How did I get there? I first started advocacy work as a school board member twenty years ago. During that time another former New Hampshire ACP Governor, Bob Englund, asked me to join the New Hampshire ACP Council, which led to my first visit to ACP’s Leadership Day. I have gone multiple times since, having learned that our legislators actually do listen to what we and ACP have to say. Over the last few years, it had become clear to me that detrimental and extreme legislation was being enacted at the state level, and I began watching and testifying on more local issues. During this time ACP significantly bolstered its state advocacy as well. Then, in the summer of 2021, I ran into my outgoing representative who told me I needed to run. “It’s a piece of cake” she said. She was the first of many wonderful and dedicated legislators I have met since.

Of course, she was retired, and I was not, though I work only half time as a hospitalist. In New Hampshire, the legislature is in session from January to June and there are usually 3-4 session days a month, so one can work it into a schedule if one’s employers are flexible as mine are. If a representative asks for and is assigned to a committee (I’m on the Health and Human Services Committee), there is more of a commitment but there is no requirement to be on one. For the 2023 session, I was able to make every vote, which is important as there were a number of ties and some wins by one vote given how evenly divided the NH House is. There is travel and I live 75 miles from the State House, which adds to the time required but has been great for listening to books.

As a physician, my focus has been to try to support legislation that improves access to care, quality of care, and reduces burdens on physicians and patients. I also work with others as a firewall against potentially damaging legislation. I was told initially that legislators do listen to physicians and have found that to be true of both sides of the aisle.

We had some success last year as follows:

• Bipartisan vote to reauthorize Medicaid expansion
• Increased regular Medicaid funding by $136 million, primarily to help nursing homes and home care
• Blocked more restrictions to abortion and reproductive rights
• Authorized a response fund for PFAS (commonly known as forever chemicals)
• Passed legislation legalizing marijuana (later vetoed by the Governor)

In 2024, there will be a lot of challenges and opportunities to shape healthcare in New Hampshire. We have heard testimony from physicians on how New Hampshire policies are making practice and recruitment more difficult, with a generally more adversarial attitude and specific obstacles like the 24-week abortion ban that has potential penalties for physicians attached. This is only part of the reason. Alarmingly, we have seen a number of obstetrical units close over the last few years, and there are proposed bills this year that would affect pediatricians and surgeons as well.

Other bills I’m watching in 2024 include:

• A constitutional amendment to preserve abortion rights
• Bills to curtail abortion and reproductive rights (the 15-day ban has been defeated)
• Bills that either support or target the LGBTQ community
• Bills expanding access to medical marijuana and others to legalize recreational use
• Many bills approaching social determinants of health relating to housing, transportation, and childcare
• There are a number of bills that would restrict procedures like circumcision, immunization, and immunization reporting that are being pushed by national organizations
• And a positive bill to continue studying environmental illness

All this means that physicians need to be more engaged in advocacy at work, in their state, and nationally. While I may be the first former ACP Governor to be elected to the legislature, I shouldn’t be the last. Physicians have expertise and experience that is extremely valuable in helping shape the laws that affect healthcare. My initial reaction when asked to run for office was that I wasn’t really qualified but found that, with the help of a good onboarding program and many other legislators from both parties who are happy to help with learning the ropes, it was a pretty natural fit. After all, we physicians have spent our careers advocating for individual patients, so why not on a macro scale? It’s not a big leap to go from fighting for prior authorization to testifying online, talking to elected officials, attending meetings, or running for office. Physicians must realize that advocacy is an integral part of practicing medicine. We can’t let others dictate the future of medical care without our input.