Sen. Tom Coburn (R) is in the final weeks of his bid to save his medical practice, facing a Sept. 30 deadline to shutter his office back in Oklahoma.

Coburn said this week that he is still hopeful that Senate GOP leaders, including Majority Leader Bill Frist (Tenn.) and Rules and Administration Chairman Trent Lott (Miss.), will hammer out a new accord that permits the continuation of his obstetrics and gynecological practice. Coburn said he’s ready to put the question to a vote on the chamber floor.

“My hope is to get a vote on it before the end of the month,” said Coburn, who campaigned in 2004 on a vow to bring what he called a return to the “citizen legislator” by promising to continue practicing medicine.

But that campaign vow has turned into a much stickier issue than the freshman Senator had expected, since Senate rules explicitly prohibit the practice of professional services such as medicine, law, engineering and others that involve “fiduciary” relationships.

Without any change in the rules, Coburn said he plans to pay about $30,000 out of his own pocket to cover the costs of a couple nurses, a receptionist and his rent in order to finish out the year administering “pre-care” to some expectant mothers.

After that, however, he won’t be able to personally fund those administrative costs and a year’s worth of medical malpractice insurance.

“I can’t take $200,000 out of my pocket,” Coburn said, estimating the annual overhead of his practice in Muskogee.

The issue has become an emotional touchstone for Coburn, who briefly hinted at it during Monday’s kickoff to the confirmation hearings for President Bush’s pick to be the next chief justice of the United States, John Roberts.

Early in his 316-word opening statement, Coburn noted that he had been home last weekend in Muskogee and delivered babies to two different families, a pair of children who may be among the last children he ever delivers.

“I am a physician. And up until the end of this month, and hopefully after that, I’ll continue to practice. This weekend I had the great fortune of delivering two little girls,” Coburn said Monday. “And I’ve had the opportunity to talk with people from all walks of life as a physician, those that have nothing and those that have everything.”

Shortly after that, Coburn became emotional and appeared to fight back tears as he pleaded with the committee and Congress for “less divisiveness, less polarization.”

In a brief interview Tuesday, he said that he is not asking to make any money off his practice, just the ability to cover his costs and continue a vocation that he believes makes him a better Senator. “That’s all I’ve asked for all along,” he said.

Senate rules would allow him to maintain the practice free of charge to his patients, much as Frist continues to practice. Frist, a multimillionaire heart surgeon, pays his malpractice costs out of his own pocket and continues to practice medicine on an ad-hoc, gratis basis, such as his trip to aid victims of Hurricane Katrina over Labor Day weekend.

Coburn has had some initial success in winning support from colleagues, particularly Lott, but he has yet to come up with the language that could win wide support in the Senate.

Earlier this summer, Lott drafted broad legislation that would change the meaning of the word “compensation” as it is currently constructed in Senate Rule 37. The original draft would have changed compensation to say that no Senator could generate “net profits” from any professional service involving fiduciary relationships.

That alteration to the rules would open the door for any Senator to maintain a small law practice or another professional service, something that Democrats decried as opening a major loophole into the system.

“We have lots of lawyers who want to go home [on weekends] and practice law,” Minority Leader Harry Reid (D-Nev.) said Tuesday, rejecting a proposal that broad. “There’s no end to this.”

And the Senate Ethics Committee, when it initially considered Coburn’s request last winter, rejected his rationale that Senators should be citizen legislators, sending him a bipartisan letter that said today’s Senate involves a “full-time responsibility.”

That has left Lott, Frist and Coburn working to craft a narrower provision that specifically allows for the practice of medicine without any net profits. That is the wording of House rules, prompted by a mid-1990s debate sparked by Coburn and several other physicians in the chamber at the time. Alternately, they may try to grant a waiver from the rules specifically just for Coburn.

“I think we ought to make an exception for him,” Lott said Tuesday. “I would prefer it a little broader, but I don’t think we can get a consensus on that.”

Politically, however, it may be difficult for the majority to carve out a specific provision that benefits only Coburn. In addition, if the carve-out covers all physicians, it may appear as though Frist is pushing a rules change to benefit himself, given that he’s the only other physician currently serving in the Senate.

Timing is quickly becoming Coburn’s biggest enemy. The current agreement, arranged with the ethics committee, was that he would wind down his practice, accepting minimum payments from patients to cover costs up to Sept. 30.

This month was already going to be one of the most crowded legislative periods of the year even before Katrina ravaged the Gulf Coast and created a bottleneck of new spending and other measures for the Senate to consider. Lott, whose own home was destroyed by the storm and who has become a key player on recovery efforts, said he hadn’t thought about Coburn’s plight in “about six weeks.”