In the beginning, through perseverance, dedication, and plain luck, you find yourself nominated to run for the national Board of Directors of ACEP. Wow, what an honor. After the initial angst of worrying who really loves you and strategizing your campaign, the first thing that hits you are the emails. You are included on the Board’s e-list and get to “peek through the keyhole” at all the correspondence among the present Board and staff. It’s intimidating in several ways: sheer volume, the brilliance of the conversation, and the importance of the content. You wonder how anyone keeps up, but the breadth of knowledge, diversity, and importance of the topics suck you in; you get hooked. You want to get right in the deep end but realize you’re not going anywhere without your floaties on.

Seemingly, though months actually go into preparation, all of a sudden, the Council meeting is called to order, and you don’t sleep for 48 hours. You try your hardest to prove you can talk intelligently, both in small groups and before the Council, without tripping over the one question you fear will alienate entire states. You pray your passion, commitment, and drive will somehow emerge and shine enough compared to the other outstanding candidates, who are your friends and colleagues.

Now you sweat, through the election itself, and find yourself being congratulated by all the people you’ve always looked up to, who insist you never needed to worry. Then Sonja Montgomery, ACEP’s governance operations director and every Board member’s guardian angel, reminds you that at 7 a.m. Monday, your butt belongs to her.

So the work begins, like a deluge from a fire hose.

The Hard Work Begins

The rest of Scientific Assembly is a blur as you run from one meeting to another. At least once, you look down at your schedule, thinking you’re finally on time for a meeting, only to realize you’re actually triple booked, and this wasn’t even one of the three! Next, they ease you in at the Board retreat, where you begin to stop worshipping your colleagues on the Board and instead simply become impressed with their work ethic, knowledge, and experience. Somewhere in this opening orientation, you discover they are your newest circle of best friends. That’s a good thing, too, because you email them several times a day and now start to rendezvous with them all over the map several times a month.

The leaders on the Board start off telling you not to feel pressured, but the high standard they set makes you want to jump right in. Like it or not, the assignments and topics of ownership (ie, committee liaison and other project assignments) get dispensed early on, and you are now responsible to represent the Board and ACEP.

The fire hose pressure is on high…We struggled to digest a 254-page informational agenda and another 219-page action item agenda to review for the April Board meeting.

Early in spring comes your advocacy schooling, a trip to Washington, D.C., to really understand the public policy and public affairs division of ACEP. When we say schooling, we mean it. The “gotcha” journalism team primes you for on-screen media events, while Gustavo Mottola, the Italian image consultant who works with ACEP during the Legislative Advocacy Conference, gives you a full dressing down with his critical but totally necessary fashion critique. If you remember you did this to help your patients and fellow emergency physicians, as well as to become a better physician, spokesperson, and overall person, you realize how much fun it really is.

The fire hose pressure is on high. We received approximately 1,500 emails in the first six months and struggled to digest a 254-page informational agenda and another 219-page action item agenda to review for the April Board meeting, weaved in between multiple conference calls, meetings, flights, etc. You spend hours wandering in airport parking lots, trying to remember where you parked this time. Of course, your clinical schedule hasn’t changed; you’re still doing the same number of clinical hours (days, nights, and weekends). Hopefully, you can catch a little time with the family this week (though with three teenaged girls at home, maybe the ED will be calmer).

You Find Your Footing

By midway through the first year, the most noticeable paradigm shift is that people seek you out. Mind you, it becomes somewhat easier to be found because the ACEP staff is the best in the business. However, you still pinch yourself some nights in Washington, D.C., during the Legislative Advocacy Conference and Leadership Summit when you realize the chair of such-and-such came to find you.

You get asked to visit chapters, residencies, and all sorts of congregations, and you quickly realize that the top-five issues in every group are the same, maybe in slightly different priority. When you keep your ears open, you actually hear more solutions than whining. The trick is to learn what is possible and which dreams haven’t yet matured to the level of Board action. There is no lack of spirit in our College membership, so every mountain is surmountable.

It’s a great thing to be soaked daily by this deluge. Before you know it, the next Council meeting is rapidly approaching. Now, the homework triples, and the 30 emails a day all have attachments requiring urgent responses. The one relief as winter approaches this year is you get to watch the next round of Council candidates try to bubble with bravado while they peek through the keyhole—that and you get to pinch yourself again that you are actually sitting at the table. For all the work and travel, we wouldn’t trade it for any other job, except for caring and advocating for the at-risk, sickest patient of the night. We are, after all, emergency physicians.

The authors are members of the ACEP Board of Directors. Dr. Hirshon is professor in the departments of emergency medicine and of epidemiology and public health at the University of Maryland School of Medicine in Baltimore. Dr. Anderson is emergency attending at MultiCare Auburn Medical Center in Auburn, Washington.