When emergency physicians advocate for changes in our health care system that will improve emergency care, increase access to care, and make our patients environments safer, people listen. In some ways academic emergency departments are the last vestiges of the huge philanthropic effort of medical school teaching hospitals in providing care to the underserved. While our history is in caring for and advocating for the poor, we in academic medical centers are now focused almost totally on the business side of medicine efficiency, throughput, funding, grants, and margin. The large public appropriations that funded teaching physician salaries and hospitals are also history. But, our emergency departments continue to take all comers, and are the last and only resort for many indigent patients who need health care.
Emergency medicine is a taxing job.
These are all good questions, and to answer them we can turn to the giants of advocacy in emergency medicine people like Ed Bernstein, Art Kellermann, and Steve Hargarten. The first lesson to be gained from these academic emergency physicians is that advocacy is most effective when it is focused. Although we may feel an altruistic sense that we must advocate for all of those who are wronged, it is not expected, or desired, that academic emergency physicians will be all-purpose advocates. In the areas of research and teaching, we have found that the best results are achieved with a focused approach. The same is true with advocacy.