Resident’s Corner

ACEP Leadership and Advocacy Conference:
A Resident’s Perspective – Fixing the Machine

Jason David, MD
PGY-1 – Department of Emergency Medicine
University of Nevada, Las Vegas School of Medicine

In my short 10 months as an Emergency Medicine Intern, I’ve seen boarding times for my patients with psychiatric complaints last more than 24 hours. I’ve heard stories of worse. I’ve been told to “stay in my lane” and posted angrily back in the maelstrom of online political discourse. I have also listened, with some perhaps misplaced guilt, to stories of ER bills not covered by insurance due to being seen by an out-of-network provider. Until this first week of May, my reaction to these stories and sometimes assaults from interest groups, friends, family, and the ever-present Facebook Newsfeed, were feelings of powerlessness. The only idea that came to mind was the Pink Floyd song, “Welcome to the Machine”.

When my residency director sent an email in January, asking who would be interested in attending the ACEP Leadership and Advocacy Conference (LAC), I honestly didn’t really understand what I was applying for. Older residents who had attended before told me I would receive a “crash course” in the current hot-button issues important to Emergency Medicine (Improving Mental Health Access from the Emergency Department and Protecting Emergency Patients from Surprise Bills), Meet members of Congress, and attempt to convince them to either vote for bills supporting our solutions to those issues, or consider sponsoring or introducing such a bill. “Sure, I’m sure my 10 minutes will be super impactful” I sarcastically thought with some measure of cynicism. Of course, the more responsible, idealistic part of me was excited- I had watched enough Schoolhouse Rock to understand that this, in theory, is how the vocal minority sticks up for itself in a representative democracy. Still, I kept my expectations measured.

Arriving in DC was a familiar experience- I had attended medical school in Bethesda, and so Reagan National felt like a second home to me. As I took the cab to the hotel, the grandeur of the various large, neoclassical buildings that serve as the seats of power for our national infrastructure were not lost on me- but I still wondered what one resident from 2,409 miles away could do to help his patients in a place like this?

The first day of the conference was amazing. The number of representatives from all over the country gave me an injection of optimism. Perhaps my voice alone would be lost in the political machinery of Washington, but all these voices combined? Moreover, it was not just the quantity of voices, it was their quality- these were leaders in Emergency Medicine, men and women who had chosen to do more than sit on the sidelines, but to grab the wheel of their specialty and fight for their vision of what Emergency Medicine could be for patients of the United States. It was surreal, especially in our era of corrosive political division, to see multitudes of Emergency Medicine physicians with different backgrounds and regions unite to create “one voice” to Congress and to the American people.

The subject matter of the first few days is something I feel every American Citizen, but especially physicians, should receive. We were taught how “The Hill” operates and what role Emergency Medicine Physicians play in that. We learned about how an ACEP resolution becomes a Law, as well as special topics including policy considerations in Firearms Injury Prevention, and Emergency Medicine Physicians in Federal Government. We heard Congressional Staffers speak out about surprise billing, and I realized how much of a struggle we still had regarding Mental Health Access and Surprise Billing.

One in five Americans struggle with some form of mental illness, and our current health care system is failing too many of these patients- with patients remaining in the emergency department for hours and days until they are secured follow-up community care. We learned about the two current pieces of legislation, known together as the “Improving Mental health Access from the Emergency Department Act”, that could facilitate transition to post-emergency care for mental health issues, increase the supply of inpatient psychiatric beds and alternative care settings, and expand approaches to providing psychiatric care in the emergency department. I also learned about the fight to protect Emergency Patients from Surprise Bills, and our efforts to support a prohibition of “balance billing” of a patient and instead adopting a proven process that encourages insurers and providers to negotiate fairly. For the first time, I felt that I could do something to protect my patients financially beyond the ED, by taking them out of the middle of provider-insurer negotiations and mandating improved transparency so that patients understand the limits of their insurance coverage and all potential out of-pocket costs by mandating deductible amounts on policyholders’ insurance cards.

Armed with this knowledge and more, I felt ready for the next day of lobbying and advocacy. Our first meeting was with Senator Jacky Rosen. As we walked to the hill, I rehearsed my specific arguments, points, and personal stories I wanted to share with the Senator. Of the five legislators we were scheduled to meet with, she was the only one who was able to meet with us personally, which was completely understandable given the busy schedules of the Congressmen and Congresswomen. However, each legislative assistant, director, or committee staff member we met with were polite, courteous, and had a demonstratable deep interest in the topics we wanted to discuss. I think the most memorable and perhaps successful meeting was with Representative Steven Horsford’s staff, who happens to represent my district (NV-04). I was allowed to take point on this discussion, and the end result was the staff stating that they would be interested in authoring a House of Representatives version of our efforts to protect emergency patients from surprise bills, which would mirror a similar effort by Senator Bill Cassidy in the upper house. Speaking truth to power as a first-year resident, and advocating on behalf of my patients back home, is an experience that will stay with me forever. Walking back to the hotel that evening, I realized that not only had I gained insight into the machine of policy, maybe I had learned a little bit about how to use it to help my patients as well.

Emergency Medicine physicians are the safety-net of our medical system. As such, we see where the holes in that system are- we save lives where and when the machine fails. Therefore, who better to advocate for those patents who fall through those holes? Who are failed by the system? The ACEP Leadership and Advocacy Conference made it possible for me to see what now seems like a natural conclusion- that those best equipped to protect patients through advocacy, are the same men and women who fight for those patients on the front lines of the American Healthcare system, every day. When it comes to advocating for patients, our lane does not just end at the bedside, it reaches to every single area in the nation where there is a chance to make those same patient’s lives a bit safer, and a bit better.

Going to the Hill: Residents Jason David and Nicholas Schulak with Dr. Joseph Kuchinski (center)
Jason David, MD, Congressman Ami Bera of California, and Nicholas Schulak, MD