Alister Martin, MD, MPP, encapsulates a mindset that embodies the spirit of emergency medicine: the entrepreneurial spirit. It would be easy for anyone looking through his resume to be curious about where he gets his drive. Afterall, his work in the emergency department (ED) alone is inspiring and would leave very little time for anything else. Dr. Martin graduated from Harvard Medical School, Harvard Kennedy School of Government, and the Harvard Affiliated Emergency Medicine Residency program. He most recently completed a White House Fellowship as senior advisor to Vice President Kamala Harris and is currently an assistant professor at Harvard Medical School. If that’s not enough, he founded a novel organization—one of many over the years—called A Healthier Democracy in October 2022.
So, where does Dr. Martin get his drive?
“I just want to be a part of the solution,” said Dr. Martin. “Logically, I think you can only do emergency medicine for so long before you start to get really upset and moved by the everyday violence of poverty our patients face, or the fact we are the only doctors some of these folks will ever have. Emotionally, I’m moved by the fact that in communities like the one I grew up in in New Jersey, the margin for error is so thin, that a slip one way or the other could result in an irreparable situation. It’s my job to try and do what I can to put my thumb on the scale for the vulnerable in the types of communities like the one where I grew up to the extent that I can.” Dr. Martin is doing everything he can to make a difference in and out of the ED while fulfilling his potential.
Ever the humble leader, he’s quick to point out there have been a few failures along the way, too. “[These initiatives] are a sub segment of all the things that I’ve done and tried, and from the failures, and from the stumbles, and the falling on my face, I learned lessons to make these other things more successful.” From addiction treatment to helping just over 5,000 clinicians get their DEA-X waiver transfers to voting rights, Dr. Martin showcases how the toughest experiences in the ED can be lessons that benefit the lives of the most vulnerable.
Front Door for Addiction Treatment
One of the first initiative’s Dr. Martin spearheaded early in his career was called Get Waivered. As fate would have it, the inspiration for it came from his first week in residency. Dr. Martin treated a young woman who had become addicted to opioid pain pills. She was a young mom who had just given birth to her second child. “She was at her son’s daycare and basically fell down the stairs, broke her left ankle, and had this big surgery,” Dr. Martin recalled. “She was put on a bunch of opioid pills. This was in 2015 before we were really talking about the opioid epidemic. She came to our hospital because she had been basically misusing prescription pills for seven weeks. And her husband had some left over from an accident he had had.”
Dr. Martin’s patient found a dealer back home in the neighborhood she grew up in and texted the dealer to obtain these drugs. When she showed Dr. Martin the text in the ED, she said, “I’m done. Delete my number, I’m getting help.” And the dealer responded back, “Good luck, I hope all goes well for you.” An hour later, she heard a knock at her door and it was her dealer at her apartment who said, “Look, I know what you texted me, but recovery’s hard. Here’s some pills for the road.” Dr. Martin recounts the story as it was told to him that the dealer gave his patient oxycodone for free. That’s when her husband intervened, and they brought her to Dr. Martin in the ED.
“I’m hearing this thinking I’ve been a doctor for all of six days, but absolutely…of course we’re going to help you. You came here and you asked for help. We’re going to help you. It’s what we do,” said Dr. Martin. “And I remember going and telling my attending, ‘Hey look, we got this woman. She’s asking for treatment. I think it’s the perfect time. This is totally reversible for her. I want to admit her, I want to get her into treatment.’ And the attending said, ‘That’s not what we do here.’” Dr. Martin admits his attending was kind, compassionate, and intelligent who was working in a system that just wasn’t set up to help patients like that. “And as a result, I have no idea what happened to that woman. But basically, that walk back from my attending’s desk to the patient’s room was the longest walk of my life,” said Dr. Martin.
It was during that walk that Dr. Martin made a commitment to himself to try and move the needle and make the ED into a proverbial front door for addiction treatment. In 2017, Get Waivered was established to help patients access recovery treatment in the ED. “Probably many other ER physicians were dealing with the same issue and letting patients down in that way,” said Dr. Martin. “So, Get Waivered was an initiative that we started in 2017 to basically get ER physicians their DEA-X waiver so they can prescribe buprenorphine.”
The X-waiver is a piece of legislation from the H.R. 2634-Drug Addiction Treatment Act of 2000 that aims to help emergency physicians prescribe buprenorphine for patients experiencing opioid withdrawal. Dr. Martin’s Get Waivered initiative increases the number of emergency physicians obtaining this waiver. “When we started there were about 400 ER clinicians who had this waiver. We have helped just over 5,000 clinicians of all specialties get the training they need to get their DEA-X waiver over the course of the last six or seven years now with the majority of those being ER clinicians,” said Dr. Martin. “The goal is to try and get 100 percent of ER physicians, and nurse practitioners, and APPs, etc., to get this waiver. Back in the day, you had to pay $200 for this thing, which is absolutely crazy. We made it free and tried to make the shift from common sense to common practice.” Subsequently, on December 30th, President Biden signed the omnibus bill which removed the X waiver completely. Dr. Martin was invited to the White House to give remarks marking the occasion.
Voting Rights and the ED
Vot-ER, an initiative to help people register to vote in health care settings, is his most notable. The intersection of medicine and politics became abundantly more obvious to Dr. Martin the more he saw patients in the ED. “I understood the connection between physical health and civic health. I had taken two years out of my medical school training. I went to the Kennedy School of Government. I also worked in politics for a year working for the Governor of Vermont, which was a fascinating experience,” he recalled.
Dr. Martin refers to the DMV experience where residents are asked to register to vote and draws a comparison to health care. “What the hell does voting have to do with driving? Aren’t voting and health more related than voting and driving? And so, we want to create that same kind of connection between health and voting,” said Dr. Martin. To date, Vot-ER has partnered with the American Medical Association to recognize voting as a social determinant of health as well as with 700 hospitals, community health centers, medical schools, and registered—either with voter registration or through vote by mail—over 80,000 people in health care facilities across the country.
Working at the White House
Dr. Martin learned about the White House Fellowship during his time at the Kennedy School from two of his mentors who had completed it and, as Dr. Martin admits, they were two of the coolest people he had ever met. “And so, I decided to apply two years ago.” He got the job. Initially, Dr. Martin worked on voting rights at the Vice President’s office because of his background with Vot-ER. But then was assigned a second role helping to run health care outreach in the West Wing Office of Public Engagement.
The national discussion around health equity and social determinants of health were the top focus points for Dr. Martin during his time at the White House. Seeing opportunities to, “mobilize the health care community to use some of the federal programs and the initiatives that were being rolled out by [the Biden] administration,” as he said. Forums were a great asset to his work. “We had health equity forums where we would identify a specific issue like homelessness. We would invite a world renowned or nationally recognized figure who is doing work in homelessness to come and basically do a White House event talking about the issue, talking about the data, and some of the background.”
While at the White House, Dr. Martin noticed opportunities to better convene the health care community around the political determinants of health, which, he notes, “are the upstream drivers that create the social determinants of health.” And this—not surprisingly—got him thinking about how to help. “I think that there are missed opportunities to have health care providers and health care groups advocate together to address, via legislation, issues like housing insecurity, climate change, and food insecurity on behalf of the patients,” said Dr. Martin. His latest initiative, A Healthier Democracy, seeks to be a convening place to bring physicians together in an effort to create social change in the health care arena. “It’s a social entrepreneurship incubator,” Dr. Martin described. “For ideas and initiatives that clinicians have, we want to be a home for that which addresses the accounting, legal, fundraising, and administrative elements so the clinicians can just focus on creating that project or initiative they know will move the needle for their patients.”
Onward and Forward
As is often the case with those who have worked in the White House, we couldn’t help but ask Dr. Martin if he has any political aspirations for himself. Though he doesn’t have any plans to run for office anytime soon, “talk to me after my hundreds of thousands of student loan debt has been addressed,” Dr. Martin jokingly said, he does like to use his platform for another cause: advocating for an overall life framework that helps fellow emergency physicians learn to relax. “If your heart cannot relax, it does not matter how hard your heart is pumping, there’s literally nothing in the chamber. And so, I take pride in figuring out ways to really relax and unwind, too. And that is not something that I used to do. I think I developed that, have had to learn that, and quite frankly, unlearn other ways of being after residency ended for me.”
Danielle Galian, MPS, is editor of ACEP Now.
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