Tarrant County Physician Online

Introducing MATRIX: Medical Assessments and Tools for Inclusive Xperiences

By Kathryn Keaton

IN 2019, TEXAS HEALTH RESOURCES Foundation announced a new series of grant cycles: the Texas Health Community Impact grants. These grants are available to five regions, with specific focuses for each county based on their most recent Community Needs Assessment.

These two-year awards are made to local organizations that work collaboratively to serve specific zip codes and address health disparities and socioeconomic hardships in innovative ways. Past Tarrant projects funded include community gardens, mental health access, and culinary job training.

For the 2025–2026 grant cycle, the Foundation awarded $5 million to 18 projects across North Texas. Project Access Tarrant County is honored to be among these recipients for a total award of $385,662 over two years.

Partnering with Cornerstone Assistance Network (CAN) and Mission Arlington, the project will utilize enhanced technology, education, and a shared employee to affect radical change in the care of patients with diabetes and/or hypertension in five target zip codes: 76010, 76011, 76104, 76105, and 76119.

We are proud to introduce our project, MATRIX: Medical Assessments and Technology for Inclusive Xperiences.

The Project

Since PATC offers specialty medical and surgical care, our clinic partners are vital. Most patients come to PATC from a referral made by primary care, and those who do not are required, with PATC’s assistance, to establish a connection with primary care.

CAN and Mission Arlington are among PATC’s founding partners. Both clinics serve as medical homes. CAN serves mostly patients in Fort Worth (MATRIX target zip codes 76104, 76105, and 76119), and Mission Arlington serves mostly Arlington patients (MATRIX target zip codes 76010 and 76011). Combined, PATC, CAN, and Mission Arlington provide a spectrum of primary and specialty/surgical care.

Community Health Worker

The single biggest innovation with MATRIX is the addition of a Community Health Worker (CHW). And not just a CHW—but a shared CHW. Once this individual is hired, they will travel between PATC, CAN, and Mission Arlington, having “office hours” at each location. While some patients will meet with the CHW at the PATC office, most will have appointments at their primary care clinic—a place and location where they have an existing relationship and feel comfortable.

The CHW’s activities will be tailored to each patient. The CHW may assist with one-on-one diabetic or hypertension education, help with access to prescription assistance, arrange transportation to diabetic eye exams, or complete hospital paperwork for PATC surgeries. The cadence will vary, but each patient will have individual appointments with the CHW. In total, Cornerstone plans to serve 100 patients and Mission Arlington plans to serve 750 in this manner. CAN’s and Mission Arlington’s aim is that 65 percent of all patients with hypertension will have blood pressure readings below 140/90 and that 68 percent of all patients with diabetes will have an A1c below 9 by the end of the grant period.

Education

A recent Tarrant County Physician article briefly mentioned that a TCU medical student chose PATC as her site to complete her Scholarly Pursuits and Thesis (SPT) project.1,2 Alex Koehl, MPH, MS-I at TCU, brings her public health expertise to PATC in creating a series of classes pertaining to social determinants of health (SDOH) common to PATC patients.

The first class will occur in late March. This class will empower patients to ask questions to understand their disease and treatment and to speak up if they do not understand their instructions. Patients who are seen pro bono often feel that they do not have agency to advocate for themselves and ask questions, leading to confusion and misunderstandings that eventually cause non-compliance and a lack of resolution of their health condition. The MATRIX grant allows for meals and incentives, encouraging attendance. The series will be facilitated in both Fort Worth and Arlington. Future topics include how to open a bank account (sometimes required for hospital charity applications), how to read a prescription bottle, and how to navigate a patient portal.

Technology

Enhanced technology will answer some of the barriers we face with our patients. We recently received a separate grant that will cover the cost of CareMessage, a messaging platform for safety-net organizations to “increase access to care, improve clinical outcomes, and address social drivers of health.”3

CareMessage will allow PATC to schedule appointment reminders (that include the address with a Google map link!), respond in real-time to questions or concerns, and generally allow for texting instead of playing phone tag. In addition, CareMessage can automatically translate any message into one of dozens of languages, meaning that any PATC staﬀ member can communicate with any patient regardless of language proficiency.

CareMessage will not replace PATC’s personal touch—all initial contact and important information will be relayed by telephone. But for simple reminders and questions where a yes- or-no response is needed, a phone call is generally not necessary.

While the messaging feature is an exciting progression in PATC’s day-to- day operations, CareMessage can go much deeper and is vital to MATRIX’s future success.

CareMessage has several preloaded educational text series. Stephen Pullman, MS-I at TCU, has also chosen PATC as his SPT site. Stephen is vetting existing diabetes and hypertension modules. In addition, as training progresses, Stephen is documenting ideas for future education modules that we can create. By the conclusion of his project, we will have multiple avenues for patient education on both preventative care and chronic conditions.

The survey element is also vital to Alex’s project. With CareMessage, patients will complete pre- and post-surveys for our SDOH classes, measuring the attendees’ level of understanding before and after the material that can be reported to the Texas Health Community Impact Grant project management team. We will also use this for participant feedback to improve future curricula.

As with all innovation, this project will have adaptations, enhancements, and changes over the course of the next two years; but we know that the future is bright. With the THR Foundation’s endorsement, the collaboration with two historic partners, and the opportunity for enhanced technology, by the end of this grant period, significant change and improvement will be affected. We look forward to keeping you updated as MATRIX continues to progress.

References:

Kathryn Keaton, “Project Access Tarrant County: Growth in 2025,” Tarrant County Physician, January/ February 2025, 21–22.
“Scholarly Pursuit and Thesis: Burnett School of Medicine at TCU: Fort Worth, Texas,” Burnett School of Medicine at TCU, June 17, 2024, https:// mdschool.tcu.edu/empathetic-scholar/ scholarly-pursuit-and-thesis/.
“Patient Engagement for Improved Health Equity,” CareMessage, February 4, 2025, https://www.caremessage.org/.

Student Article: Carrying the Torch

By Olivia Mayer, OMS-II, TCOM

In one way or another, I have always been tied to medicine by an invisible string. One of my fondest memories of my childhood was around the age of five, when I would help my mom put together goodie-baskets for the oncology patients she would be visiting the upcoming week. This was a Sunday ritual for my mother and me, one we did while simultaneously baking chocolate chip cookies in the oven. No, my mom is not a medical provider; she is a pharmaceutical sales rep who spent any extra time she had on the weekends creating those baskets to show the patients that were taking part in clinical trials for the lymphoma drug she sold that she cared about them. This was an act out of pure benevolence and servitude for those who needed it more than the average person.

In a similar light, my grandmother spent most of her nursing career as a breast cancer nurse in Buffalo, New York. Growing up, I remember Grandma always sharing her favorite memories as a nurse. She was glowing with pride when I told her that I had a similar interest in oncology. Fast forward to today—now Grandma and I share conversations and exchange information about new developments in the breast cancer world. It is truly a full-circle moment with a touch of nostalgia from my younger days. Now as a medical student, I have the immense privilege to carry the torch of my mother and grandmother into my own medical journey. Besides being introduced to this field at a very early age, oncology has piqued my interest by its very nature. The endless opportunities to become a pioneer in cancer research or navigate complex treatment options that can potentially impact countless lives is truly the epitome of medicine, and continues to be the center of my “why.”

It has always been extremely important to me that I seek out any opportunity to create an impact in this field, just as my mother and grandmother did. As the current vice president for my school’s Oncology Student Interest Group (OSIG), I have had the amazing opportunity to assist in cultivating a tight-knit community of passionate students united by a shared commitment to being a source of support and positive change for patients during their most vulnerable moments.

One of the most significant moments I have had serving as a leader of this organization was in honoring the memory of my childhood friend, Zach, who passed away from astrocytoma in the fall of 2018. I felt a personal calling to head an OSIG fundraiser in honor of Zach and in support of his charity, the Big Z Foundation. The Big Z Foundation is led by Zach’s mother and father and financially supports terminally ill children and their families around the DFW area. Just in time for North Texas Giving Day on September 19th of this year, OSIG was able to raise hundreds of dollars for the Big Z Foundation. This support will help local families by assisting with the cost of their hospital bills, treatments, and housing costs. I can only describe the feeling I experienced as true enrichment when I surprised Zach’s parents on behalf of OSIG with our collective donations for the charity. The profound gratitude they expressed is something I will forever hold near and dear.

In moments like this, sharing acts of servitude and benevolence with fellow classmates is an experience so rewarding that it is impossible to fully express in words. This journey has brought me a feeling of gratification in service that is similar to the one I reminisce about when remembering making oncology patient baskets in my childhood. As I continue on my path in medicine, it is my personal mission to continue these acts of benevolence and shed light on those around me so that the flame of my mother’s and grandmother’s torch continues to be passed forward and illuminate a new generation’s impact on the field of oncology.

Project Access Tarrant County: Growth in 2025

by Kathryn Keaton

Another year has come and gone, and Project Access Tarrant County is beginning its fourteenth full year of serving Tarrant County.

While a full 2024 annual report will be included in the next edition of Tarrant County Physician, we did experience growth and are excited that new relationships in our community are bringing new things for this year. Here’s what you can expect to see from us in the next twelve months.

Staffing

In February 2024, PATC hired a new full-time bilingual case manager, Karla Aguilar. Karla was not new to PATC—she originally came to us in 2021 to complete her internship for her undergraduate degree in public health. Over the past ten months, Karla has refreshed our enrollment and application process, increasing overall efficiency.

PATC also has an additional new employee starting this month. Joanna Lopez, our part-time bilingual program specialist, will be the first point of contact for all new referrals and will assist with processing referrals, prescreening patients, reviewing paperwork, and keeping up with patient communication.

Interns and Volunteers

In the fall of 2024, PATC invited freshman medical students from both the Burnett School of Medicine at TCU and UNT Health Science Center to volunteer with us. These students have been instrumental in keeping us on top of new referrals and other data entry. We will continue to have medical student volunteers and appreciate the time they give, however limited. Two incoming TCU students have chosen PATC for their four-year Scholarly Pursuit and Thesis (SPT) project—we’ll have more information on those projects in the following paragraphs.

In an exciting development, PATC recently finalized an agreement with the UTA School of Public Health that makes us a sanctioned site for undergraduate and graduate students’ internships, which are required for graduation. In January, three of these undergraduate interns will work in the Project Access office part-time. In addition to assisting with daily PATC activities, they will also each complete a special project related to improving or expanding Project Access services.

The TCMS Alliance also lent support over this year. We appreciate our Alliance volunteers that assist with data entry, appointment follow-ups, and patient communication.

Patient Education

In the May/June 2024 issue of Tarrant County Physician, the PATC article focused on ways PATC navigates social determinants of health. Since that article, Karla and a first-year medical student at TCU have written a curriculum geared toward PATC patients to address common barriers to medical care as part of this medical student’s SPT project. We plan to host the first class in March of 2025. It will address medication compliance and teach not only about the importance of taking medication for chronic diseases but also how to understand medication instructions, warnings, and other labels patients may see on their bottles. Future class topics may include basic financial literacy, applying for state benefits, and teaching patients how to ask their medical team questions in order to understand their conditions and care plans. We are coming up with incentives to encourage patient attendance, and we have every reason to believe this will be a great success.

Technology

PATC has used CareScope, a database that holds patient and volunteer information, since 2011. CareScope continues to provide what we need from a demographic and reporting standpoint; however, it is limited in its communication abilities. Fortunately, a new innovative program called CareMessage offered a grant to Project Access to use its software for two years. CareMessage will allow PATC staff to communicate with patients through text messages regarding appointments, enrollment deadlines, and post-appointment questions. In addition, we will be able to select sub-groups of our patients for reminders about preventive care, invite patients to our classes mentioned above, and distribute pre- and post-surveys needed for funding purposes. Another TCU medical student has chosen to work on CareMessage as his SPT project. He will assist with setting up the technology, integrating it into CareScope, and creating processes and content that we will be able to build on for years to come.

In addition, PATC launched a new website in September 2024, which you can visit at http://www.tcam.org. This website hosts all Tarrant County Academy of Medicine programs but focuses on PATC. We still have two developmental phases to go through before we have our fully operational website, but here, donors and supporters will be able to support us and find general information much more easily than before.

Fundraising and Capacity Building

As a recipient of the 2024 Community’s Foundation ToolBox Grant, our project was to create and implement a 12-month operational plan—think like a mini-strategic plan. We worked with a consultant, analyzed processes, met with focus groups, and wrote a month-by-month strategy for 2025 to recruit and retain volunteers and expand funding opportunities. Grant writing will continue, and individual giving will be given increased focus.

Patient Services

In addition to the above, our main day-to-day activities will remain the same. Our goal is to serve 250 patients in 2025, including performing 100 surgical procedures. We aim to fully utilize the 48 surgical cases Park Hill Surgery Center has committed to, with the other 52 cases being performed among our other hospital partners. We have strategies in place to make strides to reduce and perhaps even eliminate the general surgery and gynecology waiting lists.

Conclusion

We are excited about what this year will hold, and we look forward to sharing it with our supporters. In addition to the PATC column in the magazine, please be sure you are subscribed to our monthly e-newsletter and follow us on social media as we share our 2025 successes.

The Power of Palliative Care: A Physician’s Perspective

By Dr. Mo Rezaie

A Misunderstood Mission

One of the most significant misconceptions about palliative care is that it’s solely focused on end-of-life care. This couldn’t be further from the truth. Palliative medicine is a specialized area of medicine that focuses on improving the quality of life for people living with serious illnesses. By addressing physical, emotional, and spiritual needs, palliative care helps patients and their families navigate difficult times with grace and dignity.

Beyond Physical Symptoms

While palliative care can certainly help manage physical symptoms like pain and fatigue, it goes far beyond that. It’s about addressing the whole person, including their emotional, social, and spiritual well-being. This might involve counseling, support groups, or spiritual guidance.

The Importance of Early Palliative Care

Many people believe that palliative care is only for those in the final stages of life. However, palliative care can be beneficial at any stage of an illness. Early palliative care can help patients and their families make informed decisions about treatment options, manage symptoms effectively, and improve quality of life.

A Growing Need

Despite its many benefits, palliative care remains underutilized. There is a significant shortage of palliative care physicians, and many healthcare providers are not adequately trained to provide palliative care. This can lead to suboptimal care for patients with serious illnesses.

A Call to Action

To address this growing need, we must increase awareness of palliative care and encourage more healthcare providers to specialize in this field. By working together, we can ensure that all patients have access to the compassionate and effective care they deserve.

A Personal Perspective

As a palliative care physician, I have the privilege of witnessing firsthand the transformative power of this specialty. By focusing on the patient’s overall well-being, we can help them live their best lives, even in the face of serious illness.

Morvarid “Mo” Rezaie, DO, HMDC, FACOI is a Palliative Medicine physician at The Center for Cancer and Blood Disorders.

The Cost of Providing Care:A Case for Support

By Kathryn Keaton

“Project Access Tarrant County has coordinated over $20 million in donated health services.”

I’ve written sentences like this countless times—I’m sure you’ve seen this or something like it from us and from various charitable agencies. Quantifying donated care isn’t an easy task, but it is necessary to share any nonprofit’s impact and, really, the “return on investment.” So how do we quantify this for our supporters and donors?

Well, let’s walk through a patient’s story together.

“Nancy” is a 44-year-old Hispanic female who was referred by Mission Arlington for a hernia repair. She is single and lives with family members. She has two minor children and works as a housekeeper. She needs a medical interpreter for her appointments and has her own transportation.

Once the patient has been entered, screened, and medically approved, the hard work begins. We aim to initiate the enrollment process as soon as medical director approval is granted. This is currently true for many specialties, but not all—and the availability can change at any moment.

Enrollment is hard—and as I often respond when asked what documentation is required, the unintentionally vague answer is, “It depends.” Part of working with our population means that not everyone has documents often assumed to be commonplace. Income is often hardest to document, especially with patients who may get paid in cash only, not have a tax return, or not even have a bank account. In addition, we must identify in advance at which hospital the patient will most likely have surgery—each hospital’s requirements are different, even within the same system.

This chart shows the cost of Nancy’s care through Project Access—the “real dollars” spent on her prescreening and enrollment processes and coordination of her medical care to completion. In Nancy’s case, the full administrative cost is $627. Since she had six appointments, this leads to an average cost of $105 per medical appointment.

Here’s where the magic happens!

PATC receives statements from each of the donating entities. The physicians, hospitals, anesthesia providers, and any others providing services all send insurance claim forms or some form of a “mock bill” so we can document the donated value for each service. The cost for Nancy’s care totaled over $25,000. This is not “real” money, but it shows the value of the care that $627 provided. That means that the return on investment for Nancy’s hernia repair is over 97 percent!

Currently, the Project Access website is housed in the TCAM section of the Tarrant County Medical Society website; however, in the coming weeks, Project Access Tarrant County is excited to launch its standalone website under “Tarrant County Academy of Medicine.” This in-house platform will have many benefits, including the following:

• Increased Donations: Streamlined online donation process and targeted campaigns

• Enhanced Visibility: PATC will have increased visibility

• Streamlining Daily Operations: PATC can use this website to inform patients about eligibility and include online forms

Most importantly, having a dedicated website will make showing our impact and patient stories easier than ever—and supporting PATC will be easier than ever.

We’ve been using the phrase, “$1,000 can save a life” lately—and this will be a focus of our new website. By showing real patient stories and the administrative cost of their donated medical services (an average of $1,000 per patient), we plan to enable you to follow along our patients’ journeys.

Stay tuned—we can’t wait to bring this vision to life!

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.

The Importance of Men’s Health: Engaging Younger Men in Their Healthcare

By Andrew Y. Sun, M.D.

Men’s Health is a critical field within urology that emphasizes the overall health and well-being of men. Our focus primarily lies on issues related to sexual function and fertility, as these concerns are often top of mind for younger men.

The Healthcare Gap for Men

From birth until around age 18, children regularly see a pediatrician. However, after this age, healthcare trajectories diverge significantly for men and women. Women continue to receive routine care from their OB/GYNs, including Pap smears and other essential check-ups. Unfortunately, men often do not seek regular medical care until something serious occurs, typically in their 40s and 50s. This delay means that from ages 18 to 50, men may silently accumulate health issues such as high blood pressure, high cholesterol, and diabetes. Often, these conditions manifest dramatically, like a heart attack, around age 50.

Engaging Men Early

Preventing these serious health issues requires engaging men in their healthcare sooner. Sexual dysfunction and fertility are significant concerns for younger men as they begin to start families. These issues can be leveraged to bring men into the healthcare system. Fortunately, erectile dysfunction, sperm parameters, and low testosterone levels are excellent indicators of overall health. We refer to them as the “check engine light” of the body. When these issues arise—such as erectile dysfunction, low testosterone, or poor sperm count—they often signal underlying health problems, including high blood pressure, high cholesterol, and diabetes.

The Role of Men’s Health Specialists

Addressing concerns about sexual function and fertility provides a gateway to broader health assessments and interventions. By engaging with men on these topics, we can diagnose and treat health issues early, potentially preventing severe comorbidities later in life. This proactive approach is why it’s critically important to reach out to younger men and involve them in their healthcare before it’s too late.

As a men’s health specialist focusing on sexual health, including testosterone replacement and treating sexual dysfunction, I am uniquely positioned to connect with this underserved population.

Recent Developments and Challenges

Recent studies during the COVID-19 pandemic revealed a high rate of erectile dysfunction, likely due to vascular damage caused by the virus. Additionally, there has been a surge in online pharmacies selling Viagra and Cialis, leading to increased use among younger men. However, these online telehealth services often do not screen for the underlying health issues causing these symptoms. Therefore, men’s health specialists play a crucial role as primary care providers for men, ensuring proper workups to address root causes rather than just treating symptoms like erectile dysfunction.

The Broader Health Picture

News articles have highlighted the decline in sperm parameters and testosterone levels over time. These trends reflect a general decline in overall health. Diet, exercise, and proper sleep are critical components of health that are often neglected in Western countries. Much of our counseling focuses on lifestyle measures to improve overall health and metabolism.

A Case in Point

Consider the story of a 41-year-old man who hadn’t seen a doctor since he was 18. He came to me complaining of new erectile dysfunction, which was affecting his self-esteem. A full diagnostic panel revealed he had a hemoglobin A1c of 14 and a blood glucose level of 388, indicating severe uncontrolled diabetes. He was unaware of the impact diabetes could have on his penile health, but this discovery motivated him to seek treatment. This case illustrates how issues with penile health can serve as a “check engine light,” prompting men to address their overall health. With a new primary care doctor, he is now on the path to better health.

Conclusion

Men’s Health is about more than just addressing immediate concerns; it’s about fostering a lifetime of well-being. By focusing on issues that matter to younger men, we can engage them in their healthcare earlier, providing opportunities for early diagnosis and intervention. This proactive approach can help prevent severe health issues later in life, leading to better health outcomes for men. Let’s prioritize men’s health and encourage men to take charge of their well-being today.