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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.

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.  

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.  

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.

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.  

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. 

It’s Not Okay

President’s Paragraph

by Shanna Combs, MD, TCMS President

This article was originally published in the September/October 2022 issue of the Tarrant County Physician. You can read find the full magazine here.

On June 23, 2022, the Tarrant County medical community lost an amazing physician, who died by suicide.  He was a remarkable person whose work touched so many lives—he was always willing to help others.  He is greatly missed by all who knew him.     

Unfortunately, physician suicide has become an all-too-common occurrence in the United States.  

• Approximately 300–400 physicians die by suicide each year in the U.S.

• Among male physicians, the suicide rate is 1.41 times higher than the general male population.  

• Among female physicians, it is even more pronounced at 2.27 times higher than the general female population.1  

As terrible as this sounds, there is hope.  Physicians who are proactive about their mental health are able to take better care of their patients as well as have more resilience in the face of stress.  However, this is not so easy to accomplish.

There is already a stigma associated with mental health, and it is made even worse for physicians due to the concern of needing to report a diagnosis to our medical boards, licensing organizations, as well as to credentialing offices in the hospitals and health systems we work in.  We as physicians also have difficulty taking care of ourselves in general, let alone when it comes to mental health, as we are the healers and must be perfect.  

The truth is, being a physician is hard.  We train for many years to be able to do the work that we do.  We often share our war stories about medical school and residency, but when it comes to the deeper struggles we have, we tend to keep those to ourselves.  We push them down and hide behind a smile (or a mask) and continue to pretend that everything is okay.  

But it’s not okay.

We as a profession need to start taking care of ourselves and looking out for our colleagues.  It is okay to tell someone when you are struggling and to seek out help when you need it.  A psychiatrist friend puts it best—“Everyone needs a therapist.  I have one.”  At some point we all learned the physiology of the human body, and of the brain specifically. Sometimes that brain needs a little extra help from chemistry, and that is okay as well.  If you have a thyroid problem, you do not put up a fight about taking a thyroid pill. The same goes when our brain chemistry needs a little help.  We also need to reach out to one another, to check in and see if our colleagues are really doing okay and if they need any help or support.  It’s okay to not be okay, but we need to recognize this and seek out the help we so desperately need, and to help our colleagues obtain the help that they need.

We also need to work from an advocacy standpoint so that physicians can seek the help that they need without the fear of needing to report their illness.  All other aspects of medicine and healthcare are taken care of in a private manner between a physician and a patient.  Why should mental health be any different?  Until this changes, no number of wellness programs, resilience building, etc., will be able to fix the problem.  

I encourage everyone to seek help when needed and to reach out to our colleagues, partners, and friends.  We have worked tirelessly to get to the point we can practice medicine, and those around you want you to stay here.

1John Matheson, “Physician Suicide.”  American College of Emergency Physicians. Accessed August 3, 2022.,times%20more%20often%20than%20females

Mental Health Resources

National Suicide Prevention Lifeline
1-800-273-TALK (8255)
Available 24/7

Crisis Text Line
Text TALK to 741-741
Available 24/7

Physician Support Line
1 (888) 409-0141
Open seven days a week,
7:00am – 12:00am CST
Psychiatrists helping their U.S. physician colleagues and medical students navigate the many intersections of our personal and professional lives. Free and confidential. No appointment necessary.

Emotional PPE Project
The Project connects healthcare workers in need with licensed mental health professionals who can help.

Fort Worth OB/GYN: “There’s no hard and fast line where…the mom’s life is at risk.”

TCMS President and OB/GYN Dr. Shanna Combs spoke with Dallas Mourning News journalist Allie Morris about the impact of ambiguous reproductive health restrictions on the health and wellbeing of women suffering from severe pregnancy complications. Here is an excerpt:

Texas is now preparing to ban all abortions, following the reversal of Roe vs. Wade, with no exemptions for rape or incest, only for cases that put the pregnant person “at risk of death or … of substantial impairment of a major bodily function.”

Doctors say the problem is that those situations are not black and white.

“There is no hard-and-fast line where all of a sudden the mom’s life is at risk,” said Dr. Shanna Combs, an OB-GYN in Fort Worth. “So she’s infected, but she’s not septic. Does she have to be hemorrhaging before you can intervene?”

You can read the full article here.

I’ve Done My Research

President’s Paragraph

by Shanna Combs, MD

This article was originally published in the March/April 2022 issue of the Tarrant County Physician. You can read find the full magazine here.

“I’ve done my research.”

These can be some of the most dreaded words to hear as a physician from our patients and their families.  We can spend seven-plus years in medical school, residency, and sometimes fellowship, studying our field before we embark on our journey to practice medicine.  We also hone our craft through continued learning throughout our careers.  Yet, we are often confronted with the above phrase.  Since when did Dr. Google become such an expert that it can supersede our years of training and practice?

This became ever more apparent as the COVID-19 pandemic started over two years ago. (Yes, we have crossed over the two-year mark and are still counting).  With a lack of information and understanding of this novel virus as well as increased access to information on the internet, we in science and medicine saw people seeking out answers from all the resources they had access to.  This unfortunately led to propagation of numerous pieces of misinformation, distortions, and half-truths.  Add to this the politicization of our nation and the polarization regarding best measures on how to handle the COVID-19 pandemic, and unfortunately, we in science and medicine are left as the ones not to be trusted.

As a women’s health physician, I am confronted with this on an almost daily basis.  While the internet can be a valuable resource of information, it can also be a not so valuable resource of misinformation, lies, and myths.  Misinformation was commonly passed along in relation to women’s reproductive health even before the advent of the internet.  Unfortunately, nowadays it has a much wider reach with the “expertise” of Dr. Google to further spread these untruths.

What are we to do in this constant back and forth of the internet versus the doctor?

For me, I try to meet my patients and their families where they are.  I work with them to better understand where they are coming from as well as who or what their source of information is.  I cannot undo the vastness that is the internet and Dr. Google, but I can work to build a relationship with my patients and their families to come to shared decision making to provide the best care for them.  

For me, I try to meet my patients and their families where they are.  I work with them to better understand where they are coming from as well as who or what their source of information is.  I cannot undue the vastness that is the internet and Dr. Google, but I can work to build a relationship with my patients and their families to come to shared decision making to provide the best care for them. 

While this is helpful in individual encounters of patient care, I also feel that it is important for us as physicians to be out in the public arena as well. Because of this, I never turn down an opportunity to speak when asked, and I am always happy to provide my expertise for those in the media.  As physicians, we have a duty to educate. This is a responsibility not only to the individual patients we take care of, but also to the public. By offering education that is based in science and grounded in our years of continued study and experience, we can work to counteract the vast amount of distorted information that is out there.  I, for one, will continue in my efforts to dispel myth and spread truth.

President’s Paragraph

Terrible Twos

By Shanna Combs, MD

This piece was originally published in the January/February 2022 issue of the Tarrant County Physician. You can read find the full magazine here.

Welcome to 2022! This is going to be our year. Things are going to be better. So long, COVID . . . Oh wait, maybe not. Doesn’t this all sound a little too reminiscent of the start of 2021? As I write this, we are in the beginning stages of a new variant, Omicron. There is still much we do not know about this variant, and hopefully, by the time you are reading this, it will have turned out to be not as bad as the last one. 

Thinking back to the start of 2021, we were elated to have new vaccines to fight off and end the COVID pandemic. Many of us in healthcare were racing to sign up to get our shot and show it off on social media. We finally had some armor to protect us in this fight, and soon enough it would be available to protect our families, friends, and patients. Yet the conversation quickly turned to, “It was made too quickly,” “You can’t mandate that I get the vaccine,” “I am healthy; why do I have to get the vaccine?” or “It is all fake news.” So now, here we are, entering the “terrible twos” of the COVID pandemic. If there is one thing that has been demonstrated during the COVID pandemic, it is that the innate trust in physicians, medicine, and science is, unfortunately, no longer so automatic. We as physicians must continue to be voices for science and for medicine who, at the end of the day, want the best health outcomes for our patients.  

As we enter the terrible twos of the pandemic, I encourage my physician compatriots to be the voice that our patients and our society need to hear. Whether that is in your day-to-day interactions with patients, conversations with family and friends, or in public venues, we must continue to be the voice of medicine. Ways to amplify that voice exist within our own county, state, and national medical society. Those of us in medicine often focus on what makes us different, but now more than ever we need to focus on what brings us together. 

We are all tired and exhausted from this fight, and more than once I have heard others as well as myself say, “Can’t we just go back to how it used to be?” Unfortunately, I hate to say, COVID is with us for the foreseeable future. Yet, those of us in medicine went into this field for a reason. For me, that reason always comes down to my patients. I want to provide the best care to optimize the health and well-being of my patients. During these terrible twos, I call on my colleagues to remember why you embarked on this journey of medicine, and when you see a colleague struggling, help them to remember why they came to this profession. Not only can we be the voice of medicine to our patients, but we can also be the voice of support and camaraderie for our fellow physicians.

As we embark on this new year, I want to say that I support you as a fellow physician, and I look forward to the amazing work that you all contribute to your patients and to our society. Thank you for what you have done and what you will continue to do.

Meet Your 2022 TCMS President – Shanna M. Combs, MD

by Allison Howard

This piece was originally published in the January/February 2022 issue of the Tarrant County Physician. You can read find the full magazine here.

When Dr. Shanna Marie Combs was a little girl, she knew when she grew up that she wanted to be a doctor and a ballerina. Not a doctor or a ballerina – she wanted to dance and practice medicine. So that’s what she did.

The combination might seem odd, but when the OB/Gyn, who is a self-declared science nerd, ended up seeing multiple orthopedic surgeons throughout her childhood to manage dance-related ankle complications, the interest came organically.

“I was seeing orthopedic surgeons at the age of 12,” Dr. Combs says. “They all wanted to operate on me, and I would push back and be like, ‘No, I need another option.’” She laughs as she remembers her juvenile determination. “It came to the point I would have orthopedic surgeons print out journal articles for me.”

While her interest in medicine only grew as she did, Dr. Combs realized that she should pursue dance first if she wanted a real shot at both of her passions. After all, professional dancers have limited careers, and Dr. Combs was facing an even bigger challenge with her stressed ankle. 

“I used to joke that medicine was my backup career for ballet,” Dr. Combs says with a grin.

She pursued a Bachelor of Fine Arts in ballet at TCU while taking all the necessary prerequisites to apply for medical school. Even though she wasn’t ready to take that step, she wanted to be prepared. It was a hectic time – she always took the maximum number of hours and had to take her science classes in whatever order they were available to work them around her dance classes. 

After graduating, Dr. Combs joined the Ballet Theater of New Mexico in Albuquerque, where she had danced in high school. While there her life revolved around ballet – she performed, worked with students, and even managed the studio’s front desk. 

Dancing was fulfilling, and Dr. Combs looks back on that time fondly. She created a special bond with her “ballet ladies,” one that holds strong these many years later. Still, the time had its challenges. Money was tight, and she ended up taking another job as a physics lab tech at a community college.

Dr. Combs was also physically feeling the impact of constantly dancing, so after a couple of years of performing professionally she decided it was time to move on to medical school. It was at that point that she hit a snag in the plan; she didn’t get accepted to the places where she had applied. 

“I kind of had to have a real heart-to-heart with myself as to whether or not I actually wanted to do this again,” Dr. Combs says. “But ultimately, I was like, ‘No! You want to be a doctor.’ So I retook my MCATs and applied broadly and got in.”

She attended medical school at the University of New Mexico. Based on her childhood, she had thought she might go into orthopedics or perhaps pediatrics, but when she began her third-year rotations, she found she was drawn to obstetrics and gynecology. No one was more surprised than she was. 

“I said I would never do OB/Gyn as a first-year med student, and here I am, as an OB/Gyn,” Dr. Combs says. “I did not understand the scope of what an OB/Gyn does, and probably my first day on the rotation I was like, ‘Oh, I kind of like this.’ So I fell in love with the field.”

It has been her passion ever since. She completed medical school in 2008 and began her residency in obstetrics and gynecology at JPS. She finished the program in 2012 and then began working for JPS Health Network in private practice as well as in education for the residency program.

Her love for teaching and education led to her involvement in the curriculum development of the TCU and UNTHSC School of Medicine, and she ultimately became the OB/Gyn clerkship director at the new medical school. Though Dr. Combs recently left that position, she is continuing to work with students; it’s one of her favorite roles as a physician, to prepare the next generation of doctors.

“When you work with students, I always say you can learn what to do and what not to do, and I always wanted to be somebody where they hopefully learned what to do in working with me,” Dr. Combs says. “I’d always loved teaching, so once I discovered that, oh, I can teach in medicine too, I kind of continued that in residency working with medical students and residents who were below me as I moved up and ultimately into education and working with students.”

In spite of her focus on education, Dr. Combs has maintained an active private practice. Last year she transitioned to Cook Children’s Physician Network, which has been an amazing opportunity to marry her love of pediatrics and OB/Gyn, two fields of medicine that rarely intersect. 

“A lot of gynecologists won’t see kids younger than 16 or 18,” Dr. Combs explains. “There was definitely a need; it’s totally blown up. And I love it. I can’t tell you how many times women have brought their daughters and been like, ‘We’re so glad you are here.’”

“[Dr. Combs] has taken on the awesome task of advocating for female teen and young girls’ health,” says Dr. Hannah Smitherman, a pediatric emergency medicine physician who is one of her colleagues at Cook Children’s. “It’s a niche that many shy away from . . . Teens are struggling with the stressors of a rapidly changing and conflicted world.  Dr. Combs is there to help support these children, soon to be adults, through their often very personal medical issues.”

Currently she sees any patient between the ages of 0–22 that needs gynecological care, but the bulk of her practice is made up of teenagers. “I love taking care of my little ladies,” Dr. Combs says. “I try to provide a very safe place.”

Recently, after displaying quite a bit of anxiety during her appointment, one of her young teenage patients came out to Dr. Combs as lesbian when they talked privately. It was something she had been afraid to tell anyone.

“As they were leaving, the patient kind of hangs back a little bit and she’s standing next to me,” Dr. Combs says. “And I’m like, ‘What’s up?’” Her voice is hushed as she reenacts the moment.

“And she said, ‘Can I give you a hug?’ My heart just broke. I just got the impression that she felt heard and supported . . . Stuff like that – it’s the best part of the job.” 

Dr. Combs says there is one simple answer when it comes to organized medicine: “Do it!”

“As a medical student, I got involved in the New Mexico Medical Society and the AMA as well, and I remember talking with colleagues and fellow students,” Dr. Combs says. “They were like, ‘Ugh! I don’t want to deal with that stuff.’”

While she understands the hesitation physicians might feel, especially those just beginning their careers, she believes that it is critical for them to be involved in anything that impacts medicine.

“Am I a businessperson or a politician? Absolutely not,” Dr. Combs says. “Would I rather just practice medicine? Absolutely! But all those outside influences affect how I can practice medicine, so I’ve always wanted a seat at the table to kind of influence those decisions and choices.”

And if you feel underrepresented by an organization, Dr. Combs believes that is all the more reason to get involved.

“You can stand on the outside and throw stones and say, ‘They don’t speak for me,’ or you can say, ‘They don’t speak for me; I need to join that organization.’ Because the only way it’s going to change is if more membership gets involved.”

Dr. Combs tries to encourage medical students to participate just as some of her mentors encouraged her. One of those mentors, Dr. G. Sealy Massingill, who is an OB/Gyn practicing in Fort Worth, interviewed Dr. Combs when she applied for a JPS residency spot, and when she joined the program, he suggested that she participate with TMA and TCMS. 

“I encouraged her to seek out opportunities in the community and feel grateful she chose to become involved,” Dr. Massingill says. “Her commitment to equity, diversity, and access to care have been drivers for her.”

Several years ago, Dr. Combs participated in TMA’s Leadership College. Since then, she has served on the TCMS Women in Medicine Committee and Publications Committee, and on the state level, the Membership Committee and Maternal Health Congress, as well as one of the AMA alternate delegates.

Now, she is ready to lead TCMS as she begins her term as the 2022 president. Dr. Demequa Moore, who is also an OB/Gyn taking care of patients in Fort Worth, says one of Dr. Combs’ greatest strengths is that she is driven by her deep care for others. “[She] has always practiced with empathy and compassion,” Dr. Moore says. “She continues to seek opportunities to learn and improve the health of her community.”

As Dr. Combs looks back over her career, a physician of particular influence comes to mind: the late Dr. Tracy Kobs. Dr. Kobs worked with JPS residents in the operating room when Dr. Combs was in the program, and she strives to emulate him as both a physician and educator. 

“The more I learned about him over time, the more I respected him,” Dr. Combs says. “Operating, you want to get in, you want to do the job correctly, and you want to get out. And so when you’re working with learners you have to be very patient because they’re learning, and he never got frustrated or upset when things were taking too long or anything like that. He was always so patient . . .  with the breaking down of steps. And even working with students now, teaching them how to do just basic knot tying and suturing, a lot of the mechanics I learned from him I bring to teaching with students.”

She is grateful for the cheerleaders she has had along the way, and her parents have been chief among them. They supported her at every step she took and challenge she faced.

At one particularly memorable moment, the family was driving back to Texas from Colorado when Dr. Combs found out she had passed her board exams. Her mother insisted that they had to celebrate immediately, so they pulled the car over so they could dance for joy.

“I love my parents,” she says, a big smile crossing her face. “I have to say, I’m very blessed.” 

When she isn’t busy teaching, seeing patients, or attending meetings, Dr. Combs enjoys traveling with friends and family or spending time with her dogs, Duke and Poppy, and her partner, Mike Bernas.

While she has enjoyed her varied career and life experiences thus far, Dr. Combs looks to the future with anticipation because she sees it centered around her work as a physician, something that over the years, she has realized is more than just a passion.

“At the end of the day, I call it a calling,” Dr. Combs says. “You know, you hear people talk about their calling to ministry and things like that, but to be a physician has always been what’s at the center of me.”