July 2024 – Tarrant County Physician Online

Population Boom, Physician Shortage, and Indigent Healthcare: How can We Prepare?

By Kathryn Keaton

In 2018, an American Academy of Medical Colleges (AAMC) report projected a national shortage of up to 121,900 physicians by the year 2033.¹ Just a few months ago, that number was reduced to 86,000 by 2036.² While the trend is moving in the right direction, this improvement is based on the hypothetical but not guaranteed increase in graduate medical education spots.³ The current number of incoming primary care physicians is simply not sufficient to replace the number who are retiring, much less to grow to meet the expanding need, and that is just among primary care physicians. Other specialties have not been studied to the same extent, but the AAMC has stated this will be researched more in the coming years.⁴

Unfortunately, Texas ranks forty-second in primary care physician availability⁵ and is predicted to be short by over 20,000 primary care physicians by 2030.⁶ In 2021, 249 of Texas’s 254 counties reported a shortage – including Tarrant and all of its surrounding counties.⁷

While current and predicted physician shortages are hot topics in the medical realm, the metroplex is also making headlines with the recent and projected population boom. The latest census shows that DFW added over 150,000 residents between 2022 and 2023, and Tarrant County ranked number nine out of ten among Texas counties with the most growth in the same time frame.⁸ Specifically, Fort Worth had the greatest increase in population of all cities in the state between 2020 and 2023, with a growth rate of 5.3 percent,⁹ and Fort Worth’s population will likely surpass one million by the end of 2024.¹⁰

The Fort Worth Chamber recognizes that “transportation, mobility, water, and energy infrastructure” need to be prioritized¹¹ and has recently announced the new “Moving a Million” project to streamline transportation issues,¹² but the looming collision of the impending physician shortage and continuing population boom seems to be unaddressed or unacknowledged – maybe even unrecognized.

“The urgency is now,” said Gerald Harmon, MD, past president of the American Medical Association, in a 2022 podcast.¹³ And for Fort Worth and all of Tarrant County, projections show that our healthcare access will only get worse as the physician shortage and the population growth gap widens.

Leonard Glass, MD, formerly of the University of California San Diego School of Medicine, recognized the coming physician shortage when he founded Physician Retraining and Reentry.¹⁴ In partnership with the medical school faculty, this national program has been addressing this issue since 2013 by creating an online training pathway for physicians who may have left the profession or let their license lapse. They also provide training for surgeons who may no longer be able to perform procedures but who are fully capable of performing primary care duties. The program website lists five major impacts of the physician shortage. One of those five is a growth of healthcare disparities, especially among communities who already face barriers to obtaining basic healthcare.¹⁵

Tarrant County has a well-documented network of free and charitable clinics that serve mostly uninsured patients. These clinics, along with JPS resources, bridge this gap – which is mostly primary care – in our community. But as with any charitable endeavor, resources are limited. Lori Kennedy, director of healthcare services at Cornerstone Assistance Network’s clinic, says that the organization is seeing the impact of physician and advanced practitioner shortages firsthand. “The need is up, but volunteer numbers are down,” she says. She encourages retiring doctors to hold on to their licenses for at least a year after retirement. “Sometimes after a year, doctors realize they miss seeing patients and want to do a little volunteer work.” Clinics like Cornerstone rely on volunteer physicians, and retired or almost-retired physicians make up most of this volunteer base.

Linda Siy, MD, a family medicine physician, says that the Tarrant County indigent population needs are handled through specific resources and safety net programs. “The need will grow, and the population will feel the strain,” she says, “and so will our safety net programs.”

While Ms. Kennedy and Dr. Siy share their concerns from a primary care perspective, Project Access is beginning to notice that patients across many specialties are having to wait 3–4 weeks for an initial phone call and often several more weeks before the next new patient appointment opening. This is in no way a slight to our volunteers – our dedicated volunteers and their offices treat PATC referrals in the same way they would any other funded patient.

The problem of the physician shortage and its exacerbation by our population boom has to be solved on many levels from the city and county management, healthcare infrastructure, medical education, and the business sector. The alarm bells are sounding, and hopefully healthcare access is a topic of discussion during this time of growth.

The average physician is not going to be involved in these strategic planning discussions, but you can still make a difference starting today. Our charitable clinic network is always in need of primary care volunteers, and they even take care of malpractice coverage when needed.

Of course, PATC always needs your help too. One of the beautiful things about PATC is that YOU are in control of how many patients you see per year, and you don’t have to leave your practice to see them – they are scheduled in the course of your normal workday and any surgeries are done where you are already credentialed.

We know this won’t solve all of Tarrant County’s problems. Physicians alone cannot fix this issue – this will have to be addressed by the local municipalities. Unless dramatic action is taken, physician shortages will still get worse and wait times will continue to increase as the population grows. But we as a physician-led charitable program can pave the way, showing our community that we will do everything within our power to help those in need.

References:

1. Patrick Boyle, “U.S. Physician Shortage Growing,” AAMC, June 26, 2020, https://www.aamc.org/news/us-physician-shortage-growing.

2. “New AAMC Report Shows Continuing Projected Physician Shortage,” AAMC, March 21, 2024, https://www.aamc.org/news/press-releases/new-aamc-report-shows-continuing-projected-physician-shortage.

3. Global Data Plc, The Complexities of Physician Supply and Demand: Projections From 2021 to 2036 (Washington D.C.: AAMC, 2024), vi.

4. Global Data Plc, The Complexities of Physician Supply and Demand: Projections From 2021 to 2036 (Washington D.C.: AAMC, 2024), x.

5. “Texas Physician Shortage Facts,” Cicero Institute, April 3, 2024, https://ciceroinstitute.org/research/texas-physician-shortage-facts/.

6. “Physician Shortages State-By-State,” Physician Retraining and Reentry, March 23, 2022, https://prrprogram.com/physician-shortages-state-by-state/.

7. Bonnie Petrie, “Texas Primary Care Doctor Shortage Spikes during the Pandemic; Rural Texans Hit Hardest,” Texas Public Radio, November 17, 2021, https://www.tpr.org/public-health/2021-11-17/texas-primary.

8. “More Counties Saw Population Gains in 2023,” United States Census Bureau, March 18, 2024, https://www.census.gov/newsroom/press-releases/2024/population-estimates-more-counties-population-gains-2023.html.

9. “Fort Worth Soars: Unpacking the Latest Demographic Surge and Future Projections in North Texas,” Fort Worth Chamber, December 4, 2023, https://www.fortworthchamber.com/fort-worth-soars-unpacking-the-latest-demographic-surge-and-future-projections-in-north-texas/.

10. “Population,” City of Fort Worth, accessed June 6, 2024, https://www.fortworthtexas.gov/about/population.

11. “Fort Worth Soars: Unpacking the Latest Demographic Surge and Future Projections in North Texas,” Fort Worth Chamber, December 4, 2023, https://www.fortworthchamber.com/fort-worth-soars-unpacking-the-latest-demographic-surge-and-future-projections-in-north-texas/.

12. “Moving a Million,” Fort Worth Transportation Plan, accessed June 6, 2024, https://www.movingamillion.org/.

13. “Doctor Shortages Are Here— Time to Act, Drs. Harmon and Orlowski Weigh In,” AMA Moving Medicine, accessed June 6, 2024, https://ama-moving-medicine.simplecast.com/episodes/doctor-shortages-are-here-time-to-act-drs-harmon-and-orlowski-weigh-in.

14. “The PRR Program,” Physician Retraining and Reentry, accessed June 6, 2024, https://prrprogram.com/.

15. “How the Primary Care Physician Shortage Impacts Healthcare,” Physician Retraining and Reentry, September 29, 2023, https://prrprogram.com/how-the-primary-care-physician-shortage-impacts-healthcare/.

TMA Poster Session: Shaping Research and Health Policy

Student Article

by Naimah Sarwar, MS-IV

When medical students don their freshly starched white coats for their first days of medical school, they cross the bridge from being a patient to also becoming a clinician. This evolution, from one side of the doctor-patient relationship to the other, provides medical students a unique perspective. It is at this phase of our training that we arguably have the greatest ability to have clear insight into the nuances of the healthcare system. Armed with the textbook knowledge of how to recognize, diagnose, and treat our patients’ ailments, we have a front row seat to the struggles our patients have in accessing the care they need. We also become privy to the ever-growing challenges that physicians face in providing quality care to their patients while also caring for themselves. With fresh eyes, we witness the successes and failures of the healthcare system. This lens brings into focus much of the scholarly activity medical students engage in. Our curiosity and motivation to advocate for our patients drives us to ask questions, design research projects, and share our findings with others.

The poster session at the 2024 TexMed conference that took place in Dallas this year provided medical students the perfect venue to share such scholarly work with fellow attendees. Participants were required to submit an abstract outlining their projects that were then reviewed in a selection process. Once selected, presenters designed and submitted their posters for display in the gallery. Posters were judged by attendees of the conference for recognition with the “People’s Choice Award.” The gallery provided local students with an opportunity to present their work and featured several posters from the Anne Burnett Marion School of Medicine and Texas College of Osteopathic Medicine.

The works submitted covered a variety of topics, from advocacy and medical education to public health and the presentation of clinical cases. A team of students from the Burnett School of Medicine, including Carter Clatterbuck, MS-IV, and Peter Park, MS-IV, presented on the effects of the new Texas abortion legislation on medical school admission rates. They found that after the overturning of Roe v. Wade, there was a significant drop in female applicants to Texas medical schools. Many physicians stopped at the poster, surprised at how quickly health policy seems to have influenced the decisions of future students and reflected on the effects of certain health policies on their own specialties.

As a first-time presenter at the conference this year, my poster outlined my project investigating patients who connected with specialty care through Project Access. Project Access connects underserved patients who do not have access to insurance to charity care, particularly specialists and surgical services. I wanted to investigate the utilization of these services in order to better understand gaps in access to care locally. The project was inspired by an interaction on my very first day of outpatient clinic, where an unfunded patient was struggling to connect with a specialist they needed. Through my work, I hope to identify where vulnerable patients that fall through the cracks end up seeking care and the burden that inaccessibility to care places on our health system.

During the poster session, I had conversations with physicians that broadened my understanding of the challenges different communities face. One physician from the Rio Grande Valley shared how his community had a shortage of specialists. Many of his patients were thus forced to present to the emergency department with complex diseases without the specialty care they needed. In another conversation, I spoke with a retired local rheumatologist about how many of his patients would lose their jobs due to complications of their conditions. When they lost their jobs, they lost their health insurance and, by extension, access to their immunotherapies. These stories raised so many questions about further areas for study, and I realized that there is no-one-size-fits all solution to the challenges we face in our different communities.

Our clinical experiences and patient narratives have the potential to become major drivers for shaping research and health policy. The TexMed poster session fostered dialogue and facilitated the exchange of ideas between students, physicians, researchers, and clinicians from across Texas with a shared passion for policy and advocacy work. The opportunity to share research findings and to use that research as a springboard for discussions on what our work means to our patients and our practice was immensely valuable.

TexMed 2024: Education Outside of the Classroom

Student Article

by Ashley Taylor, OMS-I

When I received an email from the Texas Medical Association inviting me and other medical students to the annual TexMed conference, my initial thought was that it might be fun to do something other than go to class and study that weekend. I had no idea what TexMed was all about or why I was invited as a first-year medical student, but the thought of a change of scenery was very appealing to me, so I decided to sign up. To my surprise, I was unable to convince any of my friends to attend with me. As more of an introverted individual, the idea of going alone was daunting, but I am beyond happy that I did.

The first night I arrived at TexMed, I attended the Medical Student Section Networking Event where I met dozens of students from around the state, including several from my own school with whom I had not previously had the opportunity to become acquainted. I also began to meet physicians from various parts of the state; each of them was surprisingly friendly, engaging, and eager to get to know me and answer my questions. I am not sure why I was under the impression that the title “networking event” implied that we would all be sitting at a formal table while I tried my best to remember all of my manners while struggling to make conversation with some highly accomplished physician who did not wish to speak to me, but my expectations could not have been more off the mark. I had not been there five minutes before Melissa Garretson, MD, from Cook Children’s Medical Center was offering me her phone number and agreeing to come speak at the next UNTHSC Pediatrics Club meeting that I was organizing. I was blown away by her willingness to help me, a student she had just met, and this feeling continued the rest of the evening as I met more and more physicians who were equally kind and eager to help me succeed. I quickly grew comfortable in this new setting and could not wait to return the next day.

Friday morning came around, and I took my seat with thousands of others in the expo hall for the Opening General Session. Harvey Castro, MD, gave us a presentation on the future of medicine involving AI and what this means for us as students and physicians. His talk was both fascinating and terrifying, but what I really gathered from that morning was the realization that medicine is constantly changing and that it is crucial for all of us to stay up to date on innovations and advancements in the field in order to provide the highest quality care to patients. Another key point that I took away from his lecture was that every person there has a purpose. I found it truly inspiring to look around the room at so many different faces, knowing that we all shared the same objective of learning how we can be the best physicians possible so that we can then provide our best to others.

When the morning’s opening events were complete and we were free to attend our meetings of choice, I headed to what I found to be the most entertaining part of the weekend: the reference committee meetings. Wanting to learn more about healthcare policy, I took a seat in the Science and Public Health committee meeting, per the suggestion of a physician I had just met at lunch, completely oblivious as to how it would work. A few minutes in, I began to understand why he had made this suggestion. I was completely enthralled by the debates unfolding before me, and, naively, I had not expected such current, controversial topics to be discussed. I did my best to absorb all of the information and opinions being presented while frantically googling terms I had never heard and taking notes on the key points that I wanted to use later as subjects for my own research. This meeting was easily the highlight of the conference for me as well as an invaluable learning experience. When I started medical school last summer, I thought the only thing I would ever need to care about again was learning science and doing research, but I now know that there is much, much more to practicing medicine.

My weekend at TexMed ended up being one of the most transformative educational experiences of my life. From meeting physicians of all ages and from all different fields to learning how TMA adopts policies and what they stand for as an organization, I gained more from the conference than I could have ever imagined. I understand now that practicing medicine involves more than scientific knowledge and empathy toward patients. In order to truly put patients’ best interests first, we, as current and future physicians, must be involved on a much larger scale outside of the hospital. It is our responsibility to stay up to date on ever-changing technological advancements, to form and maintain relationships with other physicians and healthcare workers so that we may work as a successful team, and to identify areas of healthcare that need improvement. We need to then introduce and adopt policies that will benefit our patients while also allowing us to effectively practice medicine. Who knew I could learn so much outside of the classroom?

Student Article: The Seeds that We are Growing

By Rebecca Zapatta, OMS-I

I watched as my mom got out of the car and walked towards the dumpster behind the 7-Eleven. My eight-year-old eyes widened as she approached an
elderly man who was trying to stay warm. She bent down, handed him a blanket, and then spent a few minutes talking with him. When she came back to the car, she turned to my brothers and me and said we were going home to get a few things. We came back 30 minutes later with food and some of my dad’s winter clothing, and this time we all got out of the car.

These were among the most formative moments of my childhood. Through my mom’s family organization, Operation Hope, we were able to serve those most in need in our community along the Texas-Mexico border. The mission was simple. As my mom put it, “Although we are aware that we can only do so much, it still makes a difference in our hearts and lives when we give someone that little bit of love and hope. I guess you can say that these are the seeds that we are growing.”

We provided clothing and supplies for women and children living in domestic abuse shelters, visited elderly people without family at our local nursing home, and did various donation drives for those experiencing homelessness. Being exposed to suffering at a young age permeated my personality and embedded a deep desire to help others. It eventually led to my passion for medicine and social justice.

Growing up in Laredo, Texas, an underserved community, further fueled my pursuit of this journey. Many in my hometown face obstacles in securing quality primary and specialty care. There is also a huge need for mental health and addiction services. According to the Texas Health Institute, overdose rates have doubled in the last two decades.¹ Up until recently, there were no detox facilities and few halfway homes within the community.² As of February 2024, there is only one new detox facility that serves a population of over 250,000 people.

These barriers have affected hundreds of families, including my own. When loved ones began struggling with substance
abuse and mental health disorders, I saw how detrimental hindrances to medical services can be. I also learned how my Latino culture introduced an additional hurdle to receiving care. For instance, the “machismo” belief often keeps men from seeking help and reinforces stigmas by associating mental illness as a weakness or character flaw.

The disparities in my hometown aren’t singular; they’re the reality for many people across the United States. The homeless community is perhaps the hardest hit of all. This population has higher rates of disease and a shorter life expectancy. They also experience increasing incidences of substance abuse and mental illness.

Additionally, the stigmatization of people experiencing homelessness exacerbates their conditions. The article “Tackling Health Disparities for People Who are
Homeless? Start with Social Determinants” discusses how many unhoused people have gone through traumatic life experiences that health services aren’t able to address.³ This leads to a delay in seeking help, with most people waiting until their conditions are severe.

This knowledge, along with my life experiences and journey in medicine, have led me to street medicine. It is at the intersection of health, disease, culture, and society, and it’s a path that is rooted in the values my mother instilled in me.

When I met Madison Stevens last July during orientation for our first year as medical students, we talked about our common interest in serving unsheltered people as future physicians. A few months later, along with Angelica Washington and Sydney Diep, who are also first year medical students at TCOM, we created the Street Medicine Student Coalition at UNTHSC.

Our goal is to make a meaningful impact in the unhoused community in Fort Worth by meeting people where they are. We are working on creating relationships with other organizations and health providers to set up street medicine rounds. While we develop that, we are holding donation drives and panel discussions and attending a street medicine conference in May 2024.

We hope that by addressing the unique needs and circumstances facing those that experience homelessness, we will be able to reduce the barriers to care and connect people with resources in the community.
As my mom said, there are limitations to our capabilities when it comes to serving others, but we do possess the ability to cultivate the seeds of compassion and social justice. By nurturing these seeds, we make a difference not only in our own garden, but in communities beyond Fort Worth.

Find out how you can get involved with the Street Medicine Student Coalition Share a Pair Shoe & Sock Drive.

References:

“Texas Overdose Data to Action,” Texas DSHS, https://www.dshs.texas.gov/injury-prevention/texas-overdose-data-action. “City of Laredo 2022-2023 Community Health Needs Assessment,”
Texas Health Institute, May 5, 2023, https://texashealthinstitute.org/wp-content/uploads/2020/12/05-31-2023-Laredo-CHNA.pdf.
Stafford, Amanda and Lisa Wood, “Tackling Health Disparities for People Who Are Homeless? Start with Social Determinants,” International Journal of Environmental Research and Public Health 14, no. 12 (December 8, 2017): 1535, https://doi.org/10.3390/ijerph14121535.