In 2010, Joe Heck, DO, FACEP, became the first emergency physician elected to the U.S. Congress. He was elected to the U.S. House of Representatives to represent the Third District in Nevada and serves on the Committee on Armed Services, Education and the Workforce Committee, and Permanent Select Committee on Intelligence. Born in Queens, New York, but raised in Pennsylvania, he went to Penn State University and then the Philadelphia College of Osteopathic Medicine. (Joe is also the first DO ever elected to Congress.) After completing his EM residency at Albert Einstein Medical Center in Philadelphia, he moved to Nevada. After three terms in the U.S. House, Joe is now running for the U.S. Senate from Nevada for the seat being vacated by retiring Senate Minority Leader Harry Reid. In addition to his work in the emergency department until his election to the U.S. House in 2010, Joe was also a small-business owner, operating Specialized Medical Operations, which provided medical and tactical training to law enforcement and emergency medical services agencies.

In his “spare time” (like he really has any), Joe has been a member of the U.S. Army Reserve since 1991, and in 2014, he was promoted to brigadier general. After recently completing an assignment as the deputy commanding general of the 3rd Medical Command, he now serves as the deputy surgeon and director of reserve readiness on the Joint Staff. As part of his service in the reserves, Joe has been mobilized three times, including his last deployment to Iraq in support of Operation Iraqi Freedom.

ACEP Now caught up with Joe to see how the campaign was going and how he feels about the future of politics and health care.

LAC: What is the biggest difference between running for the Senate versus the House?

JH: The biggest difference, literally, is the geography. When you run for the U.S. House, you can really focus on just your district, which is geographically much smaller. Running for the U.S. Senate requires you to be present everywhere in the state. For a state like Nevada that has only three major population centers, that means traveling long distances to get to every small hamlet and town where the voters are. But that’s what the election is really about: making sure that you let every voter know, no matter how small the town they live in, that they matter to you. The second difference is the amount of money that it takes to run for the U.S. Senate. The average U.S. House race costs about $2 million to run, but the average U.S. Senate race is five to six times that amount. Realistically, you can’t raise the amount of money needed for a Senate race in just your home state. As a candidate, you have to do national fund-raising. During this campaign, I will do multiple fund-raisers in Boston, New York City, Dallas, and other “big” cities. These events are hosted by people who either know me directly or are willing to support me for my work in Congress. While it is nice to know that people outside of Nevada are willing to support my campaign, it does require a lot more time and logistical coordination. For some candidates, having to run a more national campaign means relinquishing some control of your campaign to key staff. Fortunately for me, I fall into the type A EM doc model and like to keep control over everything. Although I definitely delegate more in this campaign, I still have final sign-off on all messaging and events that take place.

LAC: What were the key determinants in your decision to risk your House seat for a Senate run?

JH: When I ran for the U.S. House in 2010, the major campaign issues and problems facing the country were national security, jobs and the economy, and health care. In 2016, those are still the same major issues/challenges facing the nation. While I am honored to serve in the U.S. House, there are 435 of us there, and there are limited chances to make major policy changes. With only 100 members of the U.S. Senate, there is the potential to have a greater impact on policy development, certainly at a national level and even somewhat back home on a statewide basis. I guess my hope would be that I would have the opportunity to do more good for more people if I’m elected to the U.S. Senate. The other factor that was important to me in deciding to run was that I felt that there were good candidates back home in Nevada that would potentially fill my U.S. House seat. Knowing that the people who had expressed interest in running to replace me were people who I trusted to take care of my district meant a lot to me. Lots of people have asked me what I will do if I don’t win the election. That’s simple—I will go back to being an ER doc. Every day in Washington, I remind people that I am an ER doc first and a member of Congress second. I have always known that at some point I was one election away from being back in the ED, something that I am totally OK with.

LAC: How can the house of emergency medicine be more supportive of EM docs who are interested in the political arena?

JH: Running for office is tough, especially when you run against an entrenched incumbent. My first campaign was for Nevada state senate in 2004, when I ran against a 20-year incumbent from my own party. At that time, that was not a very popular move with the Republican Party establishment, but I felt that the person had become “too comfortable” with their seat and wasn’t representing the people anymore. Since running for office is hard, emergency medicine needs to do more to encourage docs to get involved earlier in the political process. It is a sad reality that most physicians, including most emergency physicians, are politically apathetic. In Nevada, back in 2004, lots of physicians supported my campaign for the state senate because there were no physicians in the state senate, the state was in the middle of our malpractice crisis, and the docs were all worked up on that issue. But the reality is that there are issues at the state and national level being decided every day that will affect the future of emergency medicine and how we care for patients. You can’t wait until the last minute to voice your opinion on an issue and expect it to mean as much when you haven’t been investing any time in the people representing you. Democracy is not a spectator sport; you have to participate in order to be an effective advocate. In order to do my part to help encourage EM docs to get involved, I am establishing internship programs in my office in D.C., and I believe Rep. Raul Ruiz has done that as well. Residents, or really any EM doc, that want to spend time in D.C. on the Hill can come and spend a month working with me on health policy issues. If docs can’t get to D.C., then they should get involved with their state ACEP chapter or state or county medical society. The “where” you get involved isn’t as important as just making the commitment to be engaged.

My first campaign was for Nevada state senate in 2004, when I ran against a 20-year incumbent from my own party. At that time, that was not a very popular move with the Republican Party establishment, but I felt that the person had become “too comfortable” with their seat and wasn’t representing the people anymore. Since running for office is hard, emergency medicine needs to do more to encourage docs to get involved earlier in the political process. —Joe Heck, DO, FACEP

LAC: What do you see as potential solutions to the hyper-partisanship that exists within Congress?

JH: That’s an interesting question because I don’t believe that the Congress is really as partisan as it portrayed. Yes, the two parties will always have their differences on some major social and philosophical issues, but the Congress was able to pass very significant legislation in a bipartisan manner last year. We passed a five-year transportation bill, replaced the No Child Left Behind Act with the Every Student Succeeds Act, and passed the 54th consecutive National Defense Authorization Act. These are significant pieces of legislation that will affect the entire nation for years to come. Oh, and we also voted to do away with the Sustainable Growth Rate after 14 years—finally! My approach in Congress is simple. Rather than focusing on our differences, I try to find a member from the other side of the aisle that shares my concern on a specific issue. Maybe their district is facing the same problem that my district is, or they have a constituency or group that shares a concern with me, like health care. I will go and seek out that member and work with them to draft a bill that addresses the issue but is something that each of us can then take back to our respective parties and support. Focusing on the issue rather than party is a formula that I believe works well. That’s why Raul and I can work together on health care issues; we share the common bonds of the emergency department and focusing on fixing problems.

LAC: What are you most and least proud of in your political career?

JH: In all honesty, what I am most proud of is the staff that I have working on my behalf serving the people of my district. Nothing gives me more pleasure than to be back home in Nevada at the supermarket and have someone come up and ask me if I am Representative Heck. Although that can be a little scary sometimes, it is almost always someone who just wants to say thank you for something that one of my staff helped them with. Whether it’s a veteran who we helped get the benefits that he was having trouble receiving or someone dealing with a home foreclosure, my staff does amazing work in helping the people who live in my district. To me, being a member of Congress is not about passing bills in D.C.—it’s about taking care of the people back home. On the “least proud” part of the question, I don’t really feel there has been anything not to be proud of. I certainly have struggled with deciding how to vote on some issues. But for each vote, I try to weigh the positives and negatives of the bill and then make my decision. For the really tough ones, I ask myself if I believe that the bill would be good for my three kids and all the other kids in the state and the nation. I figure if it passes that test, then I can be at peace with the vote.

LAC: How can EM docs find out more about your campaign?

JH: The campaign website is www.heck4nevada.us. I would be happy to talk with any EM doc that wants to learn more about getting involved, running for office, or about any policy issues.

Dr. Cirillo is director of health policy and legislative advocacy for US Acute Care Solutions/EMP in Canton, Ohio.