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AFP: American Family Physician Podcast
Bonus Episode 19 -- March 11, 2026 AFP: American Family Physician
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- [00:00]
Representative Kelly Butler
Foreign.
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Steve Brown
Welcome to the American Family Physician podcast bonus episode 19 the 2026 advocacy episode update I'm Steve from the University of Arizona College of Medicine, Phoenix Family Medicine Residency and today we're going to welcome a number of experts to help us understand how family physicians, students and residents can make a difference for our specialty, our patients, and our communities beyond the exam room. We first released this episode in 2022. We've made extensive updates for 2026 and recorded new interviews. The opinions expressed in this podcast are our own and do not represent the opinions of the American Academy of Family Physicians. The editor of American Family Physician or Banner Health
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Will Humble
I believe everything is at a policy level. If we are looking at health, health begins where we live, learn, work and play. Those have the largest impact on the
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Senator Heather Carter
outcome of our patients health.
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Will Humble
How do we lead ourselves to create the necessary transformation in the US Healthcare
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Henry Sanchez Ortegosa
system to get us to that point where we can make health primary? There's a lot of opportunity and challenge ahead of us as a community to really bring primary care to every single American.
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Will Humble
It's not just about the work that
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Henry Sanchez Ortegosa
you do in your office or your
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Will Humble
clinic, but that the policymakers do have
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Henry Sanchez Ortegosa
a huge influence in terms of how we're able to practice medicine and how we're able to deliver the kind of care that we signed up to deliver.
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Steve Brown
Healthcare is a right, not a privilege, whereas wearing your white coat is a
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Senator Heather Carter
privilege, not a right.
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Steve Brown
It's important to be aware of this and to use your white coat to advocate for and to give a voice
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Henry Sanchez Ortegosa
to those without one.
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Steve Brown
Those Comments are from Dr. Renee Critchlow from our bonus episode 13, Dr. J. Lee from episode four in 2015, and Henry Sanchez Ortegosa, a fourth year medical student at Rutgers New Jersey Medical School. Before we meet our experts, I'd like to give you a brief overview of advocacy in medicine. Physician advocacy is a core part of medical professionalism. It's our job, our lane the American Medical association says that one of our key nine duties as physicians is to advocate for the social, economic, educational and political changes that ameliorate suffering and contribute to human well being. Unquote. The word advocacy is pretty broad. To break this down, I'm going to borrow from Dr. Dobson and colleagues from a 2015 article in Academic Medicine entitled From the Clinic to the Community the Activities and Abilities of Effective Health Advocates. These authors talk about five levels of advocacy clinical agency, paraclinical agency, practice, quality improvement, activism, and knowledge exchange. So let's go through these five levels. First, clinical agency. This is when you as a doctor, advocate in a clinical setting to address an immediate medical need, examples would be calling another physician for an urgent consultation or getting a medicine for a patient that fits particular life circumstances or insurance coverage. We're all pretty used to doing those things, so congratulations, you're doing advocacy. The second type of advocacy is called paraclinical agency. This is when you reach out to address a social issue impacting the health of an individual patient, like making sure a patient's air conditioner stays on in the summer or mobilizing social services for a patient. Third, quality improvement. This is pulling your practice team together to implement a practice change to improve the health of your patient population or systematically improving a process at the practice level. The fourth level of advocacy, and this is mainly the level we'll be talking about today, is activism. In the words of Dobson and colleagues, this is activities aimed at creating lasting changes to a system or policy. This can be at any level, your institution, local or state government, and the federal level. The fifth and last level of advocacy is knowledge exchange. Examples of this would be writing an op ed, giving a talk at a community organization, or promoting the benefit of vaccines on social media. So today we're going to learn and hopefully be inspired. We have some guests joining us, so here is our first guest.
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Dr. Sara Nosel
I'm Dr. Sara Nolzel. I work in the South Bronx providing direct care to my patients in a network of federally qualified health centers. And I'm really lucky to have had a long term involvement with the American Academy of Family Physicians and particularly the New York State Academy of Family Physicians, where from the time I was a resident, the first meeting I went to and got to be one of the voting members for at the Congress of Delegates and realized I could have a say in what family doctors stood for in my entire state. And I couldn't give it up after that and knew how important that was and how much it mattered and eventually got to become president of our New York state and now get to represent us as a director on the national level on the AAFP Board of Directors. And it is an awesome privilege and experience.
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Steve Brown
Why should family physicians, residents and students get involved with advocacy?
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Dr. Sara Nosel
Family physicians, students, residents and physicians. Like we're already doing advocacy every day. That inherently in, in primary care and being a family doc and getting to intimately know the people in the community that you're working for, there's so much advocacy on that one. On one level that happens there that can be extremely rewarding and incredibly frustrating and that often when you find that I write Letters to get heat on in people's apartments to make sure their electricity is not turned off so that they can make their nebulizers run or make sure that their oxygen condenser is still running. I mean, that literally, that kind of advocacy we are doing every day. And what's. What draws people to family medicine. But then you kind of hit a wall where there are systems that are in place that are impeding your patients that are not able to be managed just in the exam room. And that when you hit that wall, the ability to say, where are these rules or regulations? Either not aware that there's a problem here or where there's actually a barrier in the way we've constructed rules or regulations in our state or in our country. Sure, our patients have access to optimal health and wellness, which is really what family docs are focused on and what our patients and our communities are focused on.
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Steve Brown
Dr. Nosel, I really appreciate how you suggest getting involved in your family medicine interest group or state or local academy and following your passions. Find a group that is working on something that's important to you. What aspects of health get decided on a state or local level?
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Dr. Sara Nosel
I mean, unfortunately, I think almost every aspect of health gets decided on those levels. There's no reason that every individual shouldn't have access to health care, to health and wellness. That is a human right and not a privilege. We have to fight to make sure our patients and our families are getting access to the care they need right now. Throughout my career, I've learned, and then we've really learned as a society in the last five, ten years about that. Health care is way more than whether or not your hospital bills get paid. It's about whether you have clean drinking water. It is whether or not you have adequate education at your schools to provide opportunity. It is about whether or not you have a safe way to get to a place to be educated, whether or not there is money and finances to get additional education beyond, you know, and whether or not you have. Have support certainly in my community as well. Air quality is a big deal. All of those pieces are things that are regulated. All of those pieces are pieces that we can fight for, advocate for, and have. And physicians are like such experts about knowing how those things impact health. Now, that's not even to speak about the stuff that seems more obvious in making sure that we have adequate primary care resources, that we have not just reimbursement for the work that physicians are doing. But how do we make sure that the communities that need care that we're bringing and developing family doctors from those communities. And so those are absolutely things that like we go and talk to our legislators about, we talk about getting loan repayment, we talk about getting prospective payment and scholarships and support so that individuals can actually be pursuing the kind of care and education that is needed in our communities.
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Steve Brown
What else would you really like family physicians, students and residents to know about advocacy?
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Dr. Sara Nosel
I think that I really want family docs and I really want residents and students to know like how powerful actually going and speaking even to like your local school board, your, you know, your community legislators, your, your state and local legislators that the impact of, of you as a professional, as a someone, if you're going to pursue medicine like students and residents blow legislators out of the park. They're so excited about what their future holds and really want you to stay in your state as a student and a resident. Like, hear me, you will be, you will be the most important voice in that room. And that physicians who've maybe been struggling this year with burnout, who have felt like is what I'm doing matters? Like, does it matter? This is so hard. It feels painful. And, and really this is going to go on a lot longer. Like people are really sick. We haven't designed everything as well as we can, but there is tremendous opportunity for when you step outside of the exam room, even in that feeling of exhaustion to go and help make the changes that you know, because you've been on the front line will make a difference. And I know other parts of the country like we've seen incredible stories of our colleagues, of the work they put in and the advocacy work they did that really helped change for communities, particularly communities of color, poor communities that didn't have access to care, that were changed, that the outcomes in those communities have changed thanks to family docs stepping forward, stepping up, doing the work and advocating for the resources needed.
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Steve Brown
Thank you so much, Dr. Noel for encouraging us to be inspired and inspire others and, and get involved to make changes that can support our profession, our patients and our communities. Dr. Nosell is now the president of the American Academy of Family Physicians and provided us with this update for 2026.
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Dr. Sarah Nosel
Today I'm going to share an update of how the AAFP has been advocating for patients, physicians and family medicine. First, I want to highlight how family physicians are advocating to protect public health, including preserving access to vaccines and the ability of family physicians to provide them. We've been consistently communicating with Congress and members of key federal agencies to enact policies that support access to those life saving vaccines and therapeutics, as well as legislation to protect the process of approving vaccines. The bottom line the AFP will always be a champion for public health and policies that ensure debilitating and deadly diseases do not harm the patients and communities we serve. There has been some good news for primary care. Congress recently acted to enact several provisions that uplift primary care in their bipartisan legislative package. The bipartisan agreement provides meaningful stability to healthcare programs that patients rely on every day. So the package included several significant healthcare advancements, including the multi year reauthorization of the Teaching Health Center Graduate Medical education program through 2029, continuing funding for Community Health Centers and the National Health Service Corps through the end of the year, and a two year extension on telehealth flexibilities through 2027. Together, these provisions strengthen the primary care workforce, expand access in my under resourced community, and preserve virtual care options for our patients. Ensuring that healthcare is affordable for all patients remains a top priority for family physicians. The AFP continues to urge Congress to conduct more oversight into what's driving up healthcare costs for patients. We've directly engaged Congress. We've shared our insights into the challenges that we're facing as family docs with respect to rising costs, the consolidation and lower physician payments, and Medicare Advantage. We are also communicating with several federal agencies including the Federal Trade Commission, the Center for Medicare and Medicaid Services, the Department of justice, urging them to conduct oversight into this practice of payment down coding, a technique where health insurances are trying to drive down payments to physicians. Finally, I want to touch on one of the most exciting parts about being a family physician, which is our ability to engage directly with lawmakers and advocate ourselves. There are a few ways that you can get involved with advocacy at the afp. The first is to participate in an AAFP Speak out campaign. So this is an electronic tool. It allows you to easily send pre written letters to your members of Congress urging them to act on priorities that impact your patients and your practice. It takes less than five minutes and it makes a real impact. Our collective voice is loud. As of today, AFP members have sent more than 13,000 letters to Congress, from protecting Vaccines to preserving the Medicaid program. The second thing I want to encourage you listeners who are family physicians to do is sign up to become an AAFP Advocacy Ambassador. So we launched this program to help equip members who can connect and engage with their lawmakers really back home in your community. There are different levels of commitment to the program and based on your own level of interest and advocacy. If you're interested in learning more, please reach out to grassrootsafp.org and finally, one of my favorite events of the year is almost here, and that's the Family Medicine Advocacy Summit in Washington, D.C. last year, we had more than 300 family physicians. We all came together in Washington and educated lawmakers on important policies impacting family medicine. You can Register today@aafp.org this two day summit is an incredible learning opportunity to learn from the afp, how to be a stronger advocate yourself, and a great opportunity to get FaceTime with lawmakers and staff on Capitol Hill. Thank you so much for having me. And to the physicians who are listening today, thank you for all you do.
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Steve Brown
Thank you so much, Dr. Nossel, for this 2026 update from the American Academy of Family Physicians. We appreciate your service to our specialty and our patients. Okay, now we're going to turn our focus to advocating activism on a local and state level. Today on the podcast, we have a trifecta of experts who are going to help us understand state level advocacy. We're going to be thinking about policy, not politics today. So we have elected leaders from both major parties. These leaders are all from Arizona, but we've tried to make the advice useful for family medicine advocates nationwide. So let's meet these experts.
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Representative Kelly Butler
I'm State Representative Kelly Butler. I've been a representative for five years now. I represent part of Phoenix, North Central Phoenix, Paradise Valley, and I'm also the ranking member on the House Health Committee.
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Will Humble
My name is Will Humble. I'm the Executive director for the Arizona Public Health Association. Our core mission is really around public health advocacy, both legislative advocacy, which is trying to get state legislators to pass better bills and to not pass bad bills, and administrative advocacy, which is how we try to make state agencies to make better decisions, to set better priorities, to allocate their resources, both human and cash, in a wise way that reinforces good public health practice. In my former job, I was the director of the Arizona Department of Health Services.
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Senator Heather Carter
Hi, my name is Heather Carter and I am a former Arizona state legislator. I served eight years in the House of Representatives and two years in the Senate. And during those 10 years, six of those years I was the House health chairwoman. And the other four years I was either the vice chair in the House or the vice chair in the Senate for the Health Committee as well. So safe to say, over 10 years of serving in the legislature, I spent a lot of time working on health policy issues.
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Steve Brown
Thank you so much for being here. We really appreciate it. Why is it so Important for physicians to get involved with their state legislature.
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Representative Kelly Butler
It's incredibly important because, you know, legislators, you know, especially at the state level, just come from all walks of life, and so many don't have, you know, any real experience, experience with anything in the health industry or with the healthcare system in general. Hearing from doctors who are and from any provider and talking about the challenges in treating their patients is so important
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Senator Heather Carter
for us to be able to make educated decisions. When we are faced with voting yes or no on a bill, we need to have that information. And obviously, we're not doctors, so we are not trained to provide the medical care that you provide to your patients day in and day out. However, we do vote on bills that will not only impact your practice as a physician, but the care that you provide to your patients. And so if we don't have the information available at the time when we have to make a decision, we need to be able to reach out to people and get some questions answered. And I have found it to be really, really helpful to work with our family practitioners. Just ask them, hey, how will this bill impact you as a doctor? How will this bill hopefully improve patient care? And I think that we need more physicians involved and engaged. Obviously, it'd be great if you could run for office.
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Representative Kelly Butler
Family physicians need to get involved and meet their state legislators because you can tell the stories of your patients. You can talk about, you know, the challenges that they're seeing in a way that, you know that we may not know about. You can talk about the challenges of your practice and, you know, the administration of your. Of your practice, and all of that is unknown to your legislator until you tell them so. It's really important that people use their voice and get involved, and it makes a huge difference.
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Steve Brown
All three of our Arizona experts agree that getting to know legislators personally is an important act of advocacy.
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Representative Kelly Butler
To some legislators, they just haven't really experienced what's. They don't. Haven't walked in someone else's shoes. And so that's why it is so important to hear directly from providers who can share those personal experiences. So it's just. It's extremely important to have that rapport directly with healthcare providers.
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Will Humble
Know who your state legislators are, follow them on Twitter, other social media. Find out when they're having their town halls or community meetings. Show up, show your face, let them know who you are, your role as a family physician, the things that you're passionate and interested in. Get their contact information and then follow and then build your relationship. When the legislative session isn't happening. And then when legislative session comes and they see an email or a text, hopefully if you can get their cell number, then they will really pay attention and listen to you when they have to take an important vote. Most state legislators that are in there making really important public health and health care decisions have almost no background in public health or health care. And so they need experts that they trust without conflicts of interest to give them honest assessments of ways they should think through voting on these bills. And so it's building a relationship with legislators and being an honest, trusted, unbiased source of information to help them make good decisions because they don't have a
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Senator Heather Carter
background in is important for you to not only reach out to your own legislator so who represents you where you live, you could reach out to the legislator where you practice. But I would pay particular attention to those lawmakers that are serving on the health committee because most of the bills that will impact your practice and your patients will funnel through the health committee, but many of the bills will work their way through the health committee and will live or die on a committee vote. So if there's something you really like and you don't voice your support, that bill may die in committee or vice versa, something you really, really don't like as a practitioner. And then once we go to the floor, which is where we do all of our final votes, we debate bills on the floor amongst members only. So you have one lawmaker asking a question of another lawmaker and if that lawmaker doesn't have the answer, how are they going to find this information? And so when I'm on the floor in the middle of the night debating a scope of practice issue, I need to have that information readily available. So two things enable me to be effective on the floor debating some of these really important issues. Number one, having a working relationship with physicians prior to going to the floor so they deeply understand these issues, but then also being able to text a question. And I have to be honest with you, I have texted physicians at 2 and 3 o' clock in the morning. Now, full disclosure, you don't have to agree to take a text from a lawmaker two or three o' clock in the morning because we're not trained to do your job. Your job is to provide care for your patients. And I think that's a really, really important job. And we as elected officials then vote on bills that can impact that. So we need to have your input.
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Steve Brown
Just like we heard from Dr. Nossal earlier, getting involved in your professional associations like your local state academy of family physicians is important. Here's Senator Carter.
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Senator Heather Carter
It's really important for physicians to get involved in their professional associations. You can join the Arizona Medical association, you can join your family practice association. Those are important groups to join because they do a lot of the heavy lifting around tracking bills. They do a lot of meet and greets with lawmakers to kind of explain to them what the issues are related to those bills that have been introduced. So as a member of that organization, you get to influence that organization's voice at the Capitol. And I think that's really important to be a part of those member organizations so that you're speaking with a little bit more volume, for lack of a better term, because there are more people involved in engage. But it does not replace the need for individual doctors to contact individual lawmakers because what happens is you form relationships. I served for 10 years and some of my physician supporters were my my phone a friend.
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Steve Brown
Our public health guru, Mr. Humble, agrees.
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Will Humble
So there's the direct involvement, which we've already been talking about for a little bit, and then there's the indirect involvement, which is joining your professional association. There's two reasons that's important. Number one is you will get newsletters and information to help inform yourself both as a practitioner, but also as somebody interested in public policy. So you'll learn like what the salient topics are, the timeliness of them, how to get involved and those sorts of things. But it also gives you a voice if you're working in an organization that doesn't allow you to do those kinds of things. And so by joining your professional association, you give yourself an indirect voice in having that policy amplifier.
- [24:33]
Steve Brown
We'll get back to what issues are the most important that are decided by state legislatures in a short while. But Mr. Humble wanted to emphasize the importance of engaging with your state health department and state Medicaid program in your state. Health and well being is likely the largest part of the state budget and physicians can have a voice there.
- [24:56]
Will Humble
Also, in most health departments and most state health departments, a core area that's really under recognized as a real leverage point for improving health outcomes and public health outcomes is the licensing part of state health department missions. But the regulatory component of every state health department is an absolute key to improving health outcomes. My first suggestion is to volunteer for one of the advisory boards and advisory committees within the agency and follow through and engage and go to all of the meetings and read the minutes beforehand, talk during the meetings and begin to form relationships with the leadership in your state Medicaid agency. You know, quite honestly, I think so much attention in terms of advocacy is focused at, at the state legislature, because that's what's in the newspaper. But when the rubber meets the road, the most like state agency directors, especially Medicaid agency directors, have huge latitude in their decision making. And if in weaseling your way into your Medicaid agency and finding a way to influence their decisions is I think the most important thing that you can
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Steve Brown
do, that's great, Mr. Humble. Thank you so much. Okay, now let's turn to the most important issue, issues that are decided at the state legislature. Let's start with Representative Butler.
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Representative Kelly Butler
One of the biggest things I think that the legislature should be doing is addressing the social determinants of health, whether it be housing, even, you know, food, housing insecurity. What does it mean to. To be trying to treat a patient who, you know, doesn't have a permanent home or doesn't have access to quality health, you know, healthy food? We obviously have a huge provider shortages. We've got nursing shortages. I think we, we better start looking at those. You know, seriously, how can we address those shortages and make sure that we get enough providers? And when we are looking to expand opportunities to, to get healthcare coverage, especially for people on Medicaid, you know, that's. It's a really important input from providers to talk about, to talk about it not just as a cost to the state, but as a return on the investment that we were making. You know, how. Why does this make people healthier? Why is it important that children are healthy and can go to school, ready to learn? And those, you know, fortunately, you know, physicians and healthcare providers are very respected in our community, and their opinions matter. And so when they are down at the legislature, you know, they're listened to. Their opinions are. Are valued.
- [27:36]
Steve Brown
Both Senator Carter and Representative Butler emphasized how many issues related to scope of practice get decided at the state level. Let's hear it from Senator Carter.
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Senator Heather Carter
One thing I really want to highlight for physicians is that some of the most contentious legislation we have at the Capitol is around scope of practice. How is your training different than maybe another, another licensed professional? And when you have those conversations, this is not something that's partisan. This is nonpartisan. Right. And if an individual lawmaker is not familiar with the medical practice, they don't know the answers. I had a lawmaker asked me this question. This is a real question. I don't understand why doctors do the prescribing. Why don't the pharmacists prescribe? Because they're the ones that have all the drugs. And it was not a question in jest. That was a legitimate question. So you can't just assume that everybody knows the world that you live in. Part of your job is to help lawmakers understand the complexity of your training and your practice.
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Steve Brown
Here's some more inspiration from Senator Carter, especially about the importance of primary care and how the state can help.
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Senator Heather Carter
When I was first elected, I asked people, you know, what are the greatest challenges we face in health care in Arizona? And year after year after year, people would say, the doctor shortage. And I would ask, okay, what do we do about it? And all roads led back to GME Graduate Medical Education. So in 2019, I put together a package to address the physician shortage, and it included things like the loan program that provides funding for people to go to medical school initially, then the loan repayment program once you've gone to school, and if you have loans to repay, you could apply to get your loan repaid. Increasing the graduate medical education opportunities with a focus on primary care and ensuring that some of those spots were in rural Arizona. Really trying to incentivize rural Arizona and primary care. And then kudos to the University of Arizona. They really stepped up with a primary care scholars program where students can now identify their specialty as primary care early on in their career and they receive free tuition. They commit to staying in training in Arizona so that they can provide that service in areas where we need. I mean, the majority of the entire state is in a shortage area for primary care, so there's lots of opportunity for them. But, you know, many times the primary care office is where you absolutely enter the entire health care sector is through that primary care door. And we need to make sure that people have access to a primary care practitioner when they need it the most. We have a primary care shortage, which means we need more people going into primary care, we need more places to train for primary care, we need more support for primary care, and we need to support those who are providing primary care so that they stay in primary care. So it's not only just recruiting, but it's retention as well and looking to build that next generation.
- [31:05]
Steve Brown
As we've heard, two important health insurance sources administered by the states are kids care and Medicaid. States decide how much to spend and who to cover. Although a lot of the money comes from the federal government to the states. Here's a story from Senator Carter about expanding coverage.
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Senator Heather Carter
We restored Kids Care in 2016, and I can still tell you, Dr. Bode, she shared this story with me at an Event after we had restored kids care, she had a six year old patient. This little girl was unable to go to kindergarten because she needed a bladder surgery. She was unable to pay for her surgery because we didn't have kids care available. As soon as we passed that legislation, it was immediately put into effect. This little girl was now covered under kids care, received the surgery and was able to start kindergarten. And we both just teared up and cried hearing that. I mean, we're talking about thousands and thousands of kids receiving coverage. And those individual stories get lost in looking at the large statistics. But when you really boil it down to that individual patient, that little girl is going to get a head start on her education because she had coverage by Kids Care and did so in a timely manner for her to start kindergarten. It's one of the most, I think, impactful and exciting stories that I had heard of as a lawmaker. And it really brings it home. That's why you do what you do. People hear all these terrible, terrible, crazy things that are happening in politics and we're all probably sick of politics, right? But you can do really good things when you focus on policy and when you focus on serving the people of Arizona. And every day you as a physician, serve your patients. And so for you to be able to focus on the policy that will help you do a better job for your patients is so rewarding. It's just, it's why I woke up every day and was excited to get to the Capitol and, you know, help solve problems.
- [33:17]
Steve Brown
Here's an update from Mr. Humble about the most important issues facing states for health in 2026.
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Henry Sanchez Ortegosa
There's two things coming up over the next year that are going to be really important, especially to rural health, but also for underserved communities. The first one I want to talk about is how is your state preparing to implement the requirements, the Medicaid work, quote, unquote, work requirements that were passed as part of HR1. This is going to apply to every single state. These work requirements are going to begin in January of 2027. So state Medicaid agencies only have about a year to get ready to implement the program. And one of the critical control points in every state is going to be how well has your Medicaid agency prepared to make it easy, as easy as possible for Medicaid members to report their compliance with the work requirements or community engagement or school requirements. And you know, in some states, I think they have already invested money that they need to buy the IT infrastructure to get the talent on board. Sometimes hiring Contractors to get ready to build the platforms so that Medicaid members can report, you know, that they're in school, that they're meeting the work requirements by volunteering in the community, by, you know, working out in the community or at a job. So if a state Medicaid agency doesn't do a good job with that, it's going to have a profound impact on Medicaid enrollment in that state. So my call to action for all of you is to work with your in any capacity you can, either through relationships that you have with your Medicaid agency, or in some cases, there's a Medicaid advisory committee that meets quarterly like we have here in Arizona. But get engaged, begin asking those questions and prompt your local journalists in your state to run stories about how is our Medicaid agency preparing. The second is also applies to every single state, and that is when HR1 was passed. Congress also authorized a Rural Health Transformation Grant program over the next five years that's focused on rural America. I think they know that the work requirements and other changes that they made to Medicaid as part of HR1 or have the potential to really decimate rural healthcare in any state. Doesn't matter what kind of blue or red state you're talking about. And so they put together this Rural Health Transformation Fund. And each of your states were required to put in a plan for how they want to use that Rural Health Transformation Program money over the next two years. In some cases that's being run by their state Medicaid agencies. In some states, it's going to be run out of the state health department. Others will be collaborating with the universities or Centers for Rural Health in their state. In Arizona, it's being run basically out of the governor's office office. And so the call to action for clinicians in this manner is really to start asking questions. First of all, read the plan that your state submitted. Those were due at towards the end of 2025. But what you can do in your state is hold whoever's implementing this plan, hold them accountable to make sure that you're getting results, that there's accountability, that you're able to view quarterly reports on the progress that's being made in these Rural Transformation grants. And I was in Arizona, pleased to see that our governor included a piece around residencies, for example, so making it so that there's more rural rotation residencies in Arizona. I'm hoping and crossing my fingers that in Arizona, their plan means that they'll be working towards, you know, a plan that focuses on primary care. So anyway, those I just wanted to drop in Dr. Brown for a couple of those things that really apply to pretty much any state in the country and really to provide a mechanism so that, you know, clinicians have an opportunity to engage and do the kind of advocacy at the state level to just help at the margins. Especially when you consider, you know, the implications that would occur for a state that did poor planning either intentionally or unintentionally, and the result that that would have in terms of Medicaid enrollment and in particular the impact it would have on families.
- [38:20]
Steve Brown
Thank you so much, Mr. Humble, for a 2026 update. Ms. Butler is no longer in the Arizona State Legislature. She's now serving on the Maricopa County Community College Board. I'll just real quick share my conversation with Representative Butler about my own journey in advocacy. I found my way to it very mid career and honestly I've been inspired by the hard working lawmakers like Representative Butler doing what is right for our patients and communities.
- [38:52]
Will Humble
Yes.
- [38:53]
Steve Brown
And Representative Butler and I know each other pretty well because I came to your office before the midterms in 2018 and just wanted to get involved and have since learned that I can make a big difference with my state legislator, especially when it comes to health topics.
- [39:10]
Representative Kelly Butler
And you totally have made a huge difference. And there have been funny, well, not funny, but committee hearings where you and I are texting each other and I'm texting you questions while I'm in a committee hearing asking did you just hear this? Is this correct? So it has been really a huge lifeline to have you on, you know, as a, as a friend and a colleague that I can really count on to delve into some of the stuff.
- [39:34]
Steve Brown
That's very kind of you. We also share our frustration sometimes in committee hearings over text. So it works both ways down at the state capitol.
- [39:43]
Representative Kelly Butler
There's a lot going on down there.
- [39:46]
Steve Brown
Okay, I'll summarize here some of the most important issues regarding family medicine and health that are decided at the the state legislature, some of which we talked about here and some of which we didn't. Maybe some of these areas you're really passionate about and would like to get involved. So here's a partial list. Health coverage through kids care and Medicaid, especially for the most vulnerable. Drug pricing and transparency, telehealth, Medicaid payment parity, primary care spend, medical liability, tobacco, maternal health and mortality, safe driving, women's health, reproductive rights, scope of practice, graduate medical education and student loan repayment programs. In a second we'll end with 10 things you can do right now to advocate for family medicine, your patients, and your community. But first, here's a final thought from Will Humble, our public health leader and former administrator of the Arizona Department of Health Services.
- [40:45]
Will Humble
When I think about the healthcare community, I always think of family physicians and pediatricians as the core of public health. Like, you know, it's so often you see a surgeon on television or, you know, a practitioner who. Proceduralist, I'll call them. Right? And the proceduralists get all of the attention and they get the money, too. But it's the family physicians and the pediatricians and the primary care docs. They're at community health centers that are really carrying the public health load. And so we need their voices front and center because they are the core of public health in the healthcare community. It's not the proceduralists, it's not the surgeons, it's not the specialists. It's the family physicians, the pediatricians, and those people slogging it out in the community health centers that are the key.
- [41:38]
Steve Brown
And here's some closing words from Senator Carter.
- [41:42]
Senator Heather Carter
I just want to say thank you to the physicians for providing such incredible service. We need to value your service. Working with physicians kept me motivated through some of the most challenging times I had as a lawmaker because I knew that even no matter who was yelling and screaming at me, I was doing good work in health care. And especially my primary care physicians would reach out and say thank you.
- [42:10]
Steve Brown
Okay, let's close out with 10 things you can do right now to get involved in advocacy beyond the walls of your office. Number one, sign up for the AAFP Advocacy Network and fight for family medicine. Check out the AAFP activism accounts on social media. Number two, register for the AAFP Advocacy Summit in Washington, D.C. be inspired by the leaders in the world of primary care advocacy. And g go visit your elected representatives. Number three, check out the nonpartisan vote ER.org that's V.org and help your patients register to vote. Vote yourself and be informed about issues and candidates up and down the ballot. Number four, find out who represents you at the state legislature and follow them on social media. Go to a town hall, get to know them if you like what they say. Support them by volunteering and donating. Maybe even host a candidate meet and greet at your house. Reach out to your state academy or local AMA branch. Volunteer on their state advocacy committee. Find out what issues are coming up in your state. Six, speak out when issues arise in the legislature. Speak at a committee hearing or carry a sign in front of the Capitol. Call, text or email your legislator, especially if they're on the health committee in your state. Number seven, Write a letter to the editor. Advocate for health topics on social media. Number eight like Mr. Humble told us, volunteer for an advisory committee at your state health department or state Medicaid department. Number nine, get involved with a local group that is advocating for issues that are most important important to you, for example, like a social justice organization or women's healthcare advocacy group. And finally, number 10, gather stories from your patient and your community and share them with people operating the levers of power. Bring a learner along with you in your advocacy efforts. Okay, that's it. Thanks for listening. Thank you to Dr. Sarah Nosel, will Humble, Representative Kelly Butler and Senator Heather Carter. Please like and subscribe wherever you get your podcasts. I'm Steve Brown. Our technical guru is Tyler Coles. Our theme song is written and recorded by family physicians Bill Dabs, Ryan Evans and Justin Jenkins. This podcast is brought to you by the residents and faculty of the University of Arizona College of Medicine, Phoenix Family Medicine Residency. We'll see you soon for the next edition of the American Family Physician Podcast.