ER Doctor Running for Congress Diagnoses How to Fix the U.S. Healthcare System, with Dr. Tim Peck
Key Podcast Moments
- Tim Peck describes sleeping inside a nursing home for three months to understand why so many elderly patients end up in the ER and how earlier intervention could prevent nearly half of those hospitalizations.
- He explains how telemedicine allowed emergency physicians to reach patients at the true moment of crisis, saving lives and more than $100 million in unnecessary Medicare spending.
- Tim recounts what it means to practice in a healthcare desert, including 911 calls where no ambulance is available and families left to improvise emergency care.
- The conversation connects emergency medicine training—slowing down in chaos, listening first, and leading with incomplete information—to leadership far beyond the ED.
Episode Transcript
In this town that we're in, if it's after 50 hours of care during Monday to Friday that exists for 911 to be available for the fire department, local volunteer fire department to be available, there's no ambulance. So, they called 911 and they said, "Sorry, we don't have an ambulance for you." Just imagine what that must feel like. It's going to be an indefinite amount of wait because the one ambulance that serves an enormous area is in Louisville now because they were transporting the person, right? So, we don't know when it's going to come.
Welcome to How I Doctor, where we're bringing joy back to medicine. Today, I'm joined by Dr. Tim Peck, Harvard trained emergency physician, healthcare entrepreneur, and two-time congressional candidate who believes the only way to fix healthcare is to fix the government that controls it. He's also an ER doc who slept in a nursing home for three months to try to understand what elderly care is like from the inside. He was chief resident at Harvard's Beth Israel Deaconess Medical Center during the 2013 Boston Marathon bombing where his team treated 23 victims and saved every life. Now he is running for Indiana's 9th Congressional District as a Democrat in a deeply Republican district because he thinks, and I agree, ER docs have exactly the skills Congress needs, the ability to solve complex problems under pressure, make decisions with incomplete information and stay calm when everyone else is losing their minds. I have previously talked with other doctors, turned politicians. Tim's path I think is different. He's a centrist Democrat in a red county trying to prove that bipartisan problem solving still works and willing to lose over and over to make that case. I'm particularly excited to talk with Tim because he and I obviously share the same clinical training as emergency physicians. And I want to test this thesis that our specialty uniquely makes people prepared for political leadership and everything else. Dr. Tim Peck, welcome to How I Doctor.
Thank you, Graham. I appreciate it. It's an honor.
From Emergency Medicine to Healthcare Innovation
Tim, you've done emergency medicine, founded healthcare tech companies. And then at what point did you say, "Oh yeah, let's run for Congress in rural Indiana."
I said, "Let's run for Congress a lot earlier than I actually put my toe in the water and decided to actually make it happen." As you said, I was doing residency at Beth Israel Deaconess, the Harvard program there, and stayed on as faculty for a bit. And then I left in 2013 to create my first startup. And that startup was called Call9 and created telemedicine technology. At the time, there wasn't much out there. And so, we had to create our own technology. And as you said, I lived in a nursing home for three months to understand everything I could about that world because you as an emergency doctor know that one of our favorite things to do is point fingers at the nursing home world and say, "What are they doing? Send in those patients to us." So, I wanted to go figure out why and then how we can bring medicine to people rather than people to medicine.
Get Curious, Not Furious: Understanding Nursing Home Emergency Care
We're recording this the day after the first episode of season two of The Pit came out. I watched it last night. And I mean, the nursing home thing was even a trope on the show. The intern is now teaching the med students, "Oh yeah, hey, it's 7:00 AM or it's 7:30 or whatever." It's when the nursing homes do their bed rounds and they find somebody altered and call 911. So, it happens every day. It was a common trope that even Hollywood is using now. The thing I try to do, and I think I'm hopefully successful most of the time is just the idea of get curious, not furious. Your nursing home example is probably a really good demonstration of that. It's like, "Oh, okay. I actually want to learn what is actually happening." It's very easy for me to make assumptions about why nursing home patients come in at 6:00 AM or 7:00 AM or whatever, but it's way harder to actually go do the hard work of like, "Oh, well, let me try to understand, not just jump to conclusions about how bad this nursing home is or how lazy some person is that decided to do it this way." I think that's also a little bit of an ER doctor ethos of I think we generally try to not ask things of our team members that we wouldn't do ourselves. I try to really have a very low hierarchy world where a nurse feels comfortable to ask me anything because he or she knows that I'm willing to get down and dirty and do it too. Tell me maybe a little bit more about your nursing home story and what led you to do that.
The Patient Experience: Why Time Matters in Emergency Care
I was looking for a way to be with people at the moment of their emergency. We see these patients so much after the moment of emergency. When you really look into it nationwide, it's over 60 minutes before they see you, even at places that have quick response times because when you're thinking from the patient experience, it's when they pick up the phone to call 911 or someone else does, plus the wait, plus the time on site, plus the wait to get to you, plus the time that it takes for them to even see you because you have to get in there if it's not immediate trauma or a STEMI being called in kind of thing. And so, that's a lot of time. And I think time is a concept that having been a patient before with pretty critical illness versus a doctor, it's warped, right? Every second feels like a year as a patient. And while you're out there seeing 12 other patients and come back and feel like, "Oh, no time really has passed for me as a physician," that person's just been waiting on care, just been waiting. And so, I got obsessed around how can we shorten that time? And again, telemedicine wasn't a thing, FaceTime was, and said, "What if we use telemedicine?" And one of the stats I like is that at the time, less than 1% of doctors knew what the term telemedicine was when there was a survey. And so, yeah, using that to get to people then looked at where do people have their emergencies? And the one place where people really have emergencies and use the 911 system in a single building is a nursing home and rehab. And so, in my ED, 19% of the ambulances that came to the hospital originated from nursing homes. And so, got down to that, I really don't know what's happening there. I get bad documentation from them. I get patients that you're like, "I don't even know why they're here." I get other patients that are so super sick and you're like, "How did it get to this point?" And instead of complaining about it, I said, "Okay, maybe this is the place both operationally where everybody is using it, I can get to also just the highest need." And so, I went and I emailed thousands of nursing homes and a few of them got back to me and saying this crazy idea, "Can I sleep over in your nursing home?" And one in Long Island, New York said yes. And I found myself living there.
Finding Healthcare Solutions Where the Demand Exists
People say never waste demand. If there's a big demand for services, clearly nursing homes have a big demand for emergency care. Go to where the money is. That's a great place to provide a ton of value and learn a ton about what happens, maybe see patterns that maybe even the nursing home can't see that you're able to see it with a fresh bare eyes as well.
Definitely that the nursing home can't see and definitely that emergency doctors can't see by being there and learning, right? So, it's that cross pollination and it's go to where the money is, go where the problem is. And that's where I saw the problem be largest. And then it is the money, right? We spend a ton of money on unnecessary hospitalizations. CMS has 45% of hospitalizations that come from a nursing home are avoidable. And it was true. When you got to patients early, our very first patient, Mr. D, I'll remember him forever. He was an old gruff guy who his complaint was vague abdominal discomfort and constipation and he was diabetic and big abdominal discomfort.
The story is he was having an MI and they don't have EKGs at a nursing home necessarily being done because there's no doctor there. It's a nursing home, not a doctor home. So, with telemedicine, we could do the EKG right there by the bedside. I could see it. We have streaming telemetry. I could see that his O2 was low and put him on O2, get the IV started, call 911, give him his aspirin and have the IV ready for heparin. And so, he left the hospital a few days later with a few less percent of his ejection fraction and his life saved. And so, that was great. But we also prevented so many hospitalizations that over the course of a couple years saved Medicare $100 million in unnecessary hospitalizations over 5,000 beds that we were covering at all times.
The Power of Early Medical Intervention in Nursing Homes
Is that kind of one of the big takeaways you learned was like the information was available. The patient was already symptomatic or whatever it is. And had you just been able to intervene earlier, you actually were able to dramatically change the course of this probably chronically ill, often quite frail patient's trajectory?
Absolutely, it was about getting to and we would call it magic medicines, especially like LASIK would work better because you'd be there, just be like, "Why is this LASIK working so well?" You're so used to giving it and it's only going to work for output when they get upstairs, right? It's because you're there so early in the evolution of these problems that these medicines actually have better effect because the physiology hasn't gone haywire yet.
Tim, it's a very morbid population. Probably it sounds like probably also a really high yield group, where you can have a massive impact because the patient population's already so sick. Your number needed to treat is very small for giving LASIK to people early in their congestive heart failure fluid overload.
Understanding the Opioid Crisis Through an Emergency Physician's Eyes
One of is my son, my daughter, my nephew, my wife died of opioid overdoses. That is a real fear. And again, we have an administration right now that's feeding off of that fear. And so, it is deep and it's real of, "Oh man, I watched my high school football star become a drug addict and die. And they looked like a different person by the time they died." It just kills communities, kills families, and it's often done very quietly. And one of the great things about medicine, as you know, is that people are vulnerable to you and tell you the secrets of their life, their health life, that they don't even tell their own husbands and wives.
Wouldn't tell anybody. Yeah.
Yeah, exactly. When you're looking to represent them in politics, they do the same thing just about their more personal lives and their economic lives. And they will tell you about that mortgage that they can't pay anymore, that they didn't tell anybody. They might not even told their spouse yet. They were the one who controls the checks. And when it comes to that crossover between health and that privacy of family life, opioids are the thing that is so detrimental.
Seeing Patients Beyond Their Worst Moments
And similar to nursing homes, kind of bringing it all 360, when you're in the ED and you get these patients from nursing homes and they can't speak to you and they have quiet delirium and they're just internally preoccupied and they're sick and you're like, "This person is a shell." Three hours before I got to see them, they weren't a shell, right? They were an interactive member. And so, you see what's in front of you. And I think we do the same for patients who come to us who are on opioids, who are struggling with them. Five years ago, they were in college, they were holding a job, they were a loving family, they were a member of society, and now they're not. And you just have to remember where they were and people are people on a different moments of their journey and you're seeing them at the worst and remember that they have a better life before and they can have a better life moving forward too.
I think that's one of the things I've been most appreciative of as an attending that I wasn't as a resident that as I've seen some of my patients often with alcohol use disorder or meth use or opioid use, you see some of those patients come out the other side and you'll see them for something unrelated. Three years later, they've sprained their ankle and you see the name come up and you say, "Oh my God, there's no way that's Steve or Joe or Susan, whoever it is." Oh my God, you're a different person. You're absolutely right, Tim. We see them at their worst. We are unable to access that part of who that person is. And then hopefully if they get the treatment and the support they need, they return to this person that is three-dimensional and is not just a diagnosis or not just a frequent flyer or something like that as well.
Breaking Taboos: Weight, GLP-1 Drugs, and Life Transformation
I think weight is an even more taboo version of that where people gain tens, hundreds of pounds in moments of stress and anxiety and depression in their life and we see them and you pass immediate judgment. Ozempic and tirzepatide and all these medicines are going to really be a challenge. I think we'll have more of those experiences that you were just talking about in terms of drug and alcohol addiction, where you're going to see someone two or three years later and they're there for their sprained ankle rather than their MI. And you're saying, "Well, what happened?" Your life has changed. And so, I think I'm excited about the breaking of taboo, even though we'll have to go through a taboo moment to get there.
How to Support Dr. Tim Peck's Congressional Campaign
Tim, where can people find you, learn more about you and support you on the campaign trail?
You can find our campaign and my campaign on timpeckforcongress.com, forcongress.com. You can contact the campaign there. You can also contact me. One thing that the great Lee Hamilton, who was a representative, a Democratic representative from my area for 31 years, who was known for working across the aisle did, and he told me was, "Give out your phone number." I said, "Okay, it's a modern world. Are you sure you could do that?" And he said, "Give out your phone number." And I do give it out for people to contact me. And you have some contacts that are a little bit out there, but every once in a while-
Sure, yeah.
... you get that will engage. So, 812-287-9079, you can get in touch with me.
Amazing. That's our first phone number on the podcast for sure.
There it is. Yeah. Also working on something called Project Next, which we didn't talk about, which is a podcast that's for local issues and trying to tie local things happening to national policy of this Kentuckiana area. It's called Louisville Metro Area, so projectnextindiana.com. And yeah, please reach out and would love your donations to make this happen. As we said, I can't rely on PACS and I can't rely on larger organizations as I go after the system itself and say it's not really working the way it is. And so, individuals and especially physicians are how we've been able to fund this movement.
Dr. Tim Peck, it has been such a pleasure to get to talk to you. I just love your ability to combine the heart of emergency medicine and being a physician with representing your district and your community in such a great way. It's been wonderful to get to talk to you and best of luck on the campaign trail.
Appreciate that, Graham. Thank you so much for having me.
Thanks for joining me today. For interviews with physicians creating meaningful change, check out offcall.com/podcast. You can find How I Doctor on Apple, Spotify, or wherever you listen to podcasts. We'll have new episodes weekly. This has been and continues to be Dr. Graham Walker. Stay well, stay inspired and practice with purpose.
Tim Peck learned how to lead in the emergency department. Trained as an ER physician, he’s spent his career making decisions under pressure, calming chaos, and showing up on the worst days of people’s lives—skills that pushed him to look beyond the bedside and ask why so many emergencies happen in the first place. That curiosity led him out of the hospital and into the places where care breaks down, from nursing homes and rural healthcare deserts to families quietly devastated by the opioid crisis.
In this episode of How I Doctor, host Dr. Graham Walker explores what emergency medicine teaches about leadership, timing, and systems failure. Tim argues that ER physicians are uniquely trained for moments like this, not because they have better answers, but because they know how to slow things down when everything feels out of control.
That mindset led Tim to one of the most unconventional decisions of his career: sleeping in a nursing home for three months. Like many emergency physicians, he had grown frustrated with frequent nursing home transfers and poor documentation. Instead of blaming the system from afar, he embedded himself inside it. What he found was a population with enormous unmet need, where nearly half of hospitalizations could be avoided with earlier assessment and basic interventions.
Telemedicine became the bridge. By reaching patients before physiology spiraled. Tim and his team changed trajectories. Treatments that felt routine in the hospital worked better when delivered sooner. The result wasn’t just better outcomes, but massive cost savings and fewer unnecessary admissions.
But innovation ran into policy. Despite clear evidence and bipartisan interest, Medicare initially had no way to pay for telemedicine care in nursing homes. As Tim explains, the technology worked, the medicine worked, but the payment system couldn’t process it. That disconnect became a recurring theme throughout the conversation.
Nowhere is that disconnect more visible than in rural healthcare. Tim shares stories from his own community about 911 calls with no ambulance available, CPR performed for nearly an hour before help arrived, and hospitals slowly losing services until closure becomes inevitable
Underlying much of this collapse is simple math. In some rural communities, nearly 30% of patients are uninsured. Hospitals cannot survive when that many people walking through the door cannot pay for care. Tim is clear that while solutions may differ, physicians across the spectrum recognize the same core problem: a system built on fee-for-service incentives that reward volume, complexity, and middlemen rather than timely, effective care.
Throughout the conversation, Tim returns to the same principle: leadership starts with slowing down. Sitting instead of standing. Listening before solving. Creating space for trust. These are the habits emergency physicians practice daily, often without naming them as leadership skills. For Tim, they are the same skills required to confront healthcare’s hardest problems.
This is not a campaign speech or a partisan argument. It’s a clinician’s diagnosis of a system under strain, grounded in lived experience and shaped by emergency medicine’s insistence on showing up when things fall apart.
Thank you to our wonderful sponsor for supporting the podcast:
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Top 4 Takeaways
- Emergency Medicine Is Leadership Training
Tim argues that emergency medicine trains physicians to lead in chaos—making decisions with incomplete information, regulating emotion under pressure, and guiding teams through uncertainty. These skills aren’t abstract leadership theories; they’re practiced every shift. The ability to slow down in critical moments is what allows better decisions to happen faster. Tim believes these habits translate naturally beyond the ED because they’re built on trust, presence, and clarity.
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