In 1997, I, along with 200 other young ophthalmologists formed the National Board of Ophthalmology to protest the American Board of Ophthalmology's decision to grandfather in the older ophthalmologists and not require them to recertify.

In 2000 these legislators considered a hotel room tax hike (favored by Governor Paul Patton for helping expand the Dr. Paul's ophthalmology board is not officially recognized by the American Board of Medical Specialties (ABMS). In October Paul blocked a bill that would provide $36 million in benefits for elderly and disabled refugees saying that he was concerned that it could be used to aid domestic terrorists.

A member of the Tea Party movement he describes himself as a "constitutional conservative" and a libertarian. In 2010 Paul ran as the Republican candidate for the United States Senate seat being vacated by retiring Senator Jim Bunning of Kentucky beating Kentucky Secretary of State Trey Grayson in the primary. As a supporter of the Tea Party movement he has been vocal in advocating for term limits a balanced budget amendment and the Read the Bills Act in addition to the widespread reduction of federal spending and taxation.