For the past two weeks, the National Rifle Association has raged at doctors in a very public feud over the place of physicians in the national gun debate, and doctors have been happy to hit back. At the same time, another quieter battle is brewing within the medical profession over just how far doctors should go to fight for stronger gun laws.

After the American College of Physicians published a position paper demanding government action on gun laws, the NRA issued a now-infamous tweet telling “self-important anti-gun doctors to stay in their lane.” Outraged doctors railed against the gun group on Twitter with the hashtag #ThisIsOurLane, garnering national media coverage. Simultaneously, and with less fanfare, some physicians are demanding that their trade associations — including the American College of Physicians, the American Medical Association, and the American College of Emergency Physicians — stop contributing to NRA-endorsed politicians.

Dr. Michael Siegel of the Boston University School of Public Health is leading the charge. Siegel wants the medical lobby to consider a candidate’s position on gun policy in addition to issues like malpractice law or Medicare when considering whether to lend financial support.

“These organizations are making public statements and taking public positions in support of gun policies. Which is great. But it doesn’t make sense to support candidates who work against these policies,” Siegel said in an interview. “If candidates knew that accepting NRA money was going to mean losing money from medical organizations, that could have an impact.”

Siegel’s campaign was sparked by the same American College of Physicians paper that ignited the NRA’s own strident take-down of doctors.

Siegel was not impressed with the ACP’s October manifesto. As he wrote in an October 31 letter to ACP leadership, the words rang hollow in the context of the medical group’s political giving. In the election cycle then drawing to a close, Siegel noted, the ACP gave $46,000 to national politicians supported by the NRA. Beneficiaries included members of House Republican leadership like Kevin Brady and Paul Ryan. The ACP also contributed money to Andy Barr and Greg Walden, strong proponents of the NRA’s top policy objective, national concealed-carry reciprocity.

“This is the ultimate in hypocrisy,” Siegel wrote. “I don’t see how physicians can in good conscience contribute money to ACP when they know that a good chunk of that money is going to support politicians who have committed to fighting against gun violence prevention policies.”

In series of blog posts published over the next few days, Siegel criticized the American College of Emergency Physicians and the American Medical Association for similar behavior. The ACEP gave $475,000 to NRA-supported federal candidates and elected officials this year while the AMA gave $365,000.

Siegel has since drawn the support of a handful of doctors who share his interest in pushing their trade organizations to make a shift. Boston emergency pediatrician Eric Fleegler compared the conflict to another controversial issue: “I would be outraged if a medical society that I belong to supported an anti-vaccine politician,” Fleegler said. ”When people are voting, there are elements of each candidate they may agree or disagree with, but that’s very different from a financial contribution. That’s a true endorsement.”

This isn’t the first time doctors have highlighted the divergence between the physicians lobby’s words and political spending. In a study published in October 2017 by the Annals of Emergency Medicine, Dr. Jay Schuur of Boston’s Brigham and Women’s Hospital and Hannah Decker, an Emory University medical student, analyzed 2016 political contributions by the National Emergency Medical PAC (NEMPAC), the political arm of the ACEP. Schuur and Decker found that NEMPAC gave more to incumbent members of Congress who had voted against universal background check legislation than to those who had supported the bills.

Schuur was struck by the disconnect between the group’s words and actions. “Physicians groups have made advocacy for gun safety a big issue, and if it is such a big issue, it should be criteria by which political donations are screened,” he told The Trace.

The medical groups have pushed back against the recent criticism, arguing that it is simplistic. In a reply to Siegel’s letter, Robert Doherty, the American College of Physician’s senior vice president for governmental affairs, called the accusations of hypocrisy “wrongful assertions.” He explained that the ACP cannot be a single-issue organization. “As much as we would like to find that lawmaker who agrees with us on everything, she does not exist,” Doherty wrote. He declined to comment for this article.

The American Medical Association did not immediately respond to a call seeking comment. A spokesman for the American College of Emergency Physicians said, in an emailed statement, “ACEP is not a single-issue organization and our political giving through NEMPAC reflects the diversity of our membership.”

Indeed, research shows that doctors are not a politically homogeneous bunch. A 2016 analysis of voter registration data and physician listings by the political scientist Eitan Hersh and professor of psychiatry Matthew Goldenberg, both of Yale, found that doctors are almost evenly split between the Republican and Democratic parties.

Some doctors already think medical associations have gone too far by issuing position papers on gun violence. Arthur Przebinda, a radiologist who is also the director of the pro-firearm group Doctors For Responsible Gun Ownership, said by email that his group “stands firmly with the NRA’s assertion that medical groups are straying far out of their lanes when a vocal minority push for policies that would strip Americans of their civil right to own firearms.”

Garen Wintemute, who directs the Violence Prevention Research Center at the University of California, Davis, and has published widely on the topic since the 1980s, is skeptical of Siegel’s approach. “To accuse the American College of Physicians of hypocrisy shows really bad political judgement,” Wintemute said.

At the same time that ACP and its sister groups are growing more vocal on gun issues, Wintemute noted, they have to preserve relationships with elected officials with whom they work on a range of policies. Wintemute said doctors should privately push elected officials to embrace policies to reduce gun violence, and should change their everyday medical practice by talking about the issue with colleagues and patients. Is it a good idea for these medical organizations to talk to recipients of their money about how they’re unhappy with their position on guns? Absolutely. Depending on how those conversations go, exert leverage,” Wintemute said. “But do it in a savvy way that recognizes the value of the relationship. What Siegel and others are doing is divisive.”

Dr. Robert Begg III became a vocal advocate for stronger gun laws after he treated victims of the 2012 Sandy Hook Elementary School shooting at Danbury Hospital in Connecticut, where he still directs emergency services. In 2013, Begg testified before the Senate in favor of Senator Dianne Feinstein’s assault weapons ban and universal background checks. “Doctors who treat assault weapon wounds are also affected by these mass tragedies,” he said. “We should speak out when we’ve seen someone shot five or six times, their brains hanging out, the trauma room covered in blood.”

While Begg said he understands why professional associations might support NRA-endorsed politicians, he applauded efforts like Siegel’s to push professional associations to adopt a stronger line on gun policy. “In the past, medical societies have been timid,” Begg said.

Since the Sandy Hook shooting, advocacy by doctors has changed medical institutions’ approach to gun issues, Begg said. In 2012, he said, he was warned that his activism could cost him his job. But this year the Fairfield County Medical Association gave him an award for dedication to medical advocacy.