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/.
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.
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.
IN 1885, ELEVEN YOUNG NUNS WITH LITTLE TO NO medical experience arrived in “bawdy” Fort Worth via horse-drawn carriage. Their charge was to staff the Missouri Pacific Infirmary. While their initial task was to tend to injured and ill railroad workers, by 1889, The Incarnate Word Order had purchased land and built a hospital that became known as St. Joseph Infirmary.1 In 1923, after a boy died from lack of medical treatment at a different local hospital, Mother Superior proclaimed that both those with means and without would have equal treatment at St. Joseph – including Black patients – when many other hospitals did not.2 During the Depression, Fort Worthians lined up for food distributed by the nuns. Renamed St. Joseph Hospital in 1966, the sisters continued staffing St. Joseph Hospital, working alongside Fort Worthʼs physicians, many of whom still have core memories of the sisters and the care provided until its closure in 2004.3
These sisters never heard the term “Social Determinants of Health,” but in Fort Worth, the nuns were pioneers of the practice. The Office of Disease Prevention and Health Promotion defines Social Determinants of Health (SDOH) as “the conditions in the environments where people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality of-life outcomes and risks.”4 The World Health Organizationʼs more simple definition is “non-medical factors that influence health outcomes.”5 These issues vary greatly and are different for every community and individual, but they each fall into one of five categories: economic stability, education access and quality, healthcare access and quality, neighborhood and environment, and social and community context.6
There is no one list of what these categories include, but the factors account for 50 to 70 percent of all health outcomes.7 The Nova Institute for Health of People Places and Planet claims that “A personʼs health . . . is determined far more by their zip code than by genetics or their family history.”8 This fact is sobering considering that Fort Worthʼs 76104, home of the Hospital District, has the lowest life expectancy in the state, first reported by UT Southwestern in 2019.9
Equitable access to timely healthcare is certainly among the SDOH that Project Access Tarrant County addresses, but since the beginning, PATC has striven to go much deeper than only access to specialty and surgical care.
The two factors most impacting SDOH for many low-income, uninsured Tarrant County patients are healthcare access and financial stability. These are inextricably linked, particularly for noncitizens who rely on their health to maintain employment and upon their continued employment for their health. Even among American citizens, the uninsured percentage of the Tarrant County (and all of Texas) population is 20 percent, double the national average; however, the percentage among Tarrant County Hispanics or Latinos is over 28.10
Healthcare access, the primary SDOH that PATC addresses, has a direct link to financial stability, especially when our intervention leads to continued or regained employment. In addition, PATC strives to identify other social determinants our patients face and address and/or refer to the best of our ability.
Primary Care In addition to the growing number of JPS neighborhood clinics, Tarrant County is home to a vital network of free, low-cost, or sliding scale clinics that provide essential primary care to the underinsured or uninsured population. These clinics are geographically scattered across the county, including locations in Fort Worth, Arlington, Mansfield, Grapevine, Crowley, and others. Most of these are community- or church-based clinics, but Tarrant County is also home to one federally qualified health clinic (with three locations) and an optometry clinic that is based on a sliding scale model but also takes private insurance.
While most PATC referrals come from these clinics (including JPS), we also receive referrals from our volunteer physicians, emergency departments, and the general public. The patients that come from places other than a primary care setting are more likely to have untreated (and sometimes undiagnosed) medical conditions. At least 28 percent of all active and pending PATC patients have diabetes and/or hypertension. Among Tarrant County Hispanics and Latinos, who comprise about 90 percent of all PATC patients, heart disease is the second leading cause of death, followed by diabetes at number six. In 2020, 30 percent of adults whose annual income was below $50,000 had not had a routine check-up in the past year. Because they lack basic primary care, they may not understand the importance of preventative medical care, or they may have other SDOH barriers. Others are simply unaware of what resources are available to them.
“Ray” recently met with PATC Case Manager Karla Aguilar. Referred by a PATC volunteer ophthalmologist who specializes in retina diseases, Ray has severe diabetic retinopathy requiring surgery. He told Karla he could barely see to work and relied on his wife to drive him everywhere. While simultaneously working on the paperwork needed for Rayʼs enrollment and surgery, Karla asked about the primary care Ray has been receiving. The answer was “none.” She helped him choose from PATCʼs partner clinics and made a direct referral. She seized the opportunity to educate him on the importance of primary care, especially with a chronic disease like diabetes. Ray seemed unaware that untreated diabetes can lead to serious health conditions, including a recurrence of his retina disease. Further into the discussion, Karla discovered that Rayʼs wife and their children, ages 12 and seven, were also without a primary care home. PATC referred the patientʼs wife to the same clinic as Ray and, since their children are citizens, referred them to a social service agency that can help them apply for Medicaid.
Healthcare Literacy Ray needed a primary care physician, but the underlying problem was not understanding its importance. Formal education isnʼt the only factor in understanding oneʼs own healthcare. Language, culture, and knowledge of resources also impact this SDOH. PATC caseworkers frequently educate patients on what many would consider common knowledge. They also empower patients to ask questions and understand their own health.
“Sandra” called former PATC Case Manager Diana Bonilla to complain about her PATC volunteer physician. “Heʼs not treating me correctly,” she vented. “I want a different doctor.” After some investigating, Diana learned that the patient was not asking any questions of the doctor (who, of note, is very well known in his field) – and the patient admitted that she felt that, as a charity patient, she did not have the “right” to ask questions about her own health. After a long conversation, Diana encouraged the patient to take written notes of what she didnʼt understand about her care and questions she had about her condition. After Sandraʼs next appointment with the same doctor, she called Diana back. She excitedly told Diana that her questions were patiently answered, she understood her diagnosis and the prescribed course of treatment, and she was thrilled to complete her care with this same physician. Healthcare literacy and patient empowerment likely prevented a patient from discontinuing her medical care. In this case, a delay of care would have had a devastating impact on her health and her familyʼs wellbeing.
Another PATC patient, “Enrique,” was enrolled in PATC for heart issues, but he also had a severe psychiatric diagnosis. His mother was his caregiver. She was often sad about her sonʼs mental health diagnoses, and, apparently as a coping mechanism, she told Diana that she had started sampling her sonʼs medication. “I want to see how it makes him feel.” Taking a deep breath (and quickly Googling), Diana explained to her that not only would his medication not make her “feel” the same way as it made Enrique feel but was also very dangerous. She read off a list of possible outcomes of taking a medication that was not prescribed to her by her doctor.
PATC also provides practical solutions to common SDOH, such as interpretation and transportation barriers. The 2022 Tarrant County Public Health Community Health Assessment reports that almost 6 percent of all Tarrant households have limited English proficiency; however, among Spanish-speaking households, that number is over 20 percent. Many non-English-speaking patients have adult family or friends they prefer to take with them for interpretation, but PATC has provided interpreters for close to one thousand medical appointments. Spanish is the main language requested, but we have also received referrals for patients who speak Arabic, Burundi, Farsi, French, Hindi, Korean, Mandarin, Mandigo, Nepalese, Persian, Portuguese, Swahili, Tanghulu, Urdu, Vietnamese, and Wolof. We provide in-person interpreters whenever possible; however, for some less common languages, we employ a national phone-based service.
Healthy People 2030’s social determinants of health. 4
Transportation is another potential barrier to care, especially in Tarrant County, where most municipalities have no public transit. While Arlington does have a rideshare program, it is the largest city in the United States with no public transportation. The cities that do have mass transit are limited and they usually donʼt cross city lines. Fortunately, most PATC patients have access to transportation. PATC can provide private rides for the ones who do not.
Vulnerable Communities Immigrants and people of color are among the most vulnerable communities in Tarrant County. Because the Tarrant County Commissionerʼs Court disallows undocumented individuals from enrolling in JPS Connection,11 the countyʼs indigent program, existing SDOH barriers are exacerbated. PATC excludes those enrolled in JPS Connection 11, so most of our patients are the undocumented, a segment PATC has dubbed the “never served” when it comes to specialty and surgical healthcare. Eighty-five percent of PATC patients are Hispanic who speak Spanish only. The remaining 15 percent are mostly undocumented patients of non-Hispanic origin. Covering racial inequality in the United States down to our own community would take years of Tarrant County Physician magazines, and the Robert Wood Johnson Foundationʼs report “What Can the Health Care Sector Do to Advance Health Equity?” gives an in-depth summary of the problems and roads to solutions for some of the factors.
One of the guiding principles of this report states, Pursuing health equity entails striving to improve everyone’s health while focusing particularly on those with worse health and fewer resources to improve their health. Equity is not the same as equality; those with the greatest needs and least resources require more, not equal, effort and resources to equalize opportunities.12
Conclusion Project Access excels at providing medical treatment, and this is, of course, why the program was created. We also enjoy showcasing the medical care provided. What we have not done as well is communicate the depth of services we offer to make sure that our patients not only have access to medical services, but that we also address the issues that have prevented the care in the first place. We are not a wide program, but we are deep. PATC will never be able to fix the global issues of inequality, poverty, and education; but we can (and do) address the issues facing our individual patients that impact their access to and understanding of their own care. Hopefully, they will possess more knowledge and tools for the next time they face a healthcare crisis.
References:
Steve Martin, “Goodbye St. Joseph Hospital.” Tarrant County Physician, 90, no. 8 (August 2012): 8-9, 16.
Regrettably, Black patients were confined to the St. Joseph basement, as were Black physicians. Riley Ransom, Sr., MD, opened the 20-bed Booker T. Washington Hospital, later known as the Fort Worth Negro Hospital and then the Ethel Ransom Memorial Hospital, in 1914. “1115 E. Terrell Ave: Tarrant County Black Historical & Genealogical Society,” TCBHGS, accessed March 2024, https://www.tarrantcountyblackhistory.org/1115-e-terrell-ave#:~:text=Booker%20T.,by%20the%20American%20 Medical%20Association.
“Social Determinants of Health,” Social Determinants of Health – Healthy People 2030, accessed March 2024, https://health.gov/healthypeople/priority areas/social-determinants-health.
Karen Hacker et al., “Social Determinants of Health—an Approach Taken at CDC,” Journal of Public Health Management and Practice 28, no. 6 (September 8, 2022): 589–94, https://doi.org/10.1097/phh.0000000000001626.
“Julia” was always worried – having a hernia so severe that it’s challenging to even walk does that to you. As is so often the case, the impact extended far beyond the pain she experienced daily – it cost the 40-year-old her freedom, her job, and her joy.
Before she was suffering with the inguinal and umbilical hernia, she worked alongside her husband of 18 years to clean apartments. It was a good job that allowed them to take care of their three children. But when she had to stop working, it put a financial strain on the family. So much so that instead of enjoying their summer vacation, Julia’s children wanted to work alongside their father.
“They always wanted to help,” she says. “Which was sad to see because they were not spending their time like normal kids would.”
Getting help was difficult, though. Julia and her husband did not have medical insurance and paying for surgery out of pocket was impossible. She was stuck, and the impact was more than physical and financial.
“My mood was always negative – I was always angry or frustrated because I was in pain,” Julia says. “I was also worried that we would lose our house and worried about my illness. I had to start being extra careful with what I did – I was always worried something would happen to me.”
As these problems continued to build, Julia realized she needed to do something. She went to Mission Arlington to see if they could help her. The doctor who saw her realized that Julia needed surgery, so they took the next step toward getting her the help she desperately needed – they referred her to Project Access.
She was enrolled in the program and connected to Dr. Mohamad Saad, a Project Access volunteer, who agreed that she needed surgical intervention. He performed the hernia repair surgery at Texas Health Arlington Memorial Hospital, and anesthesia was provided by USAP – Arlington Division.
Since having the surgery, Julia’s life has turned around. She can now “walk freely” – because she is entirely without pain. And just as she was impacted physically, the emotional healing has changed her life. Her mood is uplifted, and she is able to look at her children and their future with hope rather than fear.
Julia is grateful for Dr. Saad for providing this critical service for her, but her appreciation for him goes beyond that. “He is a very good doctor – very kind . . . He is also very funny; he was always making me laugh and making me feel better.”
Looking back at where her life was before the surgery, and the healing she has since experienced, Julia is grateful for everyone who participated in her care.
“I can’t express with words how thankful I am for everyone and their help,” she says. “God bless you all for all the of the hard work that you all put in to help me.”
“Rebecca” wasn’t looking for a miracle – she just needed to see a gynecologist. The 47-year-old mother of three was suffering from abnormal uterine bleeding. Her problem eventually became so severe that she had to quit her full-time job as a phone salesperson because she was drained emotionally and physically.
“I suffered a lot,” Rebecca says. “I was in a very dark place . . . I could not even drive because I was not well in all aspects of my life.”
But in spite of her clear need, between her financial limitations and immigration status, Rebecca was faced with a resounding chorus of “Nos” as she struggling to find the help that could turn her life around.
“I was crying all of the time because I could not find anyone to help me,” she says. “I was having constant bleeding that would last months. All I wanted was help and to be treated like a human.”
Eventually, she was able to receive mental health support through Health Services of North Texas. Through this program she was connected to a psychiatrist who began helping Rebecca manage her anxiety and depression. They also referred her to Project Access.
Dr. Carolyn Quist, a Project Access volunteer, agreed to take Rebecca’s case. After finding numerous cysts on both of Rebecca’s ovaries, she determined that they needed to be removed. She performed the surgery at Baylor Surgicare in Fort Worth, and anesthesia was provided by U.S. Anesthesia Partners.
“She took really good care of me, and she always asked how I was doing emotionally, which I believe she did not have to do, but she still asked,” says Rebecca of Dr. Quist. “She is not only an amazing doctor, but she is also a wonderful person. She explained everything to me thoroughly and patiently. I will never be able to repay all of the help she has given me.”
Currently, Rebecca is still gaining strength as her body heals, but her overall health is much improved. She has hope for the future, and gratitude for those who said “Yes” to her when she needed it most.
“Project Access is an awesome team, and I will always be thankful for their help,” she says. “Knowing that they offer help for people like me makes me so happy.”
“Patricia” has one main goal in life: to love and provide for her three young children. But when the single mother suffered from a painful umbilical hernia, it caused so much physical stress on her body that she was unable to work. And though she still trudged through family activities, the pain made her emotionally distant. Everything important to her was being compromised, and she worried about their future – especially that of her seven-year-old, who has special needs.
“The pain was bearable in the beginning, but as time went on it was getting worse, and my belly button was sticking out,” Patricia says. “I fortunately did not have to go to the ED, but I did resort to pain medication for relief.”
She knew continually taking pain medicine was not a good long-term option, so Patricia went to Mission Arlington for treatment, thinking she might have ovarian cysts. Instead, she found out about the hernia and that she would need surgery. In that moment, she was overwhelmed by fear.
“I did not have the money,” she says. “And who would take care of my kids? How would they be provided for? A lot of thoughts came racing through my mind.”
Then Patricia was connected to Project Access, and everything began to change. She realized she wouldn’t face the financial avalanche of paying for a surgery she couldn’t afford, and she was going to finally get help for the pain that was holding back every part of her life.
Now as Patricia heals from the hernia repair, she tries to put the impact into words.
“The surgery was done perfectly,” she says. “I don’t have any pain anymore, and when I have my menstrual cycle, it is normal. It is no longer heavy or overbearing. I can do anything now; I feel amazing!”
She thanks God for using the doctors and Project Access to provide much-needed care and prays that all who helped continue to be rewarded for their service. “I will always be grateful for everything Dr. Saad has done,” Patricia says. “I am so thankful for the support I received since day one and for guiding me through the process. I would not be where I am now without PATC.”
When Trey Moore, MD, started his career as a urologist in Fort Worth 26 years ago, he worked in a busy emergency department and his own private practice. In both settings, many of his patients weren’t covered by insurance and could only access stopgap care. At the same time, he was surprised by the dearth of opportunities for physicians like him to give back to their community by offering their services pro bono.
So, in 2011 he jumped at the chance to join Project Access Tarrant County, a then-nascent initiative of the Tarrant County Medical Society (CMS) that connects low-income, uninsured residents to specialty and surgical services provided by a network of volunteer physicians and facilities. Since its start, Project Access has served more than 1,700 patients and provided more than $14.5 million in donated health care.
Dr. Moore especially likes the program’s focus on surgical care, which is unique in the world of health care safety-net programs. Given his specialty, many of his neediest patients – such as those suffering from large kidney stones that cause recurring, and sometimes disabling, infections – require surgery to recover fully.
“Every [pro bono service] makes a difference, whatever we do, but [Project Access is] particularly helpful because so many of these patients – until they have a surgical resolution – are stuck in a vicious cycle of not being able to go back to work and cycling in and out of emergency rooms,” he said. “It’s a big stress on the patients and their families, and it’s a big stress on the system.”
But relieving that stress would not be possible without ongoing financial support.
Project Access is one of several long-standing recipients of the Texas Medical Association Foundation’s Medical Community Grant program, which accepts applications from county medical societies and alliance chapters for up to $7,500 in matching funds to support unique community health improvement initiatives. The separate Medical Student Community Leadership Grants program accepts applications from TMA medical student chapters for up to $3,000 thanks to a fund established by Houston pathologist Roberto J. Bayardo, MD.
For more than two decades, TMAF’s grant programs have helped the Family of Medicine tackle the state’s most pressing health care concerns at the local level. Many grantees, including Project Access, have received funding over successive years, which allows for continuous programming. Physicians like Dr. Moore say this is especially important in Texas, which has the highest rate of uninsured residents in the nation.
Not only do the grant programs connect patients to life-changing care but also they honor TMA’s mission to stand up for Texas physicians by providing them with resources to create solutions to local health challenges and by reinforcing physicians’ trusted leadership in the community, says TMA Foundation Executive Director Lisa Stark Walsh.
“Our goal is to remove the obstacle of resources for members to do what they feel is necessary in their communities,” she said. “Medical Community Grants give physicians an opportunity to chip away at long-standing, intractable problems over the long term and to demonstrate their advocacy for the health of all Texans.”
Originally founded in 1966 as the Texas Medical Education and Research Foundation, TMAF is a separate, nonprofit entity that serves as the philanthropic arm of TMA. Since 1998, the Medical Community Grant and Medical Student Community Leadership Grants programs have disbursed $891,931 across more than 200 such grants to support myriad community health improvement programs all over Texas, ranging from vaccine clinics and border health services to breast cancer screenings and kids’ bicycle helmet giveaway events.
Houston neonatologist and TMAF Board President Michael E. Speer, MD, is passionate about growing the foundation’s endowment so it can offer even more grants that support Texas physicians and their patients. “If you look at the most successful colleges and charities, the best ones spend very little on themselves and most of their endowment on supporting the organization,” he said.
This growth mindset has paid off. In recent years, TMAF has fielded increased demand for the grant programs from county medical societies, alliance chapters, and medical student chapters. As a result, the upcoming application cycle will include a new focus area of physician health and wellness. This expansion stems from the success of a recent TMAF initiative, Caring for Physician Healers: Mental Health and Wellness Resources During COVID-19 Fund, which helped seven county medical societies launch or extend physician health and wellness initiatives during the ongoing pandemic. (See “Self-Investment: Physician Wellness Programs Bolster a Beleaguered Workforce,” November 2021 Texas Medicine, pages 22-25, http://www.texmed.org/Self-Investment.)
By harnessing the expertise of medicine to help address a community health problem, the TMAF grant programs complement the work of the association and represent the best of organized medicine, says TMA President-Elect and TMAF board member Gary Floyd, MD.
“Anyone in practice will find things that need to be changed,” he said. “When you’re alone or in a small group, you’re just a small voice yelling into the wind with very little result. When you join into organized medicine, particularly with TMA, you have [more than] 55,000 voices, and people tend to start listening.”
Physician-driven results Tarrant County Medical Society received its eighth TMAF Medical Community Grant in support of Project Access in 2021. The program’s organizers say it is a prime example of what physicians can accomplish working together to solve an entrenched community health problem. Tarrant CMS was inspired by the Dallas County Medical Society’s now defunct Project Access initiative, which focused on primary care. Given Tarrant County’s robust network of free and income-based primary care clinics, Tarrant CMS decided to gear its own Project Access initiative toward specialty and surgical care since that’s where the need was most acute.
Tarrant CMS Executive Vice President and CEO Brian Swift says Project Access runs on a shoestring budget that belies its impact. Patients are largely members of the working poor, and many are undocumented immigrants. They don’t qualify for Medicaid but typically don’t earn enough to afford private insurance, leaving them without coverage and beholden to emergency departments for symptom management. Without care that addresses the root cause of their medical problems, however, they are often robbed of their livelihoods – and sometimes their lives.
By providing specialty and surgical care to eligible Tarrant County residents, the initiative not only helps patients resume healthy lives but also saves area hospitals tens of thousands of dollars in emergency department costs. “These patients don’t have access anywhere else,” said Stuart Pickell, MD, Project Access’ medical director and an internist-pediatrician in Fort Worth.
Although physician volunteers provide specialty and surgical care, Project Access still requires funding to fulfill its mission. “Free isn’t free,” Mr. Swift said.
As with previous awards, the county medical society used the TMAF funds to offset the costs of its annual patient database subscription. “Data management does not come cheaply, so we really depend on that [funding] to be able to manage our Project Access database,” Mr. Swift said.
The grant-funded database – which Dr. Pickell describes as “essential” – allows staff to determine patients’ eligibility, which helps ensure Project Access is distributing its limited resources as judiciously as possible, and to track their care, including the donated value of medical services and administrative costs. In this way, the grant helps Project Access obtain more funding by quantifying its positive impact and cost savings.
Armed with the database, staff can focus on serving patients – and the broader community. Typical cases include a woman with cervical cancer who would have died without surgery, leaving her young children orphans; a construction worker with a hernia that kept him out of work; and a patient with osteoarthritis that had nearly disabled her until surgery allowed her to resume a productive life.
The Project Access model not only unburdens its patients and their loved ones from medical crises but also often allows them to return to work. This can be transformative, Dr. Pickell says, because a job offers the possibility of long-term health care access through employer health insurance.
After a decade of success, staff are now working on growing the program. With more than 500 volunteer physicians across numerous specialties, including ancillary care, their attention is focused on the limiting factor of operating room space and other facility needs. By renting such space, rather than relying on the whims of donors, Project Access can increase its patient volume.
Physicians would welcome such a change. “It’s such a gracious group of people,” Dr. Moore said. “They’re so grateful to get help. In a selfish way, it’s a great group to treat.”
Project Access also is keen to expand, both to meet the community need and to highlight the work physicians do every day to serve their patients. It’s supported in this endeavor by TMAF’s Medical Community Grant program, which allows physicians to spearhead solutions to the problems they’re facing on the ground.
“That’s why it’s so important for the foundation to continue doing what it does,” Mr. Swift said.
An engine for innovation Another repeat recipient, in this case of the TMAF Medical Student Community Leadership Grants program, the annual HOPE Health Fair in Galveston tackles a community health challenge while also providing medical students with the opportunity to fine-tune solutions over the long term.
The University of Texas Medical Branch (UTMB) TMA Medical Student Section chapter hosted its fifth annual event in November thanks, in part, to its fourth annual TMAF grant award. The fair connects approximately 250 uninsured Galveston residents – around a quarter of whom are homeless – to vaccinations, health care screenings, meals, and educational resources through the St. Vincent’s Student Clinic at UTMB. It also serves as a critical outreach opportunity in Galveston County, where 17.4 percent of residents under age 65 lack health insurance, according to the U.S. Census Bureau.
“We’re just catching ships in the night, people who frequently never have access to health care,” said John W. Davis, one of the event’s organizers and a third-year medical student at UTMB who also is pursuing a PhD.
The HOPE Health Fair received a $3,000 Medical Student Community Leadership Grant from TMAF in 2021, which covered about 40 percent of the overall cost. Without it, organizers would not have been able to host the event. “It’s very helpful for us to get this grant each year,” said Jenna Reisler, a third-year medical student at UTMB and an event organizer.
In addition to providing critical funding, the grant also has spurred innovation. Because the organizers are repeat recipients of the grant program, they take pains to improve the event each year. In 2021 they used the award to offer rapid COVID-19 testing and screenings for sexually transmitted infections, including HIV and hepatitis C.
By offering screenings, the organizers not only help attendees detect any debilitating illnesses they might have contracted but also prompt them to return to the student clinic to get their results and receive treatment. Once attendees have made the jump from the health fair to the student clinic, they can receive treatment for underlying health problems, such as diabetes and hypertension, and start to build patient-physician relationships.
In this way, the health fair functions as a kind of benevolent Trojan horse, linking Galveston’s most vulnerable residents to health care for years to come. “It’s a way to show people that we care about them,” Mr. Davis said.
Global reach Located in a top U.S. county for refugee resettlement, the Baylor College of Medicine (BCM) TMA Medical Student Section chapter and the Houston nonprofit Alliance for Multicultural Community Services have used the TMAF Medical Student Community Leadership Grants program to host the BCM-Alliance Refugee Health Fair. The annual event helps refugees navigate the local health care system – and provides medical students a glimpse at global health in action.
Like the HOPE Health Fair, the BCM-Alliance Refugee Health Fair aims to serve as a conduit for attendees to long-term health care access. At an upcoming event scheduled for this spring, student volunteers will distribute hygiene kits – including soap, hand sanitizer, masks, and health care resources in multiple languages – via a COVID-19-safe drive-thru. Attendees also will receive basic preventive health screenings and flu vaccines from local free and income-based clinics.
Although refugees can access Medicaid for up to eight months upon their arrival in the U.S., they are expected to secure private insurance afterward. This is a complicated process that can quickly fall to the bottom of a refugee’s to-do list, overtaken by tasks such as learning a foreign language, securing a job, and familiarizing oneself with the local public transit system. But the BCM-Alliance Refugee Health Fair aims to smooth attendees’ search for health care by introducing them to the Alliance and area clinics.
“Ultimately, even if these patients don’t stay on with these clinics, they at least have a starting-off point to return to if they develop a medical issue in the future,” said Avery Haugen, a fourth-year medical student at Baylor and one of the event’s organizers. “It really alleviates a lot of the stress of those first steps.”
The Baylor TMA student chapter will use its latest TMAF grant – its fifth – to print promotional flyers, purchase hygiene kit supplies, and furnish volunteers with personal protective equipment. The grant, which accounts for nearly all of the event’s budget, is critical to its success.
“This event is really not possible without the help from the TMA Foundation,” said Chris Wong, a fourth-year medical student at BCM and another event organizer.
In addition to educating refugee attendees about the local health care system, the event also serves as a critical learning experience for the medical students involved. Both Ms. Haugen and Mr. Wong are interested in global health, which is partly what prompted them to get involved with the fair.
“The event was really my first exposure to the idea of refugee health [and] the very specific health disparities that immigrants face, especially in our very complicated health system,” Mr. Wong said.
Similarly, Ms. Haugen sees the event as a unique opportunity to learn more about global health while studying medicine in Houston – and largely prohibited from international travel by the ongoing pandemic.
“For us, the refugee health fair is a really unique example of a way to promote global health on a local scale,” she said.
Concerned about those in Tarrant County who go without healthcare or who are forced to get emergency care because they cannot afford necessary medical treatments? Consider joining Project Access Tarrant County’s Lunch and Learn on April 20 from 11:45 to 1pm. At this event, you will have the opportunity to:
Learn how we are making a difference for Tarrant County’s low-income uninsured residents
Hear from our staff, physician volunteers, and patients
See how we provide healthcare services for those in greatest need and how our new initiative will expand services
You can register for this free event here. It is targeted toward those who work in healthcare and everyone who is passionate about helping the underserved of our community.
Project Access Tarrant County, which was founded in 2010, is a non-profit organization dedicated to expanding health care access and improving health outcomes for low-income, uninsured residents of Tarrant County, utilizing the charitable gifts of a network of existing voluntary providers and collaborative partnerships.
To date, Project Access has:
Scheduled 10,500 medical appointments
Enrolled over 2,100 patients
Provided over $18 million value in donated medical care
Performed 810 surgeries and hospital procedures
Their vision is for all Tarrant County residents to have access to a continuum of care, which includes specialty, pharmacy, laboratory, ancillary, and hospital care. Come on April 20 and see how you can partner with Project Access to bring healing and hope to those who most need it.
“It was stressful knowing I was not going to make ends meet.”
When “Roberto,” a 49-year-old husband and father of two, began experiencing a burning pain in his torso from an inguinal hernia, he knew he needed to do something about it. Throughout the day it would grow in intensity, making it difficult for him to work. Roberto’s hours were cut, and he eventually had to take an entire month off of work.
“I could not do anything,” he says. “I was falling into a hole of depression.”
The family was experiencing tension from the economic burden, and it was impossible to consider surgery with the financial struggles they were facing day to day. Then, he went to Cornerstone Clinic, where he was referred to Project Access.
“I am very thankful for Dr. Siadati, who was very attentive, respectful, and patient,” says Roberto. “I especially appreciated the patience Dr. Siadati showed when it came to the language barrier we had.” He thanks everyone who made his treatment possible, from those working the front desk to his doctor.
Since the surgery, Roberto has been improving steadily, and he was just cleared to return to work. He is optimistic about the future – he doesn’t feel stuck anymore in the cycle of pain and frustration. “It was a blessing, the entire process.”
Tarrant County Physician Online 