Emergency physicians might think that in the wake of the perennially popular TV show “E.R.” and the slew of hospital dramas that followed, elected officials have a pretty good – if somewhat skewed – idea about what goes on behind the emergency department’s swinging doors and in emergency care generally. But that’s not necessarily the case, several ACEP members discovered, when they hosted their legislators as part of the College’s advocacy outreach efforts.

“Even at the Congressional level, there’s a misconception about what moves the money in health care. Many think that that it’s physicians – and in the emergency medicine area it isn’t,” said Brian Oliver, M.D., a Salt Lake City emergency physician who hosted emergency department visits with two legislators last summer.

“People are surprised to learn that physician fees are roughly only 6%-7% of the ED bill,” he said. “And some people don’t realize that we don’t have the option not to see a patient.”

Nicholas Vasquez, M.D., an attending emergency physician at St. Joseph’s Hospital and Medical Center in Phoenix, was able to address another myth – about the patients emergency departments actually serve – when he recently hosted Carlos Sierra, who works with Sen. John McCain (R-Ariz.). The senator’s aide had inquired about reports he had heard about emergency departments being clogged with uninsured patients and illegal immigrants.

“That [uninsured] argument is a 1980s reality. I countered it by explaining that the majority of people we take care of are citizens, they’re insured, and they have doctors,” Dr. Vasquez said. “Those patients have sought access to the system, but for one reason or another, couldn’t get it. That’s the reality today – and ERs are a good example” of where patients go when the rest of the medical system fails them.

Vidor Friedman, M.D., chair of the College’s governmental affairs committee, concurs with Dr. Oliver and Dr. Vasquez. He maintains that one of emergency medicine’s key challenges is that physicians have the mistaken notion that most people understand what the specialty does and who emergency physicians treat.

“Most of the population does not understand that, and the critical portion of the population who doesn’t is the politicians,” said Dr. Friedman, a managing partner of Florida Emergency Physicians who practices in Orlando. “These site visits give legislators a reality check, and hopefully opens their eyes to the bigger picture.”

For his part, Dr. Oliver found that both Congress members – Reps. Rob Bishop (R-Utah) and Jim Matheson (D-Utah) – were reasonably conversant on general health care issues. But Rep. Bishop found the experience especially enlightening, he added, from the standpoint of EMTALA’s effects on operations and the mechanics of triaging diverse patients. “Rep. Bishop hadn’t been in a hospital since he was born, so everything was eye-opening to him,” he said.

Primarily, the visits afforded Dr. Oliver an opportunity to talk about pressing national issues in emergency medicine – access problems, boarding, ambulance diversion, and the rapidly escalating rate of emergency department visits nationally. He and the legislators also discussed local issues, such as disaster preparedness planning, and some of Dr. Oliver’s concerns, including faulty data from a recent Press-Ganey report about Utah emergency department wait times.

Dr. Oliver advises keeping the visit to the emergency department focused and the group size small, to avoid “having the visit turn into a circus.” But he acknowledges the merit of also talking about the big picture in health care and where emergency departments fit into it. Legislators may not realize, for example, that most health care legislation either directly or indirectly affects emergency departments because they’re often the “front door” to the system. Activities such as hosting emergency department visits can provide context for policymakers in the future, he said.

“As health reform comes down the pipeline, there is going to be a tug of war, and it’s useful for ER doctors to have a voice in what happens as things move through Congress,” Dr. Oliver noted. “I think that emergency medicine is more affected by any and all health care legislation than other specialties because everything kind of trickles down to us.”

ACEP Board member Kathleen Cowling, D.O., who works for Covenant HealthCare in Saginaw, Mich., has hosted several legislator visits in recent years. She knows from firsthand experience how relatively little policymakers know about the cases and real-life challenges emergency physicians deal with daily. For example, she frequently must dispel the mistaken notion that most emergency department patients present with minor problems.

“People are still under this misconception that ERs are overused because of insignificant problems – sprained ankles and sore throats. That’s just not true anymore, and hosting your legislator is one way to help address that particular myth,” Dr. Cowling said. She cites the recent Centers for Disease Control and Prevention report that showed that just 7.9% of emergency department visits are for truly “non-urgent” problems.

Dr. Cowling’s site-visit encounters with Rep. David Camp (R-Mich.) have been instrumental in not only dispelling myths but also strengthening relationships. “He sees firsthand how busy we are, and the problems that occur when patients don’t have access to care or when Medicare patients don’t get their medications,” Dr. Cowling said. “Making this connection is something that builds over time.”

She meets with the Congressman and his assistant Brian Sutter each year, and often forwards documents and articles that she thinks they’ll find helpful. The upshot, she adds, is that the legislators now have a better sense of what occurs daily.

Like Dr. Vasquez, Tripp Jennings, M.D., of Columbia, S.C., also encountered the surprise factor when he hosted Rep. Joe Wilson (R-S.C.) in August.

“He was frankly surprised that the percentage of non-emergent ED visits was so low, and that the issue of boarding in general is not mostly about illegal immigrants,” said Dr. Jennings, medical informatics officer for Palmetto Health and president of ACEP’s South Carolina chapter. “I think that he also left with a better understanding of the difficulties facing emergency medicine physicians and our patients.”

The encounter was a mutually beneficial one, Dr. Jennings said.

“What made me happy was that he’d actually taken the time to read the information we had sent before his visit,” he said, adding that hosting physicians needn’t have a specific agenda or “winning point” to make.

“Every time you can get in front of a legislator one-on-one and talk about emergency medicine, it sets the stage for the future. Forming these relationships will make the difference, I think, in what we can get accomplished ultimately,” Dr. Jennings said.

Douglas Kupas, M.D., with QGeisinger Health System in Danville, Pa., who with his colleague John Skiendzielewski, M.D., hosted Sen. Robert “Bob” Casey (D-Pa.) in 2009, agreed that while it’s helpful to have a “hook” for the invitation, it’s not a must. The two physicians spurred interest in a visit based on a recent Senate bill that proposes greater use of simulation technologies in medical training to improve patient safety, but the ensuing encounter provided an opportunity to inform the Senator on other emergency medicine issues that ultimately affect safety.

“I was pleasantly surprised at how interested Sen. Casey was in everything that we talked with him about. Usually, when you deal with these folks you expect them to be on a really close time schedule,” said Dr. Kupas, Geisinger’s associate chief academic officer for medical student and resident affairs.

“He had a health reform Town Hall to attend, but ended up spending a lot longer with us than was planned.”