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Student Article: Continuing the Passion for Science in Medicine

This article was originally published in the January/February 2023 issue of the Tarrant County Physician.

OFTEN ONE OF THE FIRST QUESTIONS I AM ASKED WHEN I mention that I am in medical school is, “How did you know you wanted to become a doctor?” Sometimes I scramble to find the most inspirational and motivating answer, as there were many reasons why I chose the career path that I did, However, at the core of every underlying reason was first, my love for science, and second, the desire to put that love into good use. Throughout my undergraduate years, I made sure to put scientific research at the forefront of my priorities. I took additional classes to help develop my skills as a researcher and participated in local symposiums whenever I could. Going into medical school, I kept research and the scientific process in mind as I learned about each body system. Given my medical education, I could delve further into the pathologies and the application of their respective treatments, and, if there were any developing treatments, I could keep an open mind about them and seek an opportunity to participate in the field research (if my busy school schedule let me). Thankfully, this past summer, my school presented the perfect chance to participate in the Pediatric Research Program (PRP) with Cook Children’s Hospital.

The PRP selects a group of second year medical students to take part in research “that aligns with their specialty interest.” There are also additional benefits such as being provided a mentor who guides you along the way and opportunities to present work at local/regional/national conferences. I chose neurology as y number one field of interest, so I was assigned a case study with a pediatric neurologist as my research mentor. I was excited and eager at the prospect of beginning work, especially since I had been assigned to Cook Children’s. The idea of being in an environment that was dedicated to helping children with challenging diseases brought a sense of fulfillment to my foundational goal of helping people heal.

Writing a case study was a novel experience, but I was fortunate to have a dedicated mentor who aided me through the process and helped me understand clinical information that my then year-one-medical-student mind could not comprehend. My mentor further allowed me to shadow her periodically throughout the summer, which was a nourishing experience to my medical education. I was able to interact with many pediatric patients who were affected by a variety of neurological disorders, especially congenital ones. This provided me with an appreciation for specialist physicians since they offer a great sense of hope and security to their patients- something I had associated more with primary care. What was even more admirable was my own mentor pursuing her research and developing case studies to help spread awareness of the pathologies that affect her patients.

Regarding my own project, I was able to learn more about the neurovascular complications of Marfan syndrome and the importance of considering it as a possible cause of stroke. I thoroughly enjoyed the process of gathering information and researching literature since it showed me how physicians from different parts of the country can come together and use their scientific nature to bring light to issues and possibly come to solutions. I look forward to working on more case studies and research projects as a medical student because it reaffirms my belief in using scientific methods and research to better the lives of patients and reach new heights in treatments.

A Thankful and Healthy New Year for Public Health

This article was originally published in the January/February 2023 issue of the Tarrant County Physician.

by Catherine Colquitt, MD, AAHIVS
Medical Director and Local Health Authority
Kenton K. Murthy, DO, MD, MPH, AAHIVS
Assistant Medical Director and Deputy Local Health Authority

During the holiday season, many were reunited in person to celebrate with loved ones after almost three years of relative seclusion.

There was much to be grateful for this season. While COVID-19 case counts and hospitalizations are rising in Texas and in Tarrant County, our present COVID rates pale in comparison to December 2020 or January 2021.1 And though influenza and Respiratory Syncytial Virus (RSV) infections are strikingly and unseasonably high, and the perils of a tridemic (COVID-19, influenza, and RSV) are on our minds, many of us and our patients and neighbors are fully vaccinated against COVID-19 and have already had the bivalent mRNA vaccines (for protection from the Wuhan and Omicron COVID-19 strains) as well as the current seasonal influenza vaccine.

As we shift gears from the COVID-19 pandemic to COVID-19 endemic,
we hope that our next iteration of COVID-19 vaccines will roll out side
by side with next season’s influenza vaccine. However, if new versions of COVID-19 vaccines are required to mitigate the spread of COVID-19 between now and then, our scientists and vaccine manufacturers, our distribution networks, the FDA, the Advisory Committee on Immunization Practices, the CDC, and state and local partners will work together to respond to future challenges.

It seems fitting to consider what we have to be thankful for, and gratitude in healthcare is a very active field of study at present. A meta-review in Qualitative Health Research by Day et al reviewed recent works and referenced pioneering works on gratitude research dating to the early twentieth century and organized this vast body of work into six “meta- narratives: gratitude as social capital, gifts, care ethics, benefits of gratitude, gratitude and staff well-being, and gratitude as an indicator of quality of care.”2

Given the ubiquitous articles reporting on healthcare worker
burnout and the mental and physical consequences of COVID-19 on our workforce, Day et al suggested in their conclusion that more research is needed on “gratitude as a component of civility in care settings” and that further study might help researchers to understand the intersection of gratitude “with issues of esteem, community cohesion, and the languages of valorization that often accompany expressions of gratitude.”2

Individually, we might all take a moment to self-assess using a simple exercise such as the Gratitude Questionnaire – Six Item Form (GQ-6), or we might dig more deeply into the bibliography of “Gratitude in Health Care: A Meta-narrative Review” to study our own complicated relationship with gratitude more closely.2,3 Those in healthcare have been under great strain since COVID-19 first appeared on the scene, and perhaps a gratitude practice is just what the doctor ordered to help us to reboot and revive the sense of wonderment with which we began our careers.

References
1. Texas Department of State Health Services COVID -19 Dashboard.
2. Giskin Day, Glenn Robert, Anne Marie Rafferty. 2020 Gratitude in Health Care: A Meta-narrative Review. Qualitative Health Research. 2020 Dec; 30(14): 2303-2315
3. Gratitude Questionnaire – Six Item Form (GQ-6), taken from Nurturing Wellness by Dr. Kathy Anderson.

COVID-19 Vaccine Clinics for the Week of January 21

January 19, 2023 – (Tarrant County) – Tarrant County Public Health hosts numerous pop-up COVID-19 clinics across Tarrant County each week in partnership with public and private organizations listed below. Each site has the Moderna, Pfizer, and Novavax vaccines. Infants six months and older are eligible for the vaccination. Parents need to bring proof of the child’s age and their own ID for the vaccination. Booster vaccinations are available at all of the vaccination locations. 

  
TCPH would like to bring a COVID-19 vaccination clinic to businesses, churches, and organizations in the community thatare interested in hosting a pop-up clinic. It’s easy and free to host a clinic.
 
In addition to the vaccination opportunities below, the cities of Arlington, Fort Worth, Mansfield, North Richland Hills, Hurst, and Tarrant County College have also added opportunities for vaccinations. To find a local vaccine site, the County created a vaccine finder page: VaxUpTC website.

Pop-Up COVID-19 locations:

Stonegate Nursing and Rehabilitation  
Wednesday, Jan. 25: 10 a.m. to 2 p.m.
4201 Stonegate Blvd.  
Fort Worth, TX 76109

VaxMobile-City of Forest Hill  
Thursday, Jan. 26: 9 a.m. to 4 p.m.
6800 Forest Hill Dr.   
Forest Hill, TX 76140

Tarrant County Public Health CIinics: 

Northwest Public Health Center
Monday to Friday: 8 a.m. to 12 p.m. and 1 to 5 p.m.
3800 Adam Grubb Road
Lake Worth, TX 76135

Bagsby-Williams Health Center
Monday to Friday: 8 a.m. to 12 p.m. and 1 to 5 p.m.
3212 Miller Ave.
Fort Worth, TX 76119

Southeast Public Health Center
Monday to Friday: 9 a.m. to 12 p.m. and 1 to 5 p.m.
536 W Randol Mill
Arlington TX, 76011

Main Public Health Center
Monday to Friday: 8 a.m. to 12 p.m. and 1 to 5 p.m.
1101 S. Main Street
Fort Worth, TX 76104

Southwest Public Health Center
Monday to Friday: 8 a.m. to 12 p.m. and 1 to 5 p.m.
6551 Granbury Road
Fort Worth, TX 76133

Watauga Public Health Center
Monday to Friday: 8 a.m. to 12 p.m. and 1 to 5 p.m.
6601 Watauga Road
Watauga, TX 76148

For more information go to coronavirus.tarrantcounty.com or call the Tarrant County Public Health information line, 817-248-6299, Monday – Friday 8 a.m. to 6 p.m.

COVID-19 Vaccine Clinics for the Week of January 14

January 13, 2023 – (Tarrant County) – Tarrant County Public Health hosts numerous pop-up COVID-19 clinics across Tarrant County each week in partnership with public and private organizations listed below. Each site has the Moderna, Pfizer, and Novavax vaccines. Infants six months and older are eligible for the vaccination. Parents need to bring proof of the child’s age and their own ID for the vaccination. Booster vaccinations are available at all of the vaccination locations. 

  
TCPH would like to bring a COVID-19 vaccination clinic to businesses, churches, and organizations in the community that are interested in hosting a pop-up clinic. It’s easy and free to host a clinic.
 
In addition to the vaccination opportunities below, the cities of Arlington, Fort Worth, Mansfield, North Richland Hills, Hurst, and Tarrant County College have also added opportunities for vaccinations. To find a local vaccine site, the County created a vaccine finder page: VaxUpTC website.

Pop-Up COVID-19 locations:

Baker Chapel AME Church 
Saturday, Jan. 14: 10 a.m. to 2 p.m.
1050 E. Humboldt St.  
Fort Worth, TX 76104

Advent Health Care Center of Burleson  
Tuesday, Jan. 17: 9 a.m. to 11 a.m.
301 Huguley Blvd.   
Burleson, TX 76028

Vaxmobile-Southside Community Center 
Thursday, Jan. 19: 9 a.m. to 4 p.m.
959 E. Rosedale St. 
Fort Worth, TX 76104

Tarrant County Public Health CIinics: 

Northwest Public Health Center
Monday to Friday: 8 a.m. to 12 p.m. and 1 to 5 p.m.
3800 Adam Grubb Road
Lake Worth, TX 76135

Bagsby-Williams Health Center
Monday to Friday: 8 a.m. to 12 p.m. and 1 to 5 p.m.
3212 Miller Ave.
Fort Worth, TX 76119

Southeast Public Health Center
Monday to Friday: 9 a.m. to 12 p.m. and 1 to 5 p.m.
536 W Randol Mill
Arlington TX, 76011

Main Public Health Center
Monday to Friday: 8 a.m. to 12 p.m. and 1 to 5 p.m.
1101 S. Main Street
Fort Worth, TX 76104

Southwest Public Health Center
Monday to Friday: 8 a.m. to 12 p.m. and 1 to 5 p.m.
6551 Granbury Road
Fort Worth, TX 76133

Watauga Public Health Center
Monday to Friday: 8 a.m. to 12 p.m. and 1 to 5 p.m.
6601 Watauga Road
Watauga, TX 76148

For more information go to coronavirus.tarrantcounty.com or call the Tarrant County Public Health information line, 817-248-6299, Monday – Friday 8 a.m. to 6 p.m.

New TMA Task Force on Alternative Payment Models Charts a Path Toward Value-Based Care

By Emma Freer

Originally published by Texas Medical Association on January 11, 2023.

The shift from fee-for-service to value-based care is underway, with public and private payers introducing myriad new payment models in recent years. But many physicians find the variety of plans overwhelming, and the investments necessary to support them challenging.

To help clear these hurdles, the Texas Medical Association Board of Trustees approved last May the formation of a Task Force on Alternative Payment Models (APMs). Over the next two years, its diverse membership – which spans specialties, experience levels, practice types, and geographic regions – is charged with reviewing value-based care trends, prioritizing members’ needs, and serving as a touchstone of APM policy and activity.  

Norman Chenven, MD, founding CEO of Austin Regional Clinic (ARC) and co-chair of the task force, commends TMA for convening the group. He brings with him more than four decades of experience working with APMs, dating back to health maintenance organizations in the early 1980s.  

“It’s great for TMA to develop resources for physicians adapting to the inevitable challenges of these changing payment models,” he said.  

Under a value-based care model, physicians and other healthcare professionals are paid based on the quality of patient outcomes rather than the quantity of services provided.  

The Centers for Medicare & Medicaid Services (CMS) has a stated goal of transitioning all Medicare patients to value-based care arrangements by 2030. In the meantime, it continues to test initiatives such as the Enhancing Oncology Model and the Bundled Payments for Care Improvement Advanced Model. CMS also continues to address various issues, such as how to incentivize collaboration between primary care physicians and specialists. 

David Fleeger, MD, a colon and rectal surgeon in Austin, co-chair of the task force, and past president of TMA, says he expects private payers to follow CMS’ example.  

Although value-based models have grown more common, uptake remains slow. In a 2020 survey, the Deloitte Center for Health Solutions found 97% of physician respondents still relied mostly on fee-for-service payments, with roughly a third drawing a portion of their compensation from value-based payments. Moreover, less than a quarter received incentive payments of more than 5%. 

Kim Harmon, TMA’s associate vice president of innovative practice models, says value-based care can prove daunting because of its breadth of applications, from public and private payers to every kind of physician practice. It’s also difficult to identify which physicians participate in value-based arrangements because payers aren’t required to share such information.  

With these challenges in mind, the task force hopes to empower Texas physicians to implement value-based care by offering support and sharing institutional knowledge from early adopters. 

Dr. Chenven, for instance, can speak to the start-up costs that come with participating in value-based models. At ARC, his multispecialty group, these included investments in staff and information technology to ensure patients received preventive care and kept up with chronic care.  

“No individual office or small office is going to have those resources,” he said. “There has to be collaboration across [physicians] in the community.”  

The task force also can push CMS and private payers to develop APMs that are more accessible to a wider range of specialties and practice types, Dr. Fleeger says.  

“We need to make sure that whatever gets done raises all boats,” he said.  

The task force next meets later this month, when it will begin identifying and prioritizing TMA member physicians’ needs for education and other resources related to APMs. 

Dr. Chenven says this is a critical first step to demonstrate the value in value-based care to physicians.  

“It represents a huge culture change. It’s a change in the business model of medicine, and change is always hard,” he said. “So, you need thoughtful preparation to make it go smoothly.” 

COVID-19 Vaccine Clinics for the Week of January 7

January 5, 2023 – (Tarrant County) – Tarrant County Public Health hosts numerous pop-up COVID-19 clinics across Tarrant County each week in partnership with public and private organizations listed below. Each site has the Moderna, Pfizer, and Novavax vaccines. Infants six months and older are eligible for the vaccination. Parents need to bring proof of the child’s age and their own ID for the vaccination. Booster vaccinations are available at all of the vaccination locations. 

  
TCPH would like to bring a COVID-19 vaccination clinic to businesses, churches, and organizations in the community that are interested in hosting a pop-up clinic. It’s easy and free to host a clinic.
 
In addition to the vaccination opportunities below, the cities of Arlington, Fort Worth, Mansfield, North Richland Hills, Hurst, and Tarrant County College have also added opportunities for vaccinations. To find a local vaccine site, the County created a vaccine finder page: VaxUpTC website.

Pop-Up COVID-19 locations:

Beth Eden Baptist Church 
Saturday, Jan. 7: 10 a.m. to 4 p.m.
3308 Wilbarger St. 
Fort Worth, TX 76119

Cityview Nursing and Rehabilitation  
Tuesday, Jan. 10: 10 a.m. to 2 p.m.
5801 Bryant Irvin Rd.   
Fort Worth, TX 76132

Vaxmobile-Watauga City Hall 
Thursday, Jan. 12: 9 a.m. to 4 p.m.
7105 Whitley Rd. 
Watauga, TX 76148

Tarrant County Public Health CIinics: 

Northwest Public Health Center
Monday to Friday: 8 a.m. to 12 p.m. and 1 to 5 p.m.
3800 Adam Grubb Road
Lake Worth, TX 76135

Bagsby-Williams Health Center
Monday to Friday: 8 a.m. to 12 p.m. and 1 to 5 p.m.
3212 Miller Ave.
Fort Worth, TX 76119

Southeast Public Health Center
Monday to Friday: 9 a.m. to 12 p.m. and 1 to 5 p.m.
536 W Randol Mill
Arlington TX, 76011

Main Public Health Center
Monday to Friday: 8 a.m. to 12 p.m. and 1 to 5 p.m.
1101 S. Main Street
Fort Worth, TX 76104

Southwest Public Health Center
Monday to Friday: 8 a.m. to 12 p.m. and 1 to 5 p.m.
6551 Granbury Road
Fort Worth, TX 76133

Watauga Public Health Center
Monday to Friday: 8 a.m. to 12 p.m. and 1 to 5 p.m.
6601 Watauga Road
Watauga, TX 76148

For more information go to coronavirus.tarrantcounty.com or call the Tarrant County Public Health information line, 817-248-6299, Monday – Friday 8 a.m. to 6 p.m.