Dr. Cosgrove:

“The world is run by those who show up.” I was never really one for politics. Throughout high school, I sat quietly and somewhat apathetically at the dinner table and in the classroom, listening to family and teachers discuss the most controversial topics of the day. During a college interview, I stumbled mightily when asked to comment on an important political issue. And during medical school, I was too busy trying to learn the basics of medicine to even think about what advocacy could mean for a physician, much less what it meant at all.

Yet as I progressed through residency, something changed. I realized that so much of what I did on a daily basis as an emergency medicine provider was the result of a much larger and increasingly convoluted health care system. I had questions, and I was seeking answers. Why did some of our psychiatric patients spend days boarding in the emergency department? Why was my state the only one in the country that did not have a prescription drug monitoring program? Why did I have to transfer this medically stabilized patient to another hospital because of their insurance?

While I did not have good solutions, I realized that these types of health policy issues were as applicable and as relevant to my daily practice as choosing an induction medication for rapid sequence intubation. And as this general election year was heating up, I found myself more invested in the process than ever before. I was incredibly fortunate to have been elected to the Emergency Medicine Residents’ Association (EMRA) Board of Directors in October, and since then, I have had the privilege of learning about and participating in discussions regarding many of the issues affecting emergency medicine physicians and patients. For the first time ever, I wanted a stake in the game.

Dr. Kurtz:

Unlike Abby, I used to be an avid follower of politics. In high school and college, I found myself glued to the presidential debates and enjoyed the process of developing my own set of opinions and beliefs, for the first time deciphering for myself what was right instead of simply parroting the viewpoints of my parents. But somewhere along the way through medical school and into residency, my fervor for the political process died. I felt myself becoming jaded given the constant standstill in Congress, the failure of our government to work together to make positive change, and the inability of our elected officials to accomplish just about anything at all. The fighting, name-calling, and House of Cards–style drama left me all but completely disillusioned that there was any point in even paying attention.

But at the same time, the more I grew as a physician, the more I was able to step back from the basics of my EM training and see the bigger picture. I became keenly aware of the systems issues that prevent our patients from accessing the care they need and impede us in providing the care we want to give. After being elected as the president-elect of EMRA in October, I soon found myself at the ACEP Board of Directors retreat, ACEP’s Media Training, and the Emergency Department Practice Management Association (EDPMA) annual conference, learning time and again the ins and outs of some of the more complex issues facing our specialty—from balanced billing and surprise coverage to inpatient boarding in the ED and EMTALA limitations. While still frustrated with our nation’s politics, the importance of being informed and involved resurfaced in my everyday experiences in the ED, but I wasn’t sure what to do about it.

Dr. Cosgrove and Dr. Kurtz:

Despite the differences in our backgrounds with politics and government affairs, the Leadership & Advocacy Conference in Washington, D.C., was unlike anything either of us had ever experienced. We would even go as far as saying that it was life altering. The quality of speakers, the content of their inspirational and informative messages, and the intimacy of being in the same room as people who truly care about the future of emergency medicine convinced us that we, too, want a seat at the table. As first-timers, even with our experiences in EMRA these past six months, we had very limited knowledge of many of the issues (and the acronyms—oh the acronyms!) affecting our daily practices in the ED. We talked about payment delivery reform (and how physician reimbursement is running full steam ahead into a fee-for-value instead of a fee-for-service model), the opioid epidemic (and Dr. Steven Stack’s passionate and very direct letter to physicians), mental health care reform, and ACEP’s unprecedented lawsuit against the federal government to contest a regulation that impedes fair coverage for patients who present to out-of-network emergency departments for emergency services. We were shown how to contact our representatives in effective ways regarding our viewpoints on bills that would affect patient care.

The preparation leading into ACEP Lobby Day was excellent. With our extremely limited experience lobbying legislators, we were both terrified and excited. Yet walking through the Senate and House office buildings, seeing “Nancy Pelosi” and “John McCain” written on office doors (not to mention a surprise showing by Marco Rubio), and meeting with our own federal legislators about issues that truly matter to our patients were almost as exciting as running a successful code or putting in a crash chest tube.

In just a few days, we felt transformed from residents who were somewhat disengaged from the political world around us into doctors who felt empowered to make a difference for our colleagues and patients. We would strongly urge all residents to consider attending the Leadership & Advocacy Conference next year in March. While the politics in the United States are still frustrating, being shown how to have your voice heard and seeing that it can guide the decisions and votes of our representatives are inspiring and offer hope in a broken system. And the greatest thing? All you have to do is show up.

Dr. Cosgrove is a member of the EMRA Board of Directors. Dr. Kurtz is president-elect for EMRA.