ACEP Now Medical Editor in Chief Cedric Dark, MD, MPH, FACEP, conducted interviews with each emergency physician running for Congress in 2022. The abridged versions of the interviews were published in the September 2022 print issue.

What do you think has been your greatest accomplishment since you’ve been in Congress that has benefited emergency physicians specifically?
Dr. Jackson: We helped one hospital in particular to get proper funds for the Provider Relief Fund, which actually was a big deal for them and it probably would have ended up basically collapsing without it. And then we had another hospital that we were able to make sure they kept their participation in the 340B drug processing program, which also would have been detrimental had they not. If you’re in a rural area of Texas like I am where I have 41 counties and 42,000 square miles, if you don’t take care of the rural hospitals and you don’t take care of emergency care for people in your district a lot of times they can’t get to another hospital because they’re just too far away. So, I think keeping our rural hospitals up and running, trying to do everything we can to prevent rural hospitals from collapsing, which is hard to do nowadays, I think has been my biggest contribution to emergency medicine since I’ve been in Congress.

I’ve seen recently a lot of burnout surveys; emergency medicine went from fourth or fifth burnout to being number one or number two spot this past year. What’s more stressful for you personally? Is it working in the ED or being in Congress?
Dr. Jackson: For me, it’s more stressful being in Congress. I spent 25 years as an emergency physician practicing emergency medicine. But I did most of that at urgent care centers.

Now that I’m in Congress and I’m talking to my civilian colleagues all the time, there are so many things they had to deal with that I didn’t have to deal in the military—the insurance companies, the hospitals, all the regulatory burden that was imposed upon them, the paperwork, and the administrative burden. In the military and the Navy in particular, we just took care of the patients and we didn’t worry about where the payment was coming from or anything else.

We got paid the same no matter what we did and I just think that it wasn’t as stressful for me having practiced in the military is as it is for my civilian colleagues. So, I can imagine after talking to a lot of my colleagues, it would probably be more stressful to practice in that environment than being Congress.

What is it like being the White House physician?
Dr. Jackson: I did 14 years of my active-duty career at the White House and I took care of President Bush, President Obama, and President Trump. I was there for the last three years of the Bush administration, all eight years of the Obama administration, and then the first three years of the Trump administration. But the impact I think I had there and the way I think I changed things as I kind of changed the way that we approached medicine at the White House. If you look at what the White House physician does on a day-to-day basis, it’s about probably 30 percent primary care and about 70 percent contingency planning. If everything goes well, you’re not going to be doing a lot, but you’re planning for everything, you’re planning for that bad day. What happens if the President takes a round to the chest? What happens if an IED hits a motorcade, or if the President has a stroke or a heart attack? So, it’s just contingency planning and there’s no better person in medicine to be responsible for that, especially for our head of state and our commander-in-chief, than an emergency physician.

What do you think that emergency positions should be paying attention to in Congress that we don’t really seem focused on right now?
Dr. Jackson: I think implementation of the surprise billing rule. It was pretty clear. It was very bipartisan.
The interim final rule really did not keep with the intent of the law. The interim rule basically instructed them to use a de facto benchmark. And in Congress, it specifically tried to get rid of the benchmark. Congress considered that, but they had decided that [a benchmark] wasn’t the way to go. That’s not something that would have passed Congress, so I think that we need to go back and make sure that the federal government is implementing the law as it was written.

Obviously I think we should be worried about the corporate takeover of health care, specifically physician owned practices. I hear about a lot practices are groups, they’re being consumed at a rapid rate, and just kind of really dissolving and and going away. So I think that’s a big issue.

I think the growing role of government and payers in our daily health care decisions continues to increase by the day. And then I think also the push to increase the role and the responsibility of mid-level providers, nurse practitioners, and PAs throughout medicine and specifically within emergency care is also something that we’re going to have to be really careful with because obviously it saves money, but it’s not necessarily what’s in the patients best interest in a lot of cases.

What is Congress’ role and how can we come up with some solutions to make health care more resilient in the future if we’re dealing with future pandemics?
Dr. Jackson: We have to prepare for what’s next. There were a lot of lessons learned with the COVID-19 pandemic and this won’t be the last time that this happens. We need to invest a lot of government funding into emergency preparedness. In particular, we need to take a lot of these rural hospitals and make them more self-sufficient, more independent.

There were a lot of specialty providers that were shut down because of COVID-19. But, emergency medicine was just getting busier and busier by the day. So I think we have to shift those resources and be better prepared, especially like I said in the smaller outlying hospitals that, once the once the larger hospitals are full and they’re no more beds, a lot of these patients were being stuck in community emergency departments and had nowhere to go.

Your military service is what led you to the White House where you got to be the president’s doctor?
Dr. Jackson: That’s right. I was a diving medical officer for a long time and I was with the Special Operations Special Warfare, EOD, Navy SEAL salvage divers. And I realized at some point that I wasn’t going to be promoted in the Navy and move up through the ranks unless I got board certified in something that, of course, always wanted to be in … emergency medicine.

I went back and I did an emergency medicine residency. When I finished it was 2003–2004 in the war in Iraq and Afghanistan were pretty hot and heavy at the time. And so if you were a Navy Board certified emergency medicine DOC in 2004–2005, by definition, you belong to the United States Marine Corps because that’s where they needed all of us. As soon as I got board certified after I did my written and my oral boards, they sent me straight to Camp Lejeune. And I went straight to Iraq with the 2^nd Marines. I was the officer in charge of the resuscitation component of a surgical Shock Trauma platoon that was right on the battlefield between Fallujah and Ramadi. We were pretty busy, you know, I mean, we had, on average, probably three to four severe patients a day. We had a lot of petty stuff throughout the day and some days we didn’t have any. But some days we had 15 all at once. And these were guys coming in with their arms and legs blown off or with grey matter hanging out of their head, total head to toe burns. Horrible stuff. I was doing that out there, and I never even knew that there was a doctor at the White House. 

Certainly didn’t know that there was a military position at the White House. There were six doctors there. There were two Army, two Navy, and two Air Force. They were all family practice or internal medicine. And they decided that they needed an emergency physician at the White House.

I went straight from Iraq to the White House. And that was in early 2006. I was at that time the junior physician among the 6th physicians there. And I was the only emergency physician there. White House medicine evolved a lot over the next 15 years

How much more difficult do you think VIP care is when it’s the leader of the free world? 
Dr. Jackson: Well, it’s difficult. Everybody wants to go above and beyond. They want to do things that we wouldn’t do for other patients that may not be in their best interest. So I think that if you’re the primary physician, the appointed physician for the leader of the free world for the President of the United States, that it’s part of your job to work with the specialists and provide that concierge level of care. But to make sure that that they’re not going overboard and they’re not doing more than they need to or more than they would normally do.