Tarrant County Phyician – Tarrant County Physician Online

Physician Wellness

Tarrant County Physician Wellness Program: Addressing Burnout and Promoting Resiliency

by Casey Green, MD

THE TARRANT COUNTY MEDICAL SOCIETY IS launching a new wellness initiative available to medical society members and their families. We recognize the challenges associated with an ever-changing landscape in healthcare exacerbated by the COVID-19 pandemic that contribute to stress, burnout, and job dissatisfaction.

Modeled on the successful program at Travis County Medical Society, the Tarrant County Medical Society Wellness Program seeks to proactively address those among us who may be struggling. We have a mission to enhance the health of physicians, their families, and the communities in which we all live and work.

Physician burnout, the apparent catalyst to this situation, is considered a psychological response that may be experienced by doctors exposed to chronic situational stressors in the healthcare practice environment. It is often characterized by overwhelming exhaustion, feelings of cynicism and detachment from work, and a sense of ineffectiveness and lack of accomplishment.1

Physicians experiencing burnout, according to the medical literature, exhibit a wide array of signs, symptoms, and related conditions, including fatigue, loss of empathy, detachment, depression, and suicidal ideation. Nearly 25 percent of physicians surveyed last year were experiencing clinical depression. There were also significantly increased rates of depression among their family members.2

The most cited reasons for burnout include too many bureaucratic tasks, decreasing autonomy, increased work hours, and recent additional contributing factors related to COVID-19. Of those physicians experiencing burnout, more than half report it is strongly affecting their daily life and more than two thirds acknowledge impairments in relationships.2

Physicians often have to deal with difficult and tragic situations and losses. This continued exposure to human suffering can have a significant impact on mental and emotional wellbeing over time that often goes unrecognized.

Burnout is not always related to stressors arising in a work environment or to an individual’s character traits. Family issues, personal and professional relationships, financial pressures, insufficient work-life balance, or other external stressors may also contribute. Efforts aimed at the identification, treatment, or prevention of burnout must, therefore, approach the issue from a broad enough perspective to take all of these factors into account.

Too many physicians are reluctant to seek help for fear that they will be perceived as weak or unfit to practice medicine by their colleagues or employers, or because they assume that seeking such care may have a detrimental effect on their ability to renew or retain their state medical license.

The TCMS Wellness Program has developed relationships with community therapists who work with physicians or their family members to help them back on the path to wellness. These services will be confidential and paid for by this program for the first four sessions for any members or their families.

The goal of this new initiative is to provide information and resources to support physicians and their families in order to encourage and inspire each other to practice physical, mental, emotional, spiritual, and social wellness. The program is in its final formation steps, and we hope to meet these needs with workshops, mentorship, education, and other activities to promote healing, growth, and resiliency. We are excited about the future and will share more details as the program grows.

You can find more information about how to access the program at www.tcms.org/TMAiMis/Tarrant/Wellness or call 972-449-0762.

References

1. Maslach, C., Jackson, S.E. (1981). The Measurement of Experienced Burnout. Journal of Occupational Behavior, 2(2):99-113. See also, Maslach C, Jackson SE, Leiter MP. (1996). Maslach Burnout Inventory Manual. 3rded. and Maslach C, et al. (2001). Job Burnout. Annu Rev Psychol, 52:397–422

2. Kane L. ‘I Cry but No One Cares’: Physician Burnout & Depression Report 2023. Medscape. Published January 27, 2023. Available at: https://www.medscape.com/slideshow/2023-lifestyle-burnout-6016058.

Public Health Notes

Health Equity Through a Public Health Lens

by Catherine Colquitt, MD, Tarrant County Public Health Medical Director, and Yvette M. Windgate, ED.D.

This article was originally published in the March/April issue of the Tarrant County Physician.

As we turn the page on 2022 and our “tripledemic” surge recedes, let’s take a moment to reflect on health equity and disparities through the crucible of COVID-19.

Healthy People 2030 defines health disparities as “a particular type of health difference closely linked to social economic, and/or environmental disadvantage.” It further asserts that health disparities “adversely affect groups of people who have systematically experienced greater obstacles to health based on their racial or ethnic group, religion, socioeconomic status, gender, age, mental health, cognitive, sensory, physical disability, sexual orientation or gender identity, geographic location, or other characteristics historically linked to discrimination or exclusion.”1 Our collective goal is health equity, described by Healthy People 2030 as “the attainment of the highest level of health for all people.” Achieving health equity requires valuing everyone equally, with focused and ongoing societal efforts to address avoidable inequalities, historical and contemporary injustices, and the elimination of health and health care disparities.”1

In the early 2000s, U.S. Surgeons General began to issue reports on disparities in tobacco use and access to mental health care based on racial and ethnic demographics. Since those ground-breaking reports, issues including infant mortality, pregnancy-related seats, chronic disease prevalence, and overall measures of physical and mental health have been examined through the prism of health equity. Part of the impetus of the Affordable Care Act (ACA) was to provide strategies for securing access to healthcare for traditionally underserved groups. Impactful gains were made in numbers of persons insured and access to higher quality care. However, those gains were somewhat eroded in the former presidential administration by cuts to funding for AVA navigators and outreach efforts, and the authorization of state waivers, which allowed some states to decline Medicaid expansion by instead offering their own wavers.

COVID-19 further impacted healthcare coverage losses through lost jobs and wages, resulting in increasing economic hardships, housing difficulty, and food insecurity, disproportionately affecting Black and Hispanic workers, especially those in essential in-person jobs (i.e., transportation, manufacturing, grocery, pharmacy, retail, warehouse, food processing, and healthcare). Due to healthcare workforce shortages and operational changes (e.g., video clinic visits requiring patients to have internet access), these same groups also experienced challenges to healthcare access.

During COVID-19, certain groups (i.e., Alaskan Native, American Indian, Black, and Hispanic individuals) experienced higher death and illness rates than their White or Asian counterparts, likely due in part to their work in essential jobs, higher prevalence of preexisting comorbidities for poor COVID-19 outcomes, use of public transportation, and crowding at work or home.

Additionally, according to the Kaiser Family Foundation’s survey data (The Undefeated), Black adults are more likely than White adults to report certain negative healthcare experiences, such as a provider not believing them, or refusing a test, treatment, or pain medicine the patient believed he or she needed. the Undefeated survey data revealed that Black and Hispanic individuals were less likely to have been vaccinated against COVID-19 as of April 2021. While vaccination rates against COVID-19 have risen on all ground, the gaps between White, Asian, Black, and Hispanic demographic groups have not narrowed. The effect of the health disparities laid bare by COVID-19 has been profound and predated the pandemic. For example, in 2018, the average life expectancy was four years lower in Black individuals than in White individuals, with the lowest life expectancy in Black men. That unfortunate trend continues today. In Tarrant County, the 76109 zip code in Fort Worth, a majority White neighborhood, holds a life expectancy of 82.4 years. Nearby 76104, host to historically Black neighborhoods, like Morningside, has a life expectancy of 66.7, and it is even lower for Black men at 64 years.

What can we do to address these disparities and improve the health of our county and county? The Biden administration has prioritized initiatives aimed at addressing health disparities at the federal level through several executive orders and proclamations. Locally, Tarrant county Public Health (TCPH) has created a Community Health Equity and Inclusion (CHEI) division to promote health literacy and address health equity issues concerning county residents, with the greater goal of decreasing health disparities and inequities in Tarrant County. The CHEI division educates residents and public health professionals regarding health disparity and inequity issues and engages community partners (i.e., Fatherhood Coalition of Tarrant County, Mental Health Connection of Tarrant County, My Health My Resources of Tarrant County, United Way of Tarrant County, and Brave/R Together) to find solutions that promote diversity and health equity.

TCPH continues to collaborate with community partners on annual events, such as the African American Health Expo, the North Texas Wellness Fair, and the Senior Synergy Expo. We are also participating in community celebrations, school events, and COVID-19 testing and vaccination pop-up clinics. Recently, TCPH and fifty-sic agencies- including hospital systems, institutions of higher education, city and county governmental entities, charitable organizations, and faith-based organizations- have joined forces as the Tarrant County Unity Council. This council’s purposes are:

To identify and address health equity challenges for those disproportionately affected.
To build, leverage, and expand fair resource allocation to safe, affordable, and accessible health, housing, transportation, and communication that advance racial equity and address other inequitable social conditions, with the purpose of reducing or eliminating health disparities and health inequities.

References:

Health Equity in Healthy People 2030, https://health.gov/healthypeople/priority-areas/health-equity-healthy-people-2030
L Hamel et al, Kaiser Family Foundation: Key Findings from the KFF/Undefeated Survey on Race and Health 10/2020
Life Expectancy by ZIP code in Texas, https://www.texashealthmaps.com/lfex
Tarrant County Public Health, Family Health Services, Community Health Equity and Inclusion, Community Involvement, https://www.tarrantcounty.com/en/public-health/family-health-services/health-equity–community-outreach/previoud-activities.html?linklocation=Button%20List&linkname=Community%20Involvement
Tarrant County Unity Council, https://www.tarrantcounty.com/en/public-health/family-health-services/health-equity–community-ooutreach/tarrant-county-unity-council.html

STUDENT ARTICLE: ADVOCACY FOR PATIENTS’ MENTAL HEALTH

by AIYANA PONCE, OMS-II

This article was originally published in the March/April issue of the Tarrant County Physician.

HISTORICALLY, STIGMA AGAINST MENTAL HEALTH, ACCESS to care, and discrimination contribute to worsened health outcomes. This is especially true for certain racial or ethnic groups such as those made up of Black and Hispanic individuals, as there are culturally negative views on mental health symptoms and/or treatment, a fear of mistrust of the medical community due to historical discrimination or mistreatments, or lack of access to mental health services.

To help address this, the Lay Mental Health Advocates (LMHA) program was created. This free, virtual training program is designed to teach laypersons the fundamentals needed to advocate for someone who is dealing with mental illness. LMHA focuses on teaching mental health advocacy by understanding how social determinants worse mental health and play key roles in overall health outcomes for marginalized communities. The social determinants of health are defined by the U.S. Department of Health and Human Services as “the conditions in the environments where people are born, love, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks.”

LMHA began as a volunteer project during my time as a research trainee at the National Institute of Allergy and Infectious Diseases before beginning medical school. In addition to conducting experiments in a traditional laboratory setting, I was a fellow of the National Institutes of Health Academy. This program allowed me to meet other trainee scientists equally as passionate about patient advocacy. Ultimately, the goal of this program was to implement a volunteer project that addresses health disparities in the local community.

We saw a need for interventional programs to fill the mental health gap that is particularly prevalent among marginalized communities. Our program consists of a weekly online workshop led by psychiatry residents or attendings from Duke University Hospital and local community leaders. they include interactive role-playing advocacy practice, case study reviews, and other informative components. Our eight-week-long program was modeled after the Johns Hopkins Medicine Lay Health Advocate Program and the Mental Health Allyship Program. Through LMHA, advocates can identify several different mental health conditions, gain a greater understanding of the factors that exacerbate health disparities, understand how to provide effective emotional support, and gain confidence in the role they can play in the lives of their community members by BEING mental health advocates.

The pilot program took place during Spring of 2021, and we had 100 participants whose ages ranged from 18-58. We are now on track to our third workshop series, with participants from across the county. In addition to that, we are currently expanding our team, working on our non-profit application, and establishing a volunteer program to work with the Duke Behavioral Health Inpatient Unit.

Watching this program grow beyond anything my team had imagined has been very rewarding. I wanted to share this journey with those of you reading to encourage you to continue advocating for yourself, your patients, and your community. If you ever see a problem that needs to be addressed or a gap that needs to be filled, just go for it- you never know what may come of it.

References:

1. https://www.psychiatry.org/patients-families/stigma-and-discrimination

2.https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-020–08964-3#ref-CR28

3 . https://health.choc.org/understanding-the-role-of-cultural-stigma-on-seeking-mental-health-services/

4.https://health.gov/healthypeople/priority-areas/social-determinants-health

PRESIDENT’S PARAGRAPH

by Stuart Pickell, MD, TCMS President

This article was originally published in the March/April issue of the Tarrant County Physician.

Why Do We Not Have a Pediatric Residency Program in FORT WORTH?

WHEN I MOVED BACK TO FORT WORTH in 2001, I wondered why we had so few graduate medical education (GME) programs. I came to understand, from those who should know, that Fort Worth simply wasn’t an “academic” city. We had one of the finest osteopathic medical schools in the country, several excellent medical centers, and a fine children’s hospital, but relatively few residency positions for a city our size. In 2011, the Texas Legislature, concerned that the physician workforce would not keep pace with Texas’ rising population, established a goal of 1.1 residency training positions for every Texas medical school graduate. Physicians often remain near where they train, so the reasoning was and continues to be sound. Achieving and maintaining this goal helps to build and sustain the physician workforce.

Fortunately, with no help from Tarrant County, Texas achieved its goal in 2017 (see Table 1). However, the impending graduation of student from new medical schools in the next two years will increase the demand for PGY-1 positions. the Burnett TCU School of Medicine will graduate its first class in May. A year later the Sam Houston University College of Osteopathic Medicine and the University of Houston College of Medicine will graduate their first classes. By 2024, to maintain the minimum 1.1 ratio, Texas will need to increase the number of residency positions by 5 percent, and to maintain its current 1.16 ratio, it will need to increase the number of positions by 10.8 percent.

In the last few years, Tarrant County’s medical community began meeting the challenge by starting several new residency programs. This is a welcome, albeit long overdue, development. Baylor Scott and White and Texas Health Resources have led the way to these recent changes by starting programs in internal medicine, ob-gyn, emergency medicine, and general surgery- this in addition to the programs already established at John Peter Smith and Medical City. The elephant in the room is pediatrics.

Why does Fort Worth, the 13th largest city in the country and home to the 13th largest children’s hospital, not have a pediatric physician residency program? I include the word “physician” because Cook children’s does have a pediatric residency program for nurses. In fact, it has one of the only 34 such programs in the country, but it does not have a program to train physicians- and its the only children’s hospital that has a program for nurses and not physicians. But as the population grows, won’t we need more pediatricians? Regional growth trends suggest we will. For instance, in just the last five years:

• The U.S. population increased by 2.7 percent

• The Texas population increased by 5.8 percent

• The Fort Worth population increased by 9.3 percent

• Fort Worth went from being the 16th to the 13th largest city in the country

• The number of PGY-1 pediatric residency positions in Texas increased from 211 to 213, or 0.95 percent

Looking at the 30 largest cities in the United States, Fort Worth is the only one that doesn’t have a pediatric residency program. Jacksonville, FL, which ranks just ahead of Fort Worth in population, for now, has a pediatric residency program, and it doesn’t even have a medical school. Fort Worth has two medical schools.

Within Texas you will find residency programs in the larger cities – Houston, San Antonio, Dallas, and Austin – but you will also find them in El Paso, Corpus Christi, Lubbock, Temple, Galveston, and Amarillo. The only other cities in Texas that have a medical school and no pediatric residency program are College Station, Edinburgh and Conroe. So, why not Cook Children’s?

I’ve asked this question to more than a few people affiliated with Cook Children’s – some who would like to see a physician GME program and others who would not. While they disagree on the proposition, they generally agree on the historical timeline and current sentiment. Cook Children’s, the result of a merger of Fort Worth’s two children’s hospitals in the 1980s, had a unique vision from its inception. Like many large children’s hospitals, it offered state-of-the-art care for pediatric patients, but it also vowed that patients would only be treated by board-certified pediatricians, i.e., no students or residents. Since most of Fort Worth’s hospitals didn’t have GME programs, Cook Children’s was not an outlier.

What made Cook Children’s particularly unique was its size and resources combined with its lack of GME entanglements. Cook Children’s leveraged this latter feature to recruit physicians who wanted to be clinicians, not educators. A vocal minority of the current medical staff have embraced this feature and do not want it to change. There is also a vocal minority who knew Cook Children’s wasn’t an academic institution when they joined but believe now that it should be. Many others – probably a majority, although no formal vote has been taken – would be fine with a GME program if one existed, but they could go either way.

In recent years, the subject has been revisited several times. About five years ago, Cook Children’s hired Germane Solutions, a GME consulting firm, to examine the viability of a GME program and assist in its development. Their findings are proprietary, but the consensus of the people with whom I talked is that Cook Children’s is positioned to have an outstanding GME program if it wants one. Furthermore, it would enhance the hospital’s national profile and be a financial boon to the local economy. But the success of a GME program hinges on having a medical staff who supports it. One vocal minority does, the other does not. And while the support doesn’t need to be unanimous to make it work, it wasn’t clear that enough of the middle majority supported it to the point it would reach the critical mass needed to make it worth pursuing.

Some theorize that demand for more pediatric residency positions among graduating medical students is lacking, and there is some truth to this claim. In the 2021 match, there were 1.47 pediatric PGY-1 positions for every graduating U.S. medical student who applied for one. But this doesn’t tell the whole story. Between 2016 and 2021, a concerning trend emerged. While nationally the number of pediatrics PGY-1 positions increased by 6 percent there was a 14 percent decrease in the number of U.S. medical graduates applying for them.

Fortunately, foreign medical graduates have filled the void, resulting in a match-fill rate consistently over 98 percent, which makes pediatrics appear both desired and competitive. But shouldn’t the decreased domestic interest in pediatrics provoke more questions? Why are U.S. medical students not considering pediatrics?

One perennial concern is low pay relative to other specialties, including pediatric subspecialties. As one of my residency attendings used to quip, “Little people, little money.” This must be on the minds of even the most altruistic of medical students for whom the average student loan debt upon graduation is over $200,000. But perhaps students everywhere are picking up on a trend that Cook Children’s is actively embracing- a hidden curriculum embedded in the cook Children’s philosophy as evidenced by the presence of a residency program for nurses but not physicians, that the future of primary care pediatrics is really nursing.

“Baylor Scott and White and Texas Health Resources have led the way to these recent changes . . . this in addition to the programs already established at John Peter Smith and Medical City. The elephant in the room is pediatrics.”

I hope this is not the case, because while value the contributions that nurses and APPs bring to the clinical care team, their training is qualitatively and quantitatively different from that of a physician. These teams should be supervised by physicians, and those physicians need to be trained… somewhere.

Why no Cook Children’s? Medical staff aside, they have the resources. So, how many attendings does Cook Children’s need to reach the critical mass necessary to start a residency program for physicians as well as nurses. A hospital with their resources could have a large residency program. To make a comparison, Children’s Hospital of Los Angeles is roughly the same size as Cook Children’s could start with eight, the same size as Texas Tech’s program in Lubbock. considering that physicians often practice where they train, could Cook Children’s not do this for the community’s sake?

The Cook Children’s Health Care System and its flagship hospital are. a well-kept secret that will not reach its full potential until It becomes an academic training facility with education and research affiliations. To illustrate this, U.S. News & World Report ranks the top 50 children’s hospitals in 10 different specialties. Most hospitals comparable to Cook Children’s rank in nine or 10 of these specialties, often in the top 30. Cook Children’s ranks in only six, the highest being neurosurgery at 20. The others come in at 38, 41, 43, 48 and 50.

The hospital website states: “As one of the fastest growing areas in the United States, Cook Children’s is continually looking ahead to meet the needs of a very diverse population.” No one will argue with this. Cook Children’s is one of the finest children’s hospitals in the United States. As a city and as a medical community we should be- and are- proud of it. But can it not look further ahead and become home to one of the finest pediatric residency programs as well? Becoming an academic center will enhance its national profile and bolster the pediatric workforce in Texas by exposing students to high-quality pediatric primary care and specialty services early in their training, while providing an exceptional place for them to continue their training and work after they graduate.

Most things worth doing require effort. Starting a new residency program is no exception. Some physicians to me that now is not the right time, that in the wake of COVID-19 they don’t have the bandwidth for it. But will there ever be a “right” time? wll there ever be a time when the stars in heaven align, and there is a unanimous agreement that the time has arrived?

First century rabbi Hillel the Elder once said, “If I am not for myself, who will be for me? If I am only for myself, what am I? If not now, when?” Indeed. Given the need and the benefit to the community, perhaps now is the right time after all.

References:

1. The Texas Hospital Association’s educational series on hospital finance: “Graduate Medical Education, Part 5” – https://www.tha.org/wp- content/uploads/2022/04/Financing_GME_FI- NAL.pdf

2. Data for 2011-2019 may be found in a paper written by the Academic Quality and Workforce of the Texas Higher Education Coordinating Board: “The Graduate Medical Education (GME Report: An Assessment of Opportunities for Graduates of Texas Medical Schools to Enter Residency Programs in Texas.” This was a report to the Texas Legislature per Texas Education Code, Section 61.0661, October 2020, p.x.

3. See: The Kaiser Family Foundation website: https://www.kff.org/other/state-indicator/total-medical-school-graduates/

4. See: https://www.residencyprogramslist.com/ in-texas

5. “The Graduate Medical Education (GME) Report: An Assessment of Opportunities for Graduates of the Texas Medical Schools to Enter Residency Programs in Texas.” October 2020, P. 17

6. Cook Children’s Hospital consistently ranks between the 10th and the 18th largest children’s hospital in the United States depending on whether we are looking at licensed beds, staffed beds, and when the reporting was obtained.

7. See U.S. Census data at: https://www.census. gov/
8. See data from the National Residency Matching nrmp.org/
9. Not surprisingly, every U.S. city with more than one medical school has a pediatric residency program, except Fort Worth.
10. Information obtained for this article synthe- sizes conversations I had with 10 different people, all of whom are knowledgeable of Cook Children’s Medical Center (CCMC) and the movement to develop a physician residency program. Because of the sensitive nature of this topic, I promised that I would not reveal their names or quote them directly but would make a good faith effort to com- municate their understanding of the issue. They did not all agree on whether CCMC should pursue a residency, but they did agree on the major points outlined in the article. Of the 10, eight are or were employed by CCMC, almost all in leadership posi- tions. Three of those have retired and five remain on staff. The other two, both physicians, are lead- ers in the medical community and/or at CCMC and in a position to speak to this topic.
11. See: https://educationdata.org/average-medi- cal-school-debt
12. See https://health.usnews.com/best-hospitals/ pediatric-rankings
13. See: https://www.cookchildrens.org/about/ history/
14. Mishnah Avot 1:14. See: https://www.sefaria. org/Pirkei_Avot.1.14?lang=bi

PRESIDENT’S PARAGRAPH

by Stuart Pickell, MD, TCMS President

This article was originally published in the January/February 2023 issue of the Tarrant County Physician. You can read find the full magazine here.

IT IS AN HONOR AND A PRIVILEGE TO serve as president of the Tarrant County Medical Society for 2023. I aspire to lead as ably as those who have preceded me and to move the ball forward on the many priorities we have as physicians and citizens of Tarrant County. To that end, I posed several questions at the installation event in November that I will follow up on this year, using this space as a launchpad for discussion. At the root of these questions is identity- our identity as physicians and leaders in our community.

For many physicians, and I know this is true for me, there is a sense that, like Harry Potter’s wand, we didn’t choose medicine- it chose us. We have a sense of “calling” to the profession, as if by something external to us or deep within us- either way, something so profound and unknowable that it may defy articulation.

The language of “calling” resonates with nem although for me it was problematic because I had two. When I was five years old, I told my family that when I grew up, I was going to be a minister, a doctor, and a fireman. I have done all three. Firefighting didn’t stick.

What did stick was ministry and medicine. I hoped it would be one or the other, but it never was. In college, I took classical greek and 400-level biology and chemistry courses and majored in history because I liked it. i sought advice from people I respected who were ministers and physicians and they all said the same thing: If you’ve ever thought about doing something besides ministry or medicine, do that instead. As my wife would say, “Hmmmm.”

Years later, and several years into a full-time ministry position, I told a parishioner about my dilemma. He also happened to be a therapist, which only reinforced my commitment to Calvinism. After patiently listening to me explain all the reasons why it wasn’t practical to do both, he looked at me and asked, “Why not?”

Hmmmm.

Ministry and medicine are similar. They are both vocations in the truest sense of the word, a word derived from the Latin vocare, which means “to call.” Both are professions to which the people in them tend to feel a sense of calling that compels and propels them to serve.

It makes sense that medicine, as a profession, would be hardwired toward serving others. After all, our calling first had to be validated by a medical school that saw in us what we saw in ourselves. We had to be chosen by someone else to become part of a tribe. Do you remember how you learned that you had been accepted to a medical school? I do. I got a letter. I think it’s fitting, however, that student admitted to TCU’s Anne Burnett School of Medicine literally get a call- by telephone- telling them the good news. And admissions committees seek candidates who have integrity and demonstrate empathy; people who are team players and servant leaders. This is and always has been at the core of our identity as physicians.

How we grow into that identity, and how our call to serve becomes manifest, will be as unique as each one of us. People who are called are called not just to be but to do- to apply their knowledge and expertise in a unique and meaningful way. In a way, physicians don’t have a career so much as a mission- which, at the risk of sounding pedantic, comes from the Latin word mitterre, which means “to send.” The English word is rooted in medieval Christianity, but today’s “mission” is more likely to describe the driving principles of an individual, or a business, or a non-profit group or a healthcare institution. it speaks to their identity, their raison dêtre. We are called, and we are sent, sent on a mission to serve the people in our charge- our patients- and the community in which we all live.

So, how are we doing? Are we fulfilling our mission? In many ways, we are doing quite well. We have excellent physicians in just about every specialty. We have fine institutions for adults and children and one of the best county health systems in the country. But we still have pressure points. How does the execution of our mission, individually and corporately, impact the larger community- not just us or our practices or our institutions but the people we have been called to serve?

Throughout the year I will use this space to explore this question, examining our individual and corporate roles and responsibilities as physicians in the hope that doing so will promote a constructive dialogue that furthers our mission to serve the larger community. Some of the pressure points I see and hope to explore include:

- The inadequacy of Graduate Medical Education in Fort Worth, and especially at Cook Children’s Health System. The Cook Children’s Health System and its flagship hospital are among the finest in the country. It has excellent leadership and medical and support staff. But would the community not be better served if it leveraged this prestige and became an academic center as well, training physicians and pediatric specialists who, by the way, often practice near where they train?

- Lack of access to the county healthcare system for undocumented county residents. Undocumented residents can receive emergency care at a reduced rate (which is often still too expensive for most) but are ineligible for the preventive care that might have averted the need for emergency services in the first place. Even Project Access can’t access county health facilities for use by our member physicians who are willing to donate their time and expertise to do necessary but non-emergent procedures.

- Lack of physician input in the assessment, planning and implementation of strategies to address community healthcare needs and crises. Such planning should start with physicians, the people in the community who know the patients personally and who, because of these relationships, the patients trust to act in their best interest. COVID – a crisis made worse by its politicization – quickly devolved into divisive rhetoric that led to a profound mistrust of medical authorities, especially at the national level. Our member physicians voluntarily stepped into this nightmare. We partnered with neighboring county medical societies and aided the local health authorities with its media information operations, providing an honest assessment of available information to inform and educate physicians and the public. And yet, when it came to planning and implementation, the local authorities turned to non-clinical hospital leadership for input and direction.

Working together to address challenges and overcome obstacles is the center of our mission, a mission that emanates from a calling, a calling that forges our identity as physicians. What makes our calling and its ensuing mission so important, and our profession so rewarding, is the relationship we share with each patient – one that is founded on empathy, trust, and mutual respect. It’s the one thing that remains constant in the chaos, because when our patients don’t trust anyone else, they still trust us.

Our mission is not about us – it’s about our patients and our community. And if our mission is to improve their health and safety, we must be willing to take an honest look at ourselves, to understand where we have been, assess where we are, and anticipate where we are headed. And if we discover that our mission is no longer serving our patients or our community, we must have the courage to change it.

Organized medicine helps us identify challenges, assess the adequacy of our mission, and if needed, adjust it. I am honored to be a part of that process and look forward to continuing our conversation.

Meet Stuart Pickell, MD, Our 2023 TCMS President

By Allison Howard

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

“IN MANY WAYS, MEDICINE IS A FORM OF MINISTRY,” SAYS DR. STUART PICKELL.

HIS PERSPECTIVE ISN’T SURPRISING. When you get to know Dr. Pickell, one thing quickly becomes clear – if he is interested in a project or an organization, it is because it involves serving the community. It is his desire to help others that threads his varied passions together – including his careers as both a Presbyterian minister and a physician.

“When I was five, I told my family I was going to be a minister, a doctor, and a fireman,” says Dr. Pickell. “And I did all three.”

While his stint as a fireman was limited to volunteering during high school, the experience impacted his future. During that time, Dr. Pickell became an EMT and worked for both firefighting and ambulance services. This early introduction to medicine helped to cement an interest in patient care that would continue to influence him in the years ahead.

Still, Dr. Pickell did not take a direct route to healthcare. When he attended the College of William and Mary, he was undecided between medicine and ministry. Instead of picking a degree that would only fit one or the other career path, he decided to study history and use his elective courses to take prerequisites for both seminary and medical school.

“I was in Williamsburg going to William and Mary, which is in a town where it’s always 1773,” explains Dr. Pickell. “So I was living there, with a lot of primary sources around me, and it made researching and the study of history more interesting, and it came to life more. And I knew that for ministry or medicine, it didn’t really matter what I majored in.”

Dr. Pickell was still unsure of his future path when he graduated, so he worked at a community hospital and church for two years before he decided to pursue a career in ministry, following in his father’s footsteps.

He received his Master of Divinity at Princeton Theological Seminary, and shortly after graduating, began working as the associate minister for youth and families at First Presbyterian Church in Fort Worth.

While he was enthusiastic about the job itself, leaving the East Coast to move to Texas was not originally appealing to Dr. Pickell. His interactions with some colorful Texans he met at Princeton did not leave a favorable impression. This, combined with sports rivalries imprinted since childhood, made the move less than ideal . . . so much so that it inspired some literary liberties.

“I actually rewrote the story of Jonah in the Bible; recasting it with Jonah as me and Nineveh as Fort Worth,” he says, laughing. “It was sort of therapeutic for me.”

Looking back, though, Dr. Pickell has no regrets about making the move. Texas was his future and is a place he now is grateful to call home.

“It was the second-best decision I’ve ever made – after marrying my wife,” he says.

Dr. Pickell enjoyed serving in the Church, but he still carried the desire to heal bodies alongside souls.

“I’d sit in my office, and I’d look out the window and think, ‘I don’t know if my calling to ministry is actually inside the church,’” he remembers. “‘I think maybe my ministry should be a ministry of presence, of being in the community.’”

He was hesitant, though. At that time, Dr. Pickell was still paying off student loans from his seminary and college degrees, and, perhaps more importantly, he was raised to believe that one was supposed to pick one career and stick with it.

It was the late Gordon VanAmburgh, a beloved counselor and First Presbyterian church member, who asked Dr. Pickell an important question that set him on a new trajectory.

“It was just two words, but in many ways, they changed my life,” Dr. Pickell says. “I said to him, ‘You know, I just don’t know that it’s feasible to have two careers.’ And he looked me in the eye and said, ‘Why not?’”

Dr. Pickell didn’t have an answer to that, and it led to decisions that would completely reshape his life. He applied to medical school and was accepted to
UT Southwestern, where he pursued his medical education.

Though Dr. Pickell was grateful that his prerequisites were completed, it was challenging to jump into his classes after taking an extensive break from the hard sciences.

“I wasn’t sure I was going to stay,” he says. “I liked the idea of being a doctor, but the first year was pretty rough for me. They were talking in biochemistry about discoveries five years earlier as if they were ancient history. It had been 10 years since I had taken biochemistry, so I was like, ‘I am totally lost here.’”

Though it was challenging, Dr. Rob- ert Sloane applauds him for taking the plunge to practice medicine.

“Knowing the time commitment required, it took courage on his part to train in medicine in addition to ministry,” says Dr. Sloane, who wrote a letter recommending Dr. Pickell’s acceptance into UT Southwestern. “[H]e is always caring and compassionate in his endeavors. He is committed to his work and careful in its

performance.” During his time at UT Southwestern, Dr. Pickell met his wife, Emily, while serving as an interim pastor for two small churches in and around Clifton, Texas, during a summer break. They married in the middle of his third year. Dr. Pickell completed medical school followed by a residency in internal medicine and pediatrics (Med-Peds) at the University of Mississippi Medical

Center. After completing his residency, Dr. Pickell joined an all-Med-Peds practice in Nashville but decided to return to Texas a year later. He has worked as a Med-Peds physician in Fort Worth ever since. Currently, he is a member of Texas Health Physicians Group.

For over 20 years, Dr. Pickell has thrived in building long-term relationships with patients and guiding them through complex ailments.

“Medicine is an applied science,” he says. “I like to apply principles to people to help them, whether it’s spiritually or physically, emotionally – whatever.”

Though his patients have remained at the center of his career, Dr. Pickell has maintained active participation in professional groups and committees throughout his work as a physician – including a great deal of work in ethics.

He has served on several ethics committees, including the Tarrant County Academy of Medicine’s (TCAM) Ethics Consortium, which he has chaired
for many years. And in 2016, Dr. Stuart Flynn, dean of the Anne Burnett School of Medicine at TCU, appointed Dr. Pickell to lead in the development of the medical school’s ethics curriculum.

While Dr. Pickell continues to lead the ethics curriculum, he has also expanded the reach of TCAM’s Ethics Consortium through the development of Healthcare in a Civil Society, an annual forum that has typically featured content experts from the Tarrant County community. Dr. Kendra Belfi, Dr. Pickell’s predecessor in chairing the TCAM Ethics Consortium, is grateful for his contributions to ethics in medicine.

“Dr. Pickell is a deep thinker and an articulate leader, who brings professionalism to everything he works on,” she says. “When I was about to retire and needed to find someone willing to take over chairmanship of the Consortium, I asked him to consider it – and he did. He has now been chair of the Consortium for longer than I was and has taken us to new heights.”

Throughout his years of practice, Dr. Pickell has concluded that successful leaders inspire others more through ac- actions than words.

“The biggest part of being a leader is leading by example; being willing to do what you’re asking other people to do,” says Dr. Pickell.

He speaks from experience. In addition to his work in ethics, Dr. Pickell is Project Access Tarrant County’s medical director, has served on over a dozen TCMS and TMA committees, and has worked in executive leadership positions in organizations as diverse as a health in- formation exchange company, a pioneer ACO, and an innovative primary care practice model.

“Leadership is now more about building effective teams, which is why articulating the vision is so important,” he says. “It’s not just that you have a vision and expect everyone to follow you like the Pied Piper. You must communicate it to the team, sell it to them, invite them to own it.”

Sharing a vision is key as a doctor, and it is something that Dr. Pickell believes is fostered by organized medicine. He likes to compare the relationship that physicians have with TMA and TCMS to those he shares with his own patients, many of whom he has treated for decades.

“You develop relationships and leverage them to get things done,” says Dr. Pickell. “And I think that TMA and the county medical societies are in some ways like that. They are relational, and they provide an organizational force or impetus that amplifies the message we are trying to communicate individually within our practices, broadcasting it to a larger audience than any of us can reach individually.”

As he both leads and provides support on varied projects, Dr. Pickell does it with the vision of supporting the future of medicine. In addition to his work on the ethics curriculum at the Burnett School of Medicine, Dr. Pickell has served as a preceptor to advance medical students’ hands-on education since 2002 and as an associate professor for the Department of

Internal Medicine at the Burnett School of Medicine since its inception.

Dr. Pickell’s passion for education is no surprise to those who know him; he has long desired to foster young minds in his work for both the body and the spirit. And it is a passion that extends beyond the students under his direction to the patients he cares for.

“Perhaps the most succinct statement
I could make is that I have entrusted my three children to him twice,” says Dr. Steve Brotherton, a friend, and patient of Dr. Pickell’s. “First as the youth pastor at our church, then again as their personal physician, just as I have entrusted my own health.”

“You know, I’ve always been a generalist,” says Dr. Pickell. “I like to do a lot of different things. Some people will focus on one thing and really excel at that one thing. I’ve never been wired like that.”

In many areas – ministry to medicine, education to private practice, ethics theory to hands-on application – Dr. Pickell has spent his career striking a balance between a mixed set of interests. But this extends beyond work and professional organizations.

“Husband, father, healer of bodies and souls – most know these plain facts about Stuart Pickell,” says his longtime friend Robert Johnson, who Dr. Pickell met during his time at seminary. “But there

is so much more to him: musician, actor, closeted NASCAR fan . . . and good and generous friend. For the nearly forty years I have been friends with Stuart, I have found him to be a man of great intellect, compassion, humor, and faith.”

He enjoys playing the guitar and piano, as well as writing music and essays when

he has the chance. In one particularly rewarding venture, one of the songs he wrote for a youth event in the 90s was recorded by a friend and got air time on a Denver radio station.

Dr. Pickell grins. “Yeah, that was a pretty neat experience.”

But his favorite pastime is being with his wife and their two sons, Jonathan and Will. If the family is able to spend time
at their weekend house in Clifton, even better.

“I love going down to Clifton and just being in the country,” says Dr. Pickell. “People in small towns have a strong sense of place, of community. They are grounded. I didn’t experience that growing up; maybe that’s why I like it.”

As he begins his term as TCMS president, Dr. Pickell is looking forward to using the “President’s Paragraph” to share his top concerns about medicine, such as the need to increase GME slots and funding for Project Access.

More than anything, he wants to start conversations since they are the first
step toward making tangible changes. He wants the message from TCMS to be very clear so those we interact with, such as hospital leaders and local politicians, understand the medical society’s purpose and the perspective of physicians throughout Tarrant County.

“It’s important to stay centered on why you’re doing what you’re doing,” he says. “When it comes to a ‘mission,’ I think the ‘why’ is really important. For me, this goes back to my faith. I do what I do because I believe that a loving God – who loves everyone else as much as me – has called me to serve in this way.”

We are excited to have Dr. Pickell lead us as we move forward with TCMS’s mission of advocating for the physicians and patients of Tarrant County.

Student Article: Continuing the Passion for Science in Medicine

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

by Homero Coss, OMS-II

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

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

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

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

A Thankful and Healthy New Year for Public Health

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

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

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

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

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

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

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

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

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

The Doctor’s Doctor – Gregory J. Phillips, MD

Gold-Headed Cane Award Recipient

By Allison Howard

This article was originally published in the November/December 2022 issue of the Tarrant County Physician.

When Dr. Gregory Phillips starts seeing patients for the day, it isn’t in his office, as you might expect for an internist. No—he begins by making rounds at Texas Health Harris Methodist and HCA Medical City hospitals, checking up on any of his patients who are currently admitted.

“I am usually at the hospital, I don’t know, 6:00, 6:30?” Dr. Phillips says. “And then I usually get to my office at 8:00.”

Going to see his patients in the hospital makes Dr. Phillips a bit of a unicorn in the medical world; the red tape of credentialing complications and readily available hospitalists have made the practice nearly obsolete. But Dr. Phillips has seen admitted patients throughout his over 40 years of practicing medicine in Fort Worth, and it means the world to them.

“I saw a 94-year-old lady in the office today with her daughter, and I said, ‘What was your good experience and bad experience with your hospitalization at Harris?’’ says Dr. Robert Keller, who works with Dr. Phillips at his private practice, Fort Worth Medical Specialists. “And they said, ‘Dr. Phillips showed up every day at the same time, and we could ask all of our questions and he knew all of the answers.’”

Dr. Keller, who spent years as Dr. Phillips’ call partner before joining his practice in 2021, pauses to reflect as he recalls the conversation. “That’s a classic story for Greg. He is devoted to his patients . . . I call it ‘covenantal care.’ His contract with his patients is not simply economic, it’s not simply medicine – it’s covenantal. You’re in this together.”

But Dr. Phillips’ commitment to medicine and the community extends beyond his own practice. Throughout his career he has been dedicated to organized medicine, educating medical students, supporting the arts, and advocating for the underserved of our community. And, yes, his patients.

That is why Dr. Phillips’ colleagues are recognizing him as the 2022 Tarrant County Medical Society Gold-Headed Cane recipient, an honor that is given to the “Doctor’s Doctor” for their excellence in patient care and impact on the practice of medicine in Tarrant County.

“Dr. Phillips is a ‘Doctor’s Doctor,’” says his friend and fellow physician Dr. David Donahue. “Colleagues consult him for care and counsel. Dr. Phillips’ possession of the golden cane represents a credit to his fellow physicians and is a justifiable tribute to him. The award takes on a new significance. We congratulate him.”

______

For Dr. Phillips, becoming a physician wasn’t inspired by a single moment or person. You might say it is part of his nature – because if you ask him, it was always a defining part of his life.

“I can remember from my earliest days,” he says.

“You know, people ask you what you want to be, and I think I always said I wanted to be a doctor. I’ve never really thought of anything else. And if I weren’t a doctor, I honestly don’t know what I’d be doing.”

Perhaps it isn’t surprising – his family has a strong medical background. His father was a dentist, his mother a nurse, and his two uncles and grandfather were doctors. Dr. Phillips likes to joke that his lifelong commitment to medicine took a weight off of his five younger siblings and their cousins.

“Once I said I’d be the doctor, no one else had to do that,” he says, laughing. “I was going to be the doctor out of our generation. They were all free to do whatever they wanted.”

Dr. Phillips never wavered from his vision and began his journey to becoming a physician in Fort Worth shortly after graduating from high school – but he didn’t necessarily plan to stay here.

“I never thought I’d be spending my life in Texas,” he says. “I think of myself as a West Coast kind of guy.”

After graduating Summa Cum Laude with a degree in biology from Texas Wesleyan University in 1970, he attended medical school at UT Southwestern in Dallas, and completed his residency in internal medicine at the St. Louis University Medical School in Missouri. It was when he began a fellowship in clinical nutrition at the University of California Davis that Dr. Phillips hit a bump in the road.

“I went to California, thinking I would take this fellowship and stay in academics, but the state of California ran out of money in 1978; as a result, the medical school eliminated the entire clinical nutrition program,” says Dr. Phillips. “I found a job in Fort Worth that year in 1979, and I’ve been here ever since.”

Though he has been in private practice since coming back to Texas, Dr. Phillips has still been involved in the educational side of medicine through Tarrant County’s two local medical schools—he is an adjunct clinical professor of medicine at the Texas College of Osteopathic Medicine at UNT and an assistant professor of internal medicine at the Anne Burnett Marion School of Medicine at TCU.

Though it was a deviation from his original academic plans, Dr. Phillips has found his work as in internist incredibly rewarding. Throughout his career he has built a thriving practice that has fostered long-term relationships with patients and given him ample opportunity to exercise his passion for nutrition and preventative healthcare.

“I didn’t even know what internal medicine was when I started medical school,” says Dr. Phillips. “I knew I wanted to be a doctor and had spent summers working as a surgical orderly here in Fort Worth at one of the hospitals, so I knew that I didn’t want anything to do with surgery. So then, when you go through training in medical school, you realize that there’s this whole specialty called ‘internal medicine.’ You don’t do operations, you don’t deliver babies, you don’t see kids. It’s all adult primary care medicine. Once I realized that was an actual specialty, that was what I decided that I wanted to do.”

Dr. Phillips smiles. “It’s almost like they made that specialty just for me.”

______

While he impacts the Tarrant County community every day by caring for his patients, Dr. Phillips’ dedicated involvement in organized medicine gives him a much broader reach. Beyond his TMA and TCMS membership, he is a member of the American Heart Association, American College of Physicians, National Lipid Association, and the Association of Black Cardiologists (ABC).

“My friend who was presenting about the ABC at a meeting was saying, ‘If you care for minority and underrepresented populations, you should join our organization,’” Dr. Phillips explains, noting that it might seem odd that he is a member of the Association of Black Cardiologists when he is neither Black nor a cardiologist. “But Dr. Ferdinand said, ‘You don’t have to be a cardiologist; you don’t even have to be Black. You can join our organization.’”

So that’s what Dr. Phillips did.

“It’s just one example of getting involved with an organization that has part of its mission to see what it can do to help healthcare for disadvantaged, disenfranchised populations,” he says.

Throughout his work in organized medicine, Dr. Phillips has served in numerous roles, including as our 2016 TCMS president and as a Project Access volunteer. He has sat on many boards and committees, including the Board of Directors for the American College of Physicians Texas Chapter, the Southwest Lipid Association, and the Recovery Resource Council.

Eric Niedermayer, CEO of the Recovery Resource Council, says that Dr. Phillips has had a tremendous impact on the organization, which is focused on fostering wellness and recovery for those struggling with addiction and trauma.

“[Dr. Phillips] has truly given of his time, talents, and resources every year,” he says. “During the summer of 2022, he helped the Council’s Overdose response team obtain $100,000 of Narcan to distribute to survivors of fentanyl and other opioid overdoses by providing the necessary authorization for this life-saving intervention . . . To me, he is a person I can count on to do whatever he can whenever he is asked to help. That makes him a rare find for any non-profit that is always faced with new challenges or opportunities.”

He uses the same approach for each organization he has joined – if he is going to be a member, he is going to be involved. This is what eventually led to one of his career highlights: from 1990 to 1991, he served as the president of the Texas Affiliate of the American Heart Association, and he was then appointed to the American Heart Association’s National Board of Directors from 1993 to 1995.

“So this little kind of average internal medicine doctor from Fort Worth would have no business there,” says Dr. Phillips. “I don’t do research; I don’t write grants. I’m not the chairman at the department of a famous medical school. But I’m at these meetings with all of these famous people. And it’s because I demonstrated a commitment to the mission of the organization and showed that I participate and help whatever needs to be helped.”

______

While medicine is certainly a passion for Dr. Phillips, it isn’t the cap on his interests. He loves supporting the arts and is especially involved in sponsoring local efforts. He is a patron of both the Circle Theatre and Bruce Wood Dance.

“It’s also been very rewarding because I’m not in any way an artistically talented person, but being able to work with the theater group or the dance company . . . to support their work with both time and money, is something that I’ve been able to do,” Dr. Phillips says.

He has also been an active member of Texas Wesleyan University’s Board of Trustees for over ten years, and he is currently serving on their Executive Committee. Much like his interest in the arts, Dr. Phillips views this as a way to broadly make an impact for good through the value his alma mater brings to its students and the greater Fort Worth community. Dr. Tom Cockerell, his former neighbor and longtime friend, says that civic involvement has always been a priority for Dr. Phillips, alongside his work in medicine.

“Through the years Greg has been able to continually balance a busy practice with family and civic and professional leadership demands at the local and national level,” says Dr. Cockerell. “Anyone who knows Greg admires his amiable nature, his recognition of and loyalty to important enterprises, and his good sense.”

Though he says his hobby is going to meetings, Dr. Phillips also enjoys playing golf when he has the chance. But between his practice and the different groups he is involved in, he always makes time for his family.

“I save my time off to go be with them,” says Dr. Phillips.

Whether it’s visiting his son, Lauren, in Lubbock; or his daughter, Karen, her spouse, Kyle, and his two grandchildren, Elodie and Ezra, in Santa Fe; getting to spend time with them is the highlight of his year.

As Dr. Phillips looks to the future, two things are very clear to him: he wants to keep practicing medicine and fighting for equity.

“I don’t have a plan to retire,” he says. “And I do think that people in the profession who do have time and financial resources and influence to try bringing the whole population up is something to try to focus on. I don’t know exactly where I fit into that whole puzzle, but I hope that during the rest of my career that can be one of the priorities that I have – to continue working on improving the healthcare of people who have been disadvantaged for so long.”

It is Dr. Phillips’ legacy of driven yet compassionate care for the patients of Tarrant County that has led his colleagues to recognize him as the 2022 Gold-Headed Cane recipient. With much appreciation for his service, past, present, and future, we congratulate Dr. Phillips as “the Doctor’s Doctor.”

And Just Like That

President’s Paragraph

by Shanna Combs, MD, TCMS President

This article was originally published in the November/December 2022 issue of the Tarrant County Physician.

Dr. Combs giving her first speech as the 2022 TCMS president

And just like that, my year as the Tarrant County Medical Society president is nearly over. It has been a pleasure to serve in this role, and while my time is almost up, I wanted to look back over the past year.

My time started at the end of last year during an early reprieve from the COVID pandemic. The Gold-Headed Cane and President Installation was our first in-person event since the start of COVID. It was an amazing night of getting to see old colleagues and meet new ones. It was also amazing to have four female physicians being honored in one night; it was great to share the evening’s celebration with Drs. Susan Bailey, Teresa Godbey, and Angela Self.

Being inducted by Dr. Angela Self as the new TCMS president

Unfortunately, the year took a step back due to the COVID pandemic, and we once again had to change to a virtual meeting for the TMA Winter Conference. As we have done multiple times during the pandemic, we were able to pivot and carry on. Locally, our TCMS leadership came together to promote fellow physicians to seek out positions at TMA.

As we moved to April, we started to see light and were finally able to hold TexMed in person, the first time since 2019. The best part of the meeting was seeing the inauguration of our own Gary Floyd as TMA president. Moving into summer, we were able to have a Women in Medicine event where we gathered for some much-needed stress relief making bath bombs. While we were not all successful at making the bath bombs, we had a great time gathering again in person.

Making bath bombs at the Women in Medicine event

When the Dobbs decision came out in June, I had multiple opportunities to speak with local and national media about the importance of the patient/physician relationship, and how this decision has many far-reaching implications in medicine. I will continue to work on advocating for doctors and patients to make their own medical decisions without intervention from outside forces.

At the Young Physicians Mixer

During July, I had the privilege to welcome our new Tarrant County medical students from the Texas College of Osteopathic Medicine and the Anne Burnett School of Medicine at TCU to TCMS and the world of organized medicine. It was refreshing to meet with these young students and to cheer them on as they begin their journey to having the greatest job on the planet: being a physician.

As we moved into the fall, we had another opportunity to gather again at the TMA Fall Conference. We are slowly finding our way through this COVID pandemic, returning to some form of normalcy. While I cannot quite say it seems to be over, as this has been said too many times before, we continue to find a way through.

Speaking to the incoming class of medical students

While my tenure as TCMS president may be coming to an end, I will continue to contribute to the work of our county, state, and national medical societies. If I have learned anything over the past year, it is that we must be at the table and part of the discussion; otherwise, people who don’t practice medicine will continue to try to tell us how to do our job. We have worked too hard to become physicians to allow others to practice medicine for us, and it isn’t in the best interest of our patients or our vocation – the work that still is, despite so many challenges, the best job on the planet.