republicans.

There appears to be little doubt about why they were giving: Candidates who won their support backed the medical groups’ agendas on issues such as medical device tax repeal, physician pay and medical malpractice reform — all issues that will get attention in the new Congress.

A case in point: Rep. Ami Bera, D-Calif. who pulled out a close win from his Republican challenger two weeks after the polls closed. Bera, a physician himself, attracted nearly $460,000 in independent expenditure support from seven of these medical specialty groups: the American Academy of Family Physicians PAC, the American Academy of Opthalmology Inc. PAC, the American College of Surgeons Association PAC, the American Osteopathic Information Association PAC, the American Society of Anesthesiologists PAC, the National Emergency Medicine PAC and the American Congress of OB-GYNs PAC (OB-GYN PAC). The National Republican Campaign Committee, American Crossroads and the Chamber of Commerce all spent heavily against Bera.

Bera has been a staunch champion of doctors’ interests. In his campaign materials, he notes that he cosponsored a bill to repeal the medical device tax, part of the Affordable Care Act, in opposition to many in his own party. The repeal is considered one of the major policy initiatives the new GOP Congress intends to take up as part of their opposition to Obamacare; while not necessarily the top issue for doctors’ specialty groups, many have signed on to support such a repeal.

Even more crucial for doctors is their annual — and so far futile — quest to reform the way that Medicare pays them for their work. While few in the general public will know what the abbreviation SGR stands for, you can bet every physician does: a pay cut. SGR refers to Sustainable Growth Rate, the formula dating back to 1997 for determining physician fees under the federal Medicare program. Every year since 2001, the formula has required a reduction in physician fees — most recently by a whopping 24 percent. But every year, as we reported here, Congress has come to the rescue with a temporary fix. Doctors want a permanent repeal of this system, and they got close earlier this year, only to see Congress take the easy way again and vote for a twelve-month delay of the pay cut. That keeps doctors’ fees from being cut until March.

Bera has been champion of repeal of the SGR formula. In late October, he told the Physicians News Network that he is “very optimistic” about SGR repeal post-election.

Another issue that always captures doctors’ attention is medical malpractice laws. Republicans have long favored limiting liability for medical malpractice lawsuits. Earlier this year, Bera cosponsored legislation, H.R. 4106, along with a Republican colleague, that would protect doctors from lawsuits.

Other candidates supported by the medical groups in the elections also weighed in on these issues. For example, Sen. Pat Roberts, R-Kan., enjoyed a total of nearly $581,000 in support via independent expenditures from The American College of Radiology and the American Hospital Association. Roberts has voted in favor of medical device tax repeal. He is currently the ranking member of the Health Care subcommittee, part of the Senate Finance Committee, which is key for any reform of the SGR physician pay system. Last year, the Senate Finance Committee approved by voice vote legislation that would have repealed the SGR formula. He has personally written the Department of Health and Human Services to protest caps on certain fees for physicians. He also supports limits on damages in medical malpractice lawsuits.

For the most part, the medical groups were unanimous in their support or opposition of candidates, with one notable exception: Bruce Braley, the Democratic candidate for Iowa’s open Senate seat. Braley, as a member of the House, has opposed medical malpractice reform. However, he was a champion of physician pay reform. The Cooperative of American Physicians, a California-based group that offers medical malpractice insurance to physicians, lobbies for medical malpractice reform. The group spent nearly $258,000 opposing Braley, while several medical specialty groups spent a total of nearly $429,000 supporting him. Braley, a lawyer who had trouble living down a gaffe in which he disparaged Iowa’s popular retiring Sen. Charles Grassley as a “farmer from Iowa who never went to law school,” lost the race.