Shortly after receiving his master's degree, Gaetz worked in Jacksonville as a hospital administrator, and lobbied the legislature to create hospice care programs for the dying.

[4] During his first term, Gaetz campaigned for a one-cent sales tax to fund school construction and renovation, which was easily approved by the county's voters in a 1995 special election.

He defeated Morgan handily, winning 68% of the vote and advancing to the general election, where he was opposed by William Lynch, the Democratic nominee, and John Hughes, an independent candidate.

Gaetz campaigned on his grassroots efforts to introduce himself to potentially new constituents in the district and attacked his opponent for his "misunderstanding of the legislative process.

[15] He was appointed by the Senate to the Constitution Revision Commission and by the House of Representatives as a member and current chairman of Triumph Gulf Coast, a $1.5 billion economic development and recovery fund for coastal Northwest Florida.

[16] In October 2023, Gaetz announced that he would run again in his old seat in the 2024 Florida Senate election to succeed term-limited Republican incumbent Doug Broxson.

On August 22, 2022, U.S. district judge Casey Rodgers sentenced Alford (aged 62) to 63 months plus three years supervised release after he pleaded guilty in 2021 to one count of wire fraud.

[19] In 2013, the U.S. Department of Justice filed a lawsuit against VITAS for allegedly committing Medicare fraud since 2002, when Gaetz still worked at the company.