Published 6/22/2026
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Jack M. Ayres, MD
The phrase “all politics is local” is commonly attributed to former Speaker of the House Tip O’Neill. The late Massachusetts politician argued that while national debates often dominate the headlines, political success ultimately depends on understanding and responding to the needs of constituents at home. I would further submit that all policy is local as well.
Granted, federal legislation affecting matters such as physician reimbursement and research funding is and should remain a critical focus of our advocacy efforts as doctors. However, many decisions affecting the physician-patient relationship are made not in Washington, D.C., but in state capitols and local communities. Medicaid coverage, insurance regulation, and medical liability considerations are all impacted by state legislation. State policy further shapes patient health through state-funded and state-governed transportation infrastructure, education, and social services. Finally, even some of the structural issues affecting our profession are overwhelmingly dictated by state policies on workforce development and alignment, higher education, and business.
At the federal level, advocacy can feel distant, with complex legislative processes involving numerous committees, large staffs, and lengthy policy cycles. State policymaking, on the other hand, is often more centralized, with legislators representing fewer constituents and engaging more directly with those they serve. Physicians who participate in local advocacy often discover that lawmakers are eager to hear from clinicians about the real-world consequences of policy decisions.
Jack M. Ayres, MD
My appreciation for this process began before medical school, when I deferred matriculation to work in the Kansas governor’s office during a gubernatorial election cycle. During that time, I worked with incumbent Gov. Jeff Colyer, MD, a plastic surgeon, and Lt. Gov. Tracey Mann, who now represents Kansas’s “Big First” congressional district in the U.S. House of Representatives. Of note, Gov. Colyer is one of many healthcare workers elected to office who bring their medical training into public leadership. As Robert Simari, MD, describes in his book, “A Prescription to Lead,” physicians are trained to synthesize large amounts of information, evaluate competing priorities, and make decisions grounded in both evidence and experience — skills that translate naturally to leadership in public policy.
During my time in the governor’s office, I saw how often policy initiatives would originate from conversations with individuals directly affected by an issue. Many discussions would begin with a Kansan explaining how a particular regulation or policy was impacting their profession or their community; those insights frequently became the starting point for meaningful policy solutions. Physicians, often seen as trusted leaders within their communities, are uniquely positioned to help shape policy in this way.
Moreover, I would argue that residents occupy a uniquely powerful vantage point for healthcare policy advocacy. In our average day, we likely start by rounding on inpatient floors, where we see the friction of insurance authorization for discharge planning and work to navigate it alongside case managers and social workers. We may then see a consult in the emergency department, where we confront realities of access and uncompensated care. Further, the structure of our training demands rotations through different orthopaedic service lines, each with unique challenges and nuances related to the policy ramifications of patient care. Residents witness the silos that fragment orthopaedic care, yet because we are not yet bound to any one of them, we see the system as a whole.
Residents need not identify specific policy solutions or seek to solve complex public health issues through their experience alone. In fact, effective engagement only has one prerequisite: participation in the democratic process. Registering to vote and participating in state and local elections are the first steps in advocating for your patients and profession.
Too often, the presidential election cycle draws attention away from important state, local, and even midterm elections. In November 2026, voters across the country will elect 36 state governors, 33 U.S. Senators, and every member of the U.S. House of Representatives, along with state legislators and other local officials in every state. Such elections may have a tremendous effect on policy, and your participation is critical.
I would encourage all residents to confirm who represents them at the local, state, and federal levels and become knowledgeable about the upcoming elections in your state and the policy issues driving them.
Then, take the next step. That may be as simple as making a small donation to the OrthoPAC and visiting the AAOS Advocacy Action Center. I also encourage you to join your state orthopaedic society and check out their resources regarding local issues. State orthopaedic societies have been successful in affecting policies that matter to orthopaedic surgeons, and many state societies have had recent legislative and regulatory victories around downcoding, scope of practice issues, and medical liability reform.
If all politics is local and all policy is local, then residents are not just observers of the system but a critical part of shaping it. Register to vote, stay informed, and engage. The policies affecting our patients and profession are often decided close to home, where your voice matters most.
OrthoPAC is affiliated with and connected to the 501(c)(6) Association. OrthoPAC is not connected to or affiliated with the American Academy of Orthopaedic Surgeons, which is a 501(c)(3) organization.
Jack Ayres, MD, is a third-year orthopaedic surgery resident at Prisma Health/University of South Carolina School of Medicine, Columbia in South Carolina and served on the AAOS Resident Assembly Health Policy Committee.