May 2, 2023

Where Are We on ED Boarding Advocacy Efforts?

Daniel Freess, MD, FACEP, and Nathaniel Schlicher, MD, JD, MBA, FACEP, took the stage yesterday during ACEP's Leadership & Advocacy Conference to discuss the nation’s boarding crisis and outline potential solutions at the state and national level. This is one of the key issues LAC23 attendees advocated for Tuesday during meetings with legislators. 

“Legislators are listening, and I’m confident we can find solutions,” said Dr. Schlicher. “The problem isn’t us. The problem is that the system is working exactly as it's designed.”

Dr. Schlicher discussed how misaligned financial incentives can impact hospital policies and exacerbate the challenges that emergency physicians are left to manage. “We have to stop polishing this turd and calling it chocolate,” he quipped.

He urged fellow emergency physicians to make sure that hospital leadership sees the emergency department on the busiest days, not just when everything is running smoothly.

“Let people see what’s going on,” he said. 

Boarding is not a new challenge. Issues that surfaced decades ago have been severely compounded by the pandemic and complicated by workforce constraints. Panel moderator Laura Wooster, ACEP's Senior Vice President, Advocacy and Practice Affairs, highlighted ACEP's letter to the White House and boarding story collection, which includes more than 140 anonymized firsthand accounts from emergency physicians. 

“You don’t always need the data when you have the right story,” said Ms. Wooster.

While boarding challenges manifest in the emergency department, they must be addressed where they begin, at various other points of care. 

“We need to address bed capacity, outpatient care and the backdoor of the hospital, too,” said Dr. Freess.

"We need to call it what it is. It's inpatient boarding, not emergency department boarding," added Dr. Schlicher.

There is no perfect recipe for a boarding solution because every community has unique challenges.

ACEP was on the Hill this week to encourage legislators to sign a bipartisan letter urging the Administration to swiftly convene a boarding task force with broad stakeholder representation and to cosponsor S. 1346, the bipartisan “Improving Mental Health Access from the Emergency Department Act.”

Dr. Schlicher believes that now is the time for emergency physicians to speak out.

“There are times we can wear the angry white hat. Let’s make sure that policymakers see that there is a problem.”


- ED Boarding Advocacy Updates
- ED Boarding issue paper that was distributed to legislators 
- ED Boarding infographic

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