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Recorded by Nathaniel Schlicher, MD, JD, MBA, FACEP

Six months after we released the 5th edition of the Advocacy Handbook, the world changed for all of us with the COVID-19 pandemic. Overnight the world shut down for everyone else while we stepped up into the void, often under-resourced and exposed. Cheers rang out from the rooftops; cities came out to sing. “Thank You Health Care Heroes! We are grateful for our frontline warriors! Brave soldiers of the pandemic, you are appreciated!” Pizzas, donuts, shoes, discounts, and more were showered upon us.

How quickly the world forgot us.

We lost friends to the virus and to the trauma of the frontline battle. As the dust settled, we lost scores more to burnout, moral injury, and fatigue. How did our policymakers recognize this service? The federal government, via CMS, slashed our pay. Insurers ramped up their attacks on emergency physicians, arguing we were overbilling for sepsis and other conditions. News channels on the far right attacked us as liars, charlatans, and vaccine pushers causing death, driving up vitriol and hatred towards us. Patients yelled about wearing masks in the emergency department lobby to keep the staff safe, argued the pandemic was a hoax, refused screening tests for inpatient bed placement, and generally increased the strain on an exhausted system. Hospitals became overcrowded and began a practice of record-setting boarding due to a need for surgical case revenue and an inability to discharge on the back end. We went from being heroes to being the face of everyone else’s pandemic fatigue while we struggled to provide care in the waiting room with shortages in staff and space.

We will never forget.

Those who served on the front lines of this battlefield in thin paper gowns, reusing our masks, stripping to our birthday suits in our garages to keep our families safe, will not forget. We cannot forget. More important, organized emergency medicine will not forget. The Emergency Medicine Residents’ Association and the American College of Emergency Physicians have been and will remain steadfast in our support of our health care heroes. We will continue to advocate for support through legislation like the Dr. Lorna Breen Act to provide mental health resources to those providing the care who are struggling with the emotional toll of a pandemic that no one saw coming and fewer everyday want to acknowledge happened.

Together we will advocate for our specialty to be compensated for the care that we deliver by fighting back against big insurers and working with the government to stop automatic PAYGO cuts and reductions in the conversion factor. We will advocate for safe working environments and the rights of our colleagues to speak out when safety is an issue.

We must not stop.

As the next generation steps into leadership, you will bring the stories from the frontlines to the boardrooms so that the sacrifice of the pandemic years is not forgotten. Whether out of denial or desire, the world seems to be desperately trying to forget there was ever a pandemic. We cannot let that happen. The current challenges of emergency medicine in boarding, crowding, reimbursement, staffing, safety, mental health, and more have all been influenced and exacerbated by the pandemic. We must bring these stories to the forefront to advocate for the change that will make emergency medicine the best place to practice.

Whether you are new to advocacy or an experienced warrior in the trenches of the legislative and regulatory process, this book outlines the current issues facing emergency medicine. We hope it will provide a framework for your advocacy and be a resource as you embark on this journey. Remember, advocacy is what you do every day. It is built into the DNA of emergency medicine as we fight for those who, all too often, have been forgotten.

We helped save the world when a lethal new virus swept the globe. Nothing is impossible for emergency medicine. Join us in the fight for our future!

– Nathaniel Schlicher, MD, JD, MBA, FACEP

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