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.

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:

Sevaro is a physician-led telestroke and neurology company that delivers rapid virtual neuro coverage that’s reliable. Learn more at https://sevaro.com/

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.