Court Hearing Approaches in TMA Surprise Billing Lawsuit

By Amy Lynn Sorrel

Published by the Texas Medical Association  on January 28, 2022. Read the original article here.

With a Feb. 4 court hearing on the horizon, the Texas Medical Association recently reiterated its strong opposition to a part of a federal rule that medicine says unfairly favors health insurers when directing arbiters to resolve payment disputes between insurers and physicians under the federal surprise billing law. 

TMA sued federal agencies to challenge a component of the No Surprises Act rule, under which arbiters conducting the payment dispute resolutions are required to default to the “qualifying payment amount” (QPA) as the appropriate out-of-network rate. TMA says the QPA is supposed to be the median in-network rate under the law but is deflated based upon the federal agencies’ methodology. The association’s lawsuit asks the court to strike this so-called “rebuttable presumption” provision of the rule in order to align it with the law, which directs arbiters to consider a range of relevant factors. 

TMA has asked the U.S. District Court in Tyler to decide its lawsuit as soon as possible without going to trial. The hearing on that motion for summary judgment is set for this Friday, Feb. 4.   

As federal agencies weigh in on the case in defense of their rule, a court brief filed by TMA on Jan. 24 reasserts that the regulation fails to implement the No Surprises Act the way Congress wrote it, and the consequences for patients include reduced access to care and health care consolidation. 

Congress spent years working on the No Surprises Act so it would not limit patients’ access to medical services, while protecting them from surprise medical bills, says TMA President E. Linda Villarreal, MD. 

“The last thing federal regulators should do is make health care more expensive and less accessible for people when they need it, especially during a pandemic,” she said. “The courts must reject the federal agencies’ flawed approach, because it goes against the public interest and our democratic process.” 

Dozens of national and state organizations share similar concerns and have supported TMA’s legal efforts or filed their own challenges to the rule. 

TMA’s filing also rejects the federal agencies’ claims that TMA does not have standing to pursue its case. 

TMA’s lawsuit does not delay or seek to change the No Surprises Act’s patient protections from surprise medical bills, which went into effect Jan. 1.

Tarrant County COVID-19 Activity – 01/28/22


COVID-19 Positive cases: 517,202

COVID-19 related deaths: 5247

Recovered COVID-19 cases: 401,816

Data from Tarrant County Public Heath’s (TCPH) report of COVID-19 activity in Tarrant County updated Friday, January 28, 2o22. Find more COVID-19 information from TCPH here.

*These data are provisional and are subject to change at any time.

Deaths and recovered cases are included in total COVID-19 positive cases.

TMA Chart Compares COVID Outpatient Therapeutics – View Here

The chart includes dosages, situational considerations (such as whether the patient can continue on the drug if hospitalized during the therapy), contraindications, and more. Also included are links to fact sheets and locators for the treatments.

You can download the chart, and find much more information, on TMA’s COVID-19 Resource Center.

Help State Fight Antimicrobial Resistance: Apply to Regional Committees

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Physicians all over Texas can apply for the chance to help stop the spread of multidrug-resistant organisms as part of an Antimicrobial Stewardship Regional Advisory Committee (ASRAC) for one of Texas’ public health regions.

The Texas Department of State Health Services (DSHS) is now accepting applications for new members of the regional advisory committees, established by the passage of a Texas Medical Association-supported law in 2019, House Bill 1848 by Rep. Stephanie Klick (R-Fort Worth). The committees will attempt “to address antimicrobial stewardship in long-term care facilities and to improve antimicrobial stewardship through collaborative action.”

TMA considers the establishment of the committees a valuable opportunity for members with relevant expertise to take a leadership role on the topic in their communities.

Each committee will consist of physicians, directors of nursing or an “equivalent consultant with long-term care facilities,” public health officials knowledgeable about antibiotic stewardship, and “other interested parties.” Members must attend regular committee meetings (virtual or in-person), which will be held at least once every 12 months, as well as subcommittee activities, if required. Members also may need to travel to designated locations within the public health region for those meetings and activities.

The deadline for applying is Feb. 15 at 5 pm CT. Applicants will need to list contact information of a reference who can speak to your interest in and/or involvement with collaborative action designed to improve antimicrobial stewardship. Submission of a letter of recommendation also is required.

For more information, visit the DSHS Antimicrobial Stewardship page or email the agency.

Travel expenses arising from attending ASRAC meetings or other activities will not be reimbursed.

How Not to Use Rapid COVID Tests

By Julie Appleby and Phil Galewitz

Published by KHN on January 13, 2022. Read the original version here.

Julie Ann Justo, an infectious disease clinical pharmacist for a South Carolina hospital system, hoped Christmas week would finally be the time her family could safely gather for a reunion.

Before the celebration, family members who were eligible were vaccinated and boosted. They quarantined and used masks in the days leading up to the event. And many took solace in negative results from rapid covid-19 tests taken a few days before the 35-person indoor gathering in South Florida to make sure no one was infectious.

But within a week, Justo and at least 13 members of her extended family tested positive for covid, with many feeling typical symptoms of an upper respiratory virus, such as a sore throat and a runny nose.

Like many other Americans, Justo’s family learned the hard way that a single negative result from an at-home rapid test, which takes about 15 minutes, is no guarantee that a person is not ill or carrying the virus.

There are just so many variables. Testing may come either too soon, before enough virus is present to detect, or too late, after a person has already spread the virus to others.

And most rapid tests, even according to their instructions, are meant to be used in pairs — generally a day or two apart — for increased accuracy. Despite that, a few brands are sold one to a box and, with the tests sometimes expensive and in short supply, families are often relying on a single screening.

While home antigen testing remains a useful — and underutilized — tool to curb the pandemic, experts say, it is often misused and may provide false confidence.

Some people mistakenly look at the home tests “like a get-out-of-jail-free card,” said Dr. William Schaffner, a specialist in infectious diseases at the Vanderbilt University School of Medicine in Nashville, Tennessee. “‘I’m negative, so I don’t have to worry anymore.’”

That is even more true now that the new more transmissible variant dominates the country.

“Omicron is so transmissible that it is challenging to use any kind of testing strategy in terms of get-togethers and be successful,” said Dr. Patrick Mathias, vice chair of clinical operations for the Department of Laboratory Medicine & Pathology at the University of Washington School of Medicine.

Rapid tests are pretty good at correctly detecting infection in people with symptoms, Mathias said, with a 70% to nearly 90% range of accuracy estimated in several studies. Other studies, some that predate current variants or were performed under more controlled settings, have shown higher rates, but, even then, the tests can still miss some infected people. That raises the risk of spread, with the chance rising dramatically as the number of people attending an event grows.

Results of antigen tests are less accurate for people without symptoms.

For the asymptomatic, the rapid tests, “on average, [correctly] detect infection roughly 50% of the time,” said Shama Cash-Goldwasser, an adviser for Prevent Epidemics at Resolve to Save Lives, a nonprofit group run by Dr. Tom Frieden, a former director of the Centers for Disease Control and Prevention.

Looking back, Justo said her family took precautions, but she acknowledges missteps that put them at increased risk: Not all family members were tested before getting together because of a shortage of test kits. Some members of her family who could find rapid tests tested just once because of the need to ration tests. And in attendance were several children under age 5 who are not yet eligible for a covid vaccine. They were later among the first to show symptoms.

“We probably were relying too heavily on negative rapid tests in order to gather indoors with others without other layers of protections,” she said.

Even if everyone tested properly before the party, health experts said, it wouldn’t mean all attendees are “safe” from getting covid. Testing merely reduces the risk of exposure; it doesn’t eliminate it.

Other factors in assessing risk at a gathering: Is everyone vaccinated and boosted, which can help reduce the likelihood of infection? Did attendees properly follow all the steps outlined in the test kits’ instructions, which can differ by brand? Did anyone test too early after exposure or, conversely, not close enough to the event?

One critical detail “is the timing of the test,” said Schaffner at Vanderbilt. Another, he said, is how well the tests can spot true positives and true negatives.

Test too early, such as within a day or two of exposure, and results won’t be accurate. Similarly, testing several days before an event won’t tell you much about who might be infectious on the day of the gathering.

Schaffner and others recommend that self-testing start three days after a known exposure or, if one feels ill, a few days after the onset of symptoms. Because the timeline for detecting an infection is uncertain, it’s always a good idea to use both tests in the kit, as instructed — the second one 24 to 36 hours after the first. For an event, make sure one of the tests is performed on the day of the gathering.

Antigen tests work by looking for proteins from the surface of the virus, which must be present in adequate amounts for a test to spot. (Lab-based PCR tests, or polymerase chain reaction tests, are more accurate because they can detect smaller amounts of the virus, but they take longer to get results, possibly even days, depending on the backlog at the labs.)

Covid markers may linger as remnants long after live virus is gone, so some scientists question the use of tests — whether antigen or PCR — as a metric for when patients can end their isolation, particularly if they are looking to shorten the recommended period. The CDC recommends five days of isolation, which can end if their symptoms are gone or resolving, with no fever.

Some patients will test positive 10 days or more after their first symptoms, although it is unlikely they remain infectious by then.

Still, that means many people are using the rapid tests inappropriately — not only over-relying on them as a safeguard against covid, but also as a gauge for when an infection is over.

Rapid home tests need to be used over multiple days to increase the chance of an accurate result.

“Each individual test does not have much value as serial testing,” said Dr. Zishan Siddiqui, chief medical officer at the Baltimore Convention Center Field Hospital and an assistant professor of medicine at Johns Hopkins University. And, because the tests are less reliable in those without symptoms, he said, asymptomatic people should not be relying on a single rapid test to gather with friends or family without taking other mitigation measures.

Worse still, a recent study looking at the omicron variant found that rapid tests could not detect the virus in the first two days of infection, even though lab-based PCR tests did find evidence of covid.

The study examined 30 vaccinated adults in December 2021. “Most omicron cases were infectious for several days before being detectable by rapid antigen tests,” according to the study, which has not been peer-reviewed.

False negatives are also more likely when the extent of the disease in a certain area, called community spread, is rampant, which is true for most of the United States today.

“If there’s a lot of community spread, that increases the likelihood that you have covid” at a gathering, explained Cash-Goldwasser, since one or more attendees who tested negative may have received a false result. Positivity rates are running over 25% now in some U.S. cities, indicating a lot of virus is circulating.

So, right now, “if you get a negative result, it’s important to be more suspicious,” she said.

Vaccinations, boosters, masking, physical distancing, ventilation and testing separately are all imperfect strategies to prevent infection. But layered together, they can serve as a more effective barrier, Schaffner said.

“The rapid test is useful” — his own family used them before gathering for Thanksgiving and Christmas — “but it’s a barrier with holes in it,” he added.

The virus moved through those gaps to crash the party and infect the Justo family. While most of the attendees largely had mild symptoms, Justo said she was short of breath, fatigued and experienced headaches, muscle pain and nausea. It took about 10 days before she felt better.

“I certainly spent a lot of time going back to what we could have done differently,” Justo said. “Thankfully no one needed to go to the hospital, and I attribute that to the vaccinations — and for that I am grateful.”

HHS Distributing $2 Billion to Physicians and Other Health Care Providers Impacted by COVID-19

The U.S. Department of Health and Human Services (HHS), through the Health Resources and Services Administration (HRSA), is making more than $2 billion in Provider Relief Fund (PRF) Phase 4 General Distribution payments to more than 7,600 physicians and other healthcare providers across the country this week. You can find more information here.

“The COVID-19 pandemic is an unprecedented challenge for health care providers and the communities they serve,” noted HRSA Administrator Carole Johnson. “The Provider Relief Fund remains an important tool in helping to sustain the critical health care services communities need and support the health care workforce that is delivering on the frontlines every day.”

Phase 4 payments have an increased focus on equity, including reimbursing a higher percentage of losses for smaller clinics. HHS is also incorporating “bonus” payments for those who serve Medicaid, Children’s Health Insurance Program (CHIP), and Medicare beneficiaries. Approximately 82 percent of all Phase 4 applications have now been processed.

View a state-by-state breakdown of all Phase 4 payments disbursed to date.

View a state-by-state breakdown of all ARP Rural payments disbursed to date.

As individual providers agree to the terms and conditions of Phase 4 payments, it will be reflected on the public dataset.

Tarrant County COVID-19 Activity – 01/25/22

COVID-19 Positive cases: 498,340

COVID-19 related deaths: 5174

Recovered COVID-19 cases: 386,979

Data from Tarrant County Public Heath’s (TCPH) report of COVID-19 activity in Tarrant County updated Tuesday, January 25, 2o22. Find more COVID-19 information from TCPH here.

*These data are provisional and are subject to change at any time.

Deaths and recovered cases are included in total COVID-19 positive cases.

PAC-ing a Punch for Medicine: Involvement in TEXPAC Lays Foundation for Legislative Victories

By Joey Berlin

Published by the Texas Medical Association  for the January 2022 issue of Texas Medicine. Read the original article here.

Well before he became an internist in Temple, Jimmy Widmer, MD, witnessed firsthand the significance of political activism as a high school student in 2003 when medicine-friendly lawmakers in the Texas Legislature passed House Bill 4 – the sweeping medical liability reforms that stopped the frivolous lawsuits, obscene liability premiums, and a physician exodus that were destroying the practice of medicine in the state. 

He has relatives in medicine, so Dr. Widmer’s parents knew what sham lawsuits and their ripple effects were doing to the state’s physician community, and they did their part to help. 

“We were the only house on the street with a ‘4’ sign,” Dr. Widmer recalled. “I remember that to this day.” 

Now that he’s at the helm of TEXPAC, the Texas Medical Association’s political arm, Dr. Widmer urges his TMA colleagues to join the effort to unify medicine’s voice in politics. 

TEXPAC leaders say victories like HB 4 happen because of grassroots, physician-driven efforts to elect friends of medicine to office. The same goes for more recent major victories like the new law that allows physicians to earn exemptions from insurers’ prior authorization requirements, or the overwhelmingly successful stands against nonphysicians’ attempts to practice medicine. 

TEXPAC helps generate those victories with a dogged, systematic evaluation of candidates who have the profession’s best interests at heart, endorsing and funding the ones who demonstrate their medical mettle. It’s the Party of Medicine, not of Democrats or Republicans; a candidate’s stances on TMA’s top issues, and the impressions of TEXPAC physicians in a candidate’s district, are what carry the most sway. 

Even in what he describes as a caustic modern political landscape, Dr. Widmer says staying on the sidelines isn’t an option, with medicine under attack from every direction. 

“No longer can we afford as physicians to have the mentality that, ‘I’m just gonna go to my office, practice, and [then] go home.’ There’s too much at stake,” he said. “There are too many people trying to do what we have gone to school and trained years to do. We have to stand up for that, and we have to get active and get involved.” 

Members’ role 

The annual financial contribution required of a TEXPAC member – while an important piece of the puzzle – is just one aspect of what the organization needs from its participants, says TEXPAC Executive Director Christine Mojezati. 

Physicians who join TEXPAC have the flexibility to make their membership as involved as they want or are able. That can just mean paying your dues, but TEXPAC asks its doctors to do more to fully help medicine’s cause. Some of the most important activities a TEXPAC member can engage in are: 

• Participating in your county medical society, including taking part in its legislative committee and/or candidate evaluation process. 

• Getting to know the legislators in your district or area, such as by visiting them in their local office, calling them for a conversation, or taking them to coffee or lunch. Doing so gives physicians a chance to relate stories about their practice and how certain policies are affecting their day-to-day life and their patients. 

• Responding to TMA Action Alerts, which mobilize members to contact lawmakers on particular issues or legislation of urgent importance. 

“Financial contributions not only gain us access but also give us a seat at the table,” Ms. Mojezati said. “But there’s nothing like the personal stories of a physician about how they cared for their patient, or why a certain bill or law would affect how they would care for their patient.” 

An entry point to getting acquainted with your local elected officials is participating in TMA’s monthly First Tuesdays at the Capitol lobbying events during regular sessions of the Texas Legislature, says Fort Worth allergist-immunologist Robert Rogers, MD, a past chair of TEXPAC. First Tuesdays – which went virtual in 2021 because of the COVID-19 pandemic – allows physicians face time with legislators, an avenue for cultivating the relationships that lead to receptive ears. 

“It is really meaningful for our elected representatives and senators to actually know us – to be able to recognize you by name when they see you in the Capitol or in their local office,” Dr. Rogers said. “That doesn’t mean we always get everything we want. But it’s much easier to have a discussion about issues with the people that you’ve already developed a relationship with.” 

Those conversations – and other vital TEXPAC activities – aren’t merely confined to the four-plus months when the legislature meets every odd-numbered year. In fact, much of the work comes during the interim period between sessions, when TEXPAC makes itself available as a resource both to legislators and to candidates running in even-numbered years. The interim, Ms. Mojezati explains, is when legislation is written, refined, and prefiled, and when there’s time for stakeholder meetings. 

“TEXPAC provides all the background information that any of us would need to be able to go in and discuss issues that are important” in conversations with lawmakers, Dr. Rogers added. “It’s really helpful to do that during the interim, because [lawmakers] have a lot more time to meet with us and discuss things.” 

Finding medicine’s friends 

If one impediment to joining TEXPAC is believing that your voice won’t be heard in an organization of thousands of members, think again.  

In evaluating candidates for an endorsement, TEXPAC’s focus is highly localized, says Sara Austin, MD, an Austin neurologist and chair of TEXPAC’s Candidate Evaluation Committee. That means when you provide input on whom medicine should support in your district, you and your community colleagues won’t be drowned out by thousands of others hundreds of miles away. 

For incumbents running to keep their seat, eligibility for TEXPAC endorsement comes down to meeting two criteria: an objective analysis of their voting record and a subjective score based on the candidates’ meetings and interactions with local physicians, both TEXPAC members and nonmember physicians. (See “TEXPAC’s Endorsement Process,” this page.) 

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TEXPAC evaluates candidates on a point system based on how they voted on key bills most important to medicine’s agenda: Voting with medicine on a particular bill is worth one point; not doing so is worth zero. Candidates lose points if they filed or signed onto an antimedicine measure, such as a bill that would dangerously expand other practitioners’ scope of practice or seeking to raise the medical liability damages cap. An 80% score on that point system allows for a possible endorsement. 

The subjective portion consists of physicians – with the help of detailed TEXPAC candidate briefing documents – interacting with candidates and grading them on a scale of one to five, the higher the better. Averaging a score of three is required for consideration for an endorsement. 

The “80 and three” rule is a weed-out process for incumbents. Candidates who pass both of those tests and earn local physicians’ recommendation for an endorsement must then pass muster with the Candidate Evaluation Committee, which sends its recommendations to the full TEXPAC board for approval. 

For new candidates with no voting record to evaluate, the interviews and interactions with local physicians and county medical societies largely determine which aspiring officeholders make it to the Candidate Evaluation Committee. Incumbents also need to prove they’re willing to sit down and listen to their district’s doctors. 

“There are some incumbents who never vote with the House of Medicine, so we definitely don’t endorse those people,” Dr. Austin said. “[We also] try to find out from the local physicians if that [legislator] was available or accessible [to meet]. That’s important.” 

For state Sen. Charles Schwertner, MD (R-Georgetown), TEXPAC was “instrumental in helping me understand the lay of the land” when he first ran for a House of Representatives seat in 2010 as a “very green” candidate. TEXPAC also was instrumental in helping him obtain early financing and in fundraising efforts. He launched his run with local support from the Williamson County Medical Society. 

“That’s what TEXPAC is all about: making sure that the individuals that are friends of medicine have the amount of resources necessary to get their campaign message out, and then hopefully win election and be able to serve,” Senator Schwertner said. 

TEXPAC endorsements also involve a degree of pragmatism, Dr. Rogers adds. In addition to a candidate’s promedicine stance, the Party of Medicine considers his or her likelihood to win.  

“We have a couple of major objectives in the candidate process. One is to try to help elect people that are naturally inclined to support what we do, if there’s a competitive race,” he said. “We also know that there are a lot of races that are not competitive at all, and who’s going to get elected is very clear. And we need to have influence with people that are actually going to be in the building making decisions. That means that we might endorse the candidate that isn’t apparently very helpful to TMA, but that really could be helpful on a specific issue.” 

Sometimes, Dr. Rogers added, one helpful vote on one specific bill “can happen from somebody that isn’t a natural friend.” 

If you’re a TEXPAC member whose candidate did not earn endorsement, the organization’s Physicians For program offers another way to support your preferred candidate by connecting TEXPAC doctors with other physicians in their House or Senate district to rally around their preferred candidate. 

The program “has proven to be very successful,” said Ms. Mojezati, TEXPAC’s executive director. “Not only has it helped candidates be victorious in races but it also helps because [in] any situation where TEXPAC either did not endorse them or didn’t make any endorsement, we now have physician relationships with that candidate. We never want to not have friends in the Capitol.” 

TEXPAC has maintained success rates of 95% or greater with its endorsements during recent election cycles. For instance, during the 2020 state primary elections and a handful of ensuing runoffs – which usually involve most of Texas’ most competitive races – TEXPAC made more than 130 endorsements, and 98% of those candidates won and moved on to the general election. In the November 2020 general election, 97% of TEXPAC-endorsed candidates won their sought office.

Overcoming apathy 

TEXPAC acknowledges physicians’ reluctance to get involved in politics: “It’s a highly charged arena right now,” notes Dr. Widmer, TEXPAC’s chair.  

And there’s a level of apathy, Dr. Rogers adds; physicians just want to do their jobs. 

But much progress has happened on TEXPAC’s watch, from tort reform in 2003 to the 2021 legislation allowing physicians to earn a “gold card” out of the prior authorization process.  

Back during the days of tort reform, long before jumping into politics, Senator Schwertner was a young physician taking part in the first-ever First Tuesdays in 2003. HB 4’s success that year was the product of a unified approach between physicians and business interests, and that unity and having “as many allies to the House of Medicine” as possible are key to legislative success, he said.  

More recently, he noted, TEXPAC has been vital in bolstering TMA’s fight against scope-of-practice bills and “the onerous profitmaking and tactics of insurance companies,” such as narrow networks. 

“Medicine is a highly regulated, government-controlled, and actually government-funded profession. As such, it is vital to those individuals from just a … professional standpoint to be involved,” Senator Schwertner said. “If you’re not being an active participant, and voting and helping choose candidates … that share your ideals, then someone else is doing it for you. And you’re going to live under the laws that those other individuals pass.” 

Casting aside the repulsion of modern red-versus-blue politics – and doing what’s best for patients and the practice of medicine – is important to medicine’s success, Dr. Widmer adds. 

“If we keep that as the focus of what we’re doing with TEXPAC, then we will be stronger for it. We will have a more cohesive, hopefully larger body, and we’ll be able to make a bigger impact.” 

Navigating Blindly

Kristian Falcon, OMS-III

This article was originally published in the November/December issue of the Tarrant County Physician. You can read find the full magazine here.

“Si se puede!” (Yes, you can). . .

. . . is what I have been told throughout my life by my parents and by my entire familia. Being the first ever in my family to go into the medical field is a commonality that many Hispanic students share. My father emigrated from Mexico at the age of 18 and had to delay attending university to first learn English. My mother immigrated here at the age of 26, after already holding a teaching license and an equivalent master’s degree in Mexico. She had to redo her education after first learning English to regain her teaching license in the U.S. 

Learning English at the same time as my mother was no easy feat. She taught me my vowels and how to read while we taught her proper syntax and English grammar. When it came time to apply to college, how was I supposed to ask my parents to revise my application essays since when growing up, I was the one who edited and revised their emails and text messages?

When I began college, my father asked me, “What are you going to do with a degree in biology?” to which I responded, “Be a scientist.” He wasn’t asking because he didn’t believe in me; he was asking because he truly didn’t know what I could do with such a degree, and to be 100 percent honest, I didn’t either. Becoming a doctor was not a thought I had before; I fell into this path through getting involved with my passion to serve others and my interest in science. Once I realized that I pictured my future self as being a physician, my family grew concerned about the difficult path I would face. They suggested alternative careers, knowing that no one from our family had ever gone down this path before and that many who try, fail. 

Maybe I was naïve and didn’t do the proper research on what a career as a physician entailed, but without any guidance, I faced only my short-term goals, one at a time. What I didn’t realize was that becoming a doctor involved much more than just meeting specific checkboxes. It required immense dedication, time, and sacrifice. 

At times, I questioned if I even belonged in medical school. During my application process I was told, “You only interviewed there because you’re Hispanic and speak Spanish,” or “You’re lucky you’re underrepresented in medicine; you’ll get accepted anywhere.” I was continually discredited of my merits and accomplishments because of my ethnicity, even though I had years of volunteering, research, and experiences in the medical field as an EMT, and had not only a bachelor’s but also a master’s degree. Upon entering medical school there were less than 20 Hispanic medical students in my class of 220. Hispanic students make up only 15 percent of the student population of all the health professional colleges combined in the health science center I attend, while in Texas, the Hispanic population comprises roughly 40 percent of the state’s population. 

Lacking representation and not having mentors who had faced similar paths, I struggled to fit in and find my place. While many of my colleagues had family and friends that were doctors, I grew up not knowing a single person in this field besides my own doctor. I faced obstacles because I had to find resources on my own to help me accomplish my goals. Every medical experience, preceptorship, or shadowing opportunity was one I went out and found on my own; I didn’t have the luxury of growing up with those opportunities around me. I carved my own path.  

Within the first month of my third year, I was reminded of the importance of having Hispanic representation in the medical field. I attended to many patients who were Hispanic and spoke only Spanish. While medical translators are vital and do an amazing job of communicating adequately with a patient when there is a language barrier, being able to communicate directly and relate to a patient forms a bond unlike another. Conversations with a translator can sometimes be procedural and very formal; being able to communicate freely in one’s own language allows for a more human interaction and a better understanding between a provider and a patient. 

It is the moment when I see a patient become more animated and more comfortable that I remember why I chose this career and that I bring more representation to this field. I remember why I chose to be the first in my family to carve this path, and why I choose to be involved in leadership and advocacy so that many others like me can take this path a little less blindly. While I still have over a year left until I graduate and become a physician, my message to those who seek this path is, “Si se puede!”

Join TMA’s Virtual Winter Conference on Jan. 28 & 29

Register to participate in the 2022 TMA Winter Conference with your physician colleagues on January 28 and 29. The conference has transitioned to a fully virtual event due to the surge of COVID-19 cases.

Virtual Conference Schedule


Friday, Jan. 28

TMA virtual business meetings take place throughout the day; you can find the complete schedule here. There are no in-person events scheduled.

  • On-demand, inside the virtual platform:
    • TMA Foundation Grants and Donor Recognition – videos
    • Vaccines Defend What Matters – public health initiative
    • Turn It Off Today – public health initiative
  • Expo Hall Hours – 11am – 2pm
    Virtual exhibits and one-on-one appointments with exhibitors are available.
    • 11am – Noon – “Hidden Icon Search” game; winner will recieve a 1-year subscription to the Headspace App.



Saturday, Jan. 29

TMA virtual business meetings continue; you can find the complete schedule here. CME sessions are available via livestream.

  • Live stream, inside the virtual platform: 
    • 9-9:10 am – Opening Remarks
      E. Linda Villarreal, MD, President, TMA
    • 9:10-9:30 am – AMA Awards Recognition
    • 9:30-10:15 am – COVID-19 Update with DSHS (CME)
    • 10:15-11 am – Ask the Expert: Employee Vaccinations (CME)
      Sheri Williams, TMA and Laura Goodson, JD
    • 11 am-Noon – Extra Life: A Short History of Living Longer
  • Expo Hall Hours – 8am – 1pm
    Virtual exhibits and one-on-one appointments with exhibitors are available.
    • 8am – 1pm – “Word Scramble” game; prizes will be awarded to winners.
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