ACEP Now: What obstacles exist in Congress to address hospital boarding? What would be your recommendations on how to address them?

U.S. SENATE CANDIDATE RAUL GARCIA, DO, FACEP (R-WA) is challenging incumbent Maria Cantwell (D-WA) in Washington State. Dr. Garcia has been a successful small business owner of his own medical practice, one of the founding Deans of two medical schools, and the Medical Director of two hospitals. He is currently the Medical Director of Astria ToppenishHospital in Toppenish, Washington. Dr. Garcia founded “Opportunity for Washington” as a non-profit, nonpartisan effort promoting education and change. He helped found the Partnership for Food Security in 2020 to promote COVID-19 education, particularly in the Latino community. Dr. Garcia earned his DO at the New York Institute of Technology College of Osteopathic Medicine and trained at SBH Health System Bronx. A native of Pinar del Rio, Cuba, Dr. Garcia escaped Cuba with his mother at age 11 and later gained asylum in the U.S. and settled in Miami, where he attended college and earned a Bachelor of Science degree in Microbiology/Immunology.

Dr. Garcia: I was on the ACEP board for six years here in Washington, so having a physician in Congress who understands our perspective is going to be a breath of fresh air. I support the public reporting of boarding issues to raise awareness. There’s a role for government in educating the public, so they can become advocates for our goals. The biggest issue comes down to reimbursements, which have been declining annually. This lack of funding impacts hospitals’ ability to hire staff, and often, the boarding problems in Washington aren’t due to lack of beds but rather a lack of personnel. We need increased reimbursements across the board to resolve this and encourage more people to join health care professions.

Increasing funding for community primary care and public education would also help reduce ED traffic for non-emergency cases. Half the patients I see could likely be managed in primary care, but we lack the resources to support that system or educate the public about alternatives. I intend to advocate for CMS policies that allow more flexibility in discharging patients when ERs are at capacity. Boarding patients in EDs makes it hard to meet metrics, especially with a single provider managing a full ED. I experience this daily, and Washington, unfortunately, ranks 50th in medical bed availability, leading us to board patients for days at a time. I look forward to finding better solutions.

ACEP Now: What are your thoughts on consolidation among insurers and health care providers?

Dr. Garcia: I believe it helps insurance companies but not providers. The No Surprises Act was well-intentioned, but it unintentionally allowed insurers to avoid paying us. For example, my emergency medicine group is currently in litigation with UnitedHealthcare over unpaid bills. Insurance companies are driving health care these days, leaving little power to physicians or patients. We need laws that restore power to doctors and patients. While I support free enterprise, I don’t think insurance companies belong on Wall Street, as they’re more focused on profit margins for shareholders than approving necessary care. This issue is very personal to me, and I’ll strongly advocate for it.

ACEP Now: How would you encourage other physicians to follow in your footsteps from bedside practice to a legislative role?

Dr. Garcia: I’ve been in emergency medicine for 26 years, and I love my job. However, I realized that one decision as an elected official can impact a large number of people. In emergency medicine, we help one person at a time, but as legislators, we can influence policy that benefits many. I encourage my colleagues to get involved at any level—city, county, state, or federal. Congressman McCormick, an emergency physician, recently endorsed me, and we’re both working to open the doors for more doctors to get involved in addressing the health care crisis.

ACEP Now: What are you hoping to accomplish in Congress?

Dr. Garcia: Our campaign is focused on addressing the fentanyl crisis. I plan to introduce the Americans Against Fentanyl Act, which would impose manslaughter charges on dealers and require comprehensive rehabilitation programs for addicts. This approach was effective in Portugal’s heroin crisis in 2001, and we can replicate that success here. Additionally, we need to address the cost of living. My oldest son struggles despite having two incomes in his household, and this speaks to the urgent need to control inflation and government spending. We should only spend what we have rather than borrowing and taxing. As a physician, I understand the importance of providing care to everyone, regardless of background, and I believe that those in public office need to embody a commitment to serving people. That’s why I’m running.

ACEP Now: What’s the best thing about being an emergency physician?

Dr. Garcia: Being able to help anyone, anywhere, at any time with their emergency is one of the greatest gifts of my career.

ACEP Now: If emergency medicine didn’t exist, what specialty would you have chosen?

Dr. Garcia: OB-GYN, because it offers the full spectrum of patient care. You get to deliver babies, perform surgeries, and run a private practice. Plus, in my experience, women tend to be better patients.

ACEP Now: What do you think about artificial intelligence? Will it make medicine better or worse?

Dr. Garcia: We have to be cautious about how much we rely on AI. It has the potential to improve our field, but we need to be mindful of how far we take it. Recently, one of my doctors sent a robot to take notes in our meeting. It’s a great tool, but there’s a balance to be struck.

ACEP Now: Who do you have for the Major League Baseball World Series this year?

Dr. Garcia: I’ll go with the New York Yankees. Growing up in Cuba, we were taught to criticize America, yet we’d rush home to see if the Yankees won.