Vote. That’s the bare minimum, says North Carolina State Representative and ACEP member Timothy Reeder, (R-D9), MD, FACEP.

When he’s not actively pushing for laws in North Carolina that make positive changes in health care, or still working full time in the ED, Dr. Reeder encourages emergency physicians to get involved in advocacy efforts, meet with legislators at the state and federal level, donate money, and run for office. But voting comes first, and it’s the foundation of his Hierarchy of Advocacy argument. It sounds basic enough, but Dr. Reeder says you would be surprised.

“Physicians have to vote, that’s the baseline, and we know that physicians actually vote less than the general population,” Dr. Reeder said. The importance of voting is clear as he won his first race by 354 votes out of more than 30,000 cast. “If 12 people at each precinct had voted the other way, I would not have been elected.”

To improve physician advocacy success, Dr. Reeder breaks it down.

His presentation includes a pyramid to show where to start and where to go. Dr. Reeder delivers his Hierarchy of Advocacy talk whenever time permits, from medical students, resident and attending physicians, other health care professionals, and any others who will listen to improve their advocacy skills. This road map to successful advocacy starts small—voting—and leads to a candidacy for public office, something Dr. Reeder never really thought would happen to him until it did. Although he was active in advocacy and health policy on the Board and as President of the North Carolina Medical Society, he did not envision running for office. That changed with a phone call on October 25, 2021, when a former NC House of Representative, an anesthesiologist, called to tell him of the desperate need for a physician voice in the legislature and asked him to run for office.

Dr Reeder had one week to decide to change the course of his career. “As I did leadership training over the years, I said that leadership opportunities come when unexpected doors open up,” he said. “Now I had to face my own words and decide if I should follow my own advice.”

Here’s how the hierarchy works:

• Vote: The foundation of advocacy is participation in the electoral process. Dr. Reeder urges physicians to overcome apathy and recognize that every vote contributes to shaping policy.
• Develop Relationships with Legislators: Advocacy extends beyond the ballot box. Dr. Reeder compares the process of building relationships with policymakers to dating – physicians must cultivate connections over time, becoming trusted sources of expertise. “You want legislators to have your number saved in their phone. When somebody has a question related to health care, you need to be the person they call. Physicians are uniquely positioned to speak for patients. Make sure they call you.”
• Make Financial Contributions: While money does not buy votes, it does facilitate access. Dr. Reeder stresses that even modest political donations – $500 to $1,000 – can significantly support candidates aligned with health care priorities. He asks emergency physicians to “give a shift”—their salary for working one ED shift.
• Offer Campaign Support: Engagement deepens when physicians actively participate in campaigns, whether by hosting fundraisers, making phone calls, or knocking on doors. These efforts strengthen relationships and demonstrate a commitment to shaping policy.
• Run for Office: The pinnacle of advocacy is direct political involvement. Dr. Reeder’s own journey into the legislature exemplifies how physicians can bring their expertise into governance, ensuring that health care policy is informed by those who understand it best.

From Emergency Medicine to State Leadership

Dr. Reeder’s journey into medicine began with volunteer work in an emergency department during high school. Drawn to the fast-paced and diverse nature of emergency medicine, he pursued medical education at Ohio State University before completing his Master of Public Health at the University of North Carolina at Chapel Hill. His career at East Carolina University’s Brody School of Medicine and leadership roles in state medical organizations set the stage for where he is now.

In 2022, Dr. Reeder was elected to the North Carolina House of Representatives, securing a narrow victory that underscored the impact of physician advocacy at the state level. His platform included a focus on health care policy, Medicaid expansion, and hospital workforce protections, all informed by his firsthand experience in emergency medicine. One of Dr. Reeder’s legislative successes is the Hospital Violence Protection Act, which mandates collecting and reporting data on violence toward health care workers and requiring a sworn law enforcement officer at every hospital with an emergency department. He credits his advocacy for bringing attention to workplace safety issues that might otherwise have been overlooked.

Additionally, he has worked on initiatives related to mental health funding, Medicaid expansion, and opioid crisis management. His knowledge of emergency department operations allows him to advocate effectively for policies that improve patient care and physician working conditions.

Breaking Barriers: Physicians as Advocates

Dr. Reeder’s advocacy extends beyond policy; he is committed to educating physicians on how to engage effectively in legislative affairs. He frequently speaks at medical conferences, challenging his peers to abandon the mindset that policy is someone else’s responsibility.

Physicians, he asserts, often assume that hospital administrators or professional organizations will handle advocacy. However, he warns that this passive approach cedes influence to other stakeholders, including insurance companies and non-physician lobbying groups. “If we’re not at the table, we’re on the menu,” he quips, emphasizing the need for proactive engagement.

To facilitate this, he promotes initiatives like White Coat Wednesdays, where physicians visit the state legislature to discuss pressing health care issues. He also encourages doctors to invite lawmakers into their clinical settings, allowing them to witness firsthand the challenges of emergency medicine, such as ED boarding, limited resources, and administrative burdens like prior authorization.

Overcoming Apathy and Resistance

Despite the clear benefits of advocacy, many physicians remain disengaged. Dr. Reeder confronts this reluctance directly, often using blunt humor to challenge excuses. He dismisses the common claim that physicians are too busy to vote or contribute financially, arguing that prioritizing advocacy is a professional responsibility. “Because I am part of the physician tribe, I can call them lazy,” he says.

As Dr. Reeder continues his tenure in the North Carolina House of Representatives, he remains committed to strengthening physician advocacy. Future legislative priorities include prior authorization reform, expanding mental health services, and addressing health care workforce shortages. He also aims to streamline the Interstate Medical Licensure Compact, making it easier for physicians to practice across state lines.

His long-term goal is to inspire more physicians to step into leadership roles, whether within hospital systems, medical societies, or public office. He envisions a future where doctors are not only caregivers but also architects of the policies that shape modern medicine and the health care system.

“Sometimes in our specialty, because we’re working for large health systems and institutions, we rely on them to do everything for us, whether it’s new technology or advocating for issues that frontline health care workers need,” Dr. Reeder said. “We can’t rely on them to do this for us. Physicians must defend our profession and create the future.”

Mr. Scheid is Communication Director at ACEP.