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The Evolving Challenges in Medicine: A Look at the Long-term Impact of the COVID-19 Pandemic

Public Health Notes

By Catherine Colquitt, MD, TCPH Medical Director

This article was originally published in the March/April 2026 issue of  Tarrant County Physician.

The opportunities, rewards, and privileges of practicing medicine are many, but the pressure of practice can at times be stressful or overwhelming. Our colleagues straining to cope may be reluctant to report or seek treatment for depression, anxiety, or substance abuse disorders. Many of these conditions have been exacerbated by the COVID-19 pandemic and its aftermath.

Tarrant County Public Health (TCPH) has for many years offered chronic disease self-management programs which host lay group support programs customized to each participant’s needs. These are facilitated by a trained lay leader with input from the rest of the support group and are tracked to mark progress on the journey toward successful chronic disease self-management, including anxiety, depression, and obsessive-compulsive disorder, among other chronic conditions. However, many physicians and other healthcare workers already feel too over-extended to participate in a time-consuming peer support program such as TCPH offers.

While healthcare worker (HCW) burnout is lower now than at the height of the COVID-19 pandemic, HCW burnout and stress have not returned to the pre-pandemic baseline according to most sources, including a large study of Veterans Health Administration (VHA) HCWs surveyed annually in 140 VA Medical Centers from 2018 to 2023. In response to survey data, the VHA implemented “several system-level programs to revise organizational practices and policies” to reduce or mitigate burnout. These include reducing workloads by hiring more staff, increasing telehealth and telework options, and introducing “whole health practices” in employee healthcare in which much attention is directed at mitigating the mental health impact of medical conditions and stressors at work or home affecting VHA employees.1 

Scientific Reports released a study evaluating anxiety
and depression among HCWs two years after the COVID-19 infection began. A remarkably high percentage (50.8 percent) of their sampled HCWs reported “long COVID,” which authors defined as “persistence of multi-system symptoms for more than twelve months, including fatigue, shortness of breath, brain fog, depression, and anxiety.” The authors used PHQ-9 and GAD-7 scales to assess anxiety and depression in HCWs two years after COVID infection (higher scores indicate more instances of anxiety and depression, while lower scores indicate fewer). They found that students had the highest PHQ-9 and GAD-7 scores, with doctors, nurses, and administrative staff reporting lower PHQ-9 and GAD-7 scores. Authors concluded that “policymakers and healthcare administrators should consider optimizing mental health support systems,” including “implementing regular mental health screenings, providing personalized psychological interventions, offering counseling services, reducing work-related stress, and promoting the use of mental health assessment tools to improve the psychological well-being” of healthcare workers, especially students and those who have long COVID.2 

Center for Infectious Disease Research and Policy summarized a Morbidity and Mortality Weekly Report study of US HCWs surveyed online in 2022 and 2023 in which 26 percent of participants “reported symptoms of mental illness but only 20% sought treatment during the previous year, mainly because of difficulty getting time off from work and worries about confidentiality and cost.” HCWs were surveyed using PHQ-2 and GAD-2 tools and cited work stress, burnout, inadequate staffing, greater workload or job demands, fear of COVID-19, and COVID-19 misinformation as their leading stressors.3 

Like our patients, we physicians escape through connections to our chosen online communities, but perhaps we should more often step out of our comfort zone to ask a colleague how they are doing in a manner which suggests that we really care to know, and this might lead to a colleague expressing concern for our well-being as well. Who among us is at risk for self-harm? According to actuarial data, the typical physician at risk is 45 years old; Caucasian; amid some marital discord or divorced, separated, or single; self-treating with alcohol or drugs; a “workaholic”; and a risk-taker. Our hypothetical colleague may also have chronic pain or some other serious medical comorbidity, is concerned about a looming change in status (financial, professional, social) and may be frankly overwhelmed by the increasing demands of work. Our colleague will likely also have access to medications or firearms with which to act.4,5,6

Psychiatric concerns in physicians are often left unaddressed until far advanced just as we often under-diagnose psychiatric conditions in our patients. Furthermore, we may fear the possible professional repercussions of asking for help with a psychiatric illness, opening ourselves up to the scrutiny and judgment of physician health programs, credentials committees, colleagues, or lawyers.

It is my personal hope that we will all use our training, honed by the COVID-19 pandemic, to minister to those suffering and in pain in the ways unique to our healing arts. COVID-19 has changed us all in ways we don’t yet fully realize.

References:

  1. Debra C. Mohr et al., “Burnout Trends Among US Health Care Workers,” JAMA Network Open 8, no. 4 (2025): e255954, https://doi.org/10.1001/jamanetworkopen.2025.5954.
  2. Lin Zhang et all., “Anxiety and Depression in Healthcare Workers 2 Years After COVID-19 Infection and Scale Validation,” Scientific Reports 15 (2025): Article 13893, https://doi.org/10.1038/s41598-025-98515-w.
  3. Mary Van Beusekom, “1 in 4 US Healthcare Workers Report Mental Distress During COVID, Survey Suggests,” Center for Infectious Disease Research and Policy, January 20, 2025, https://www.cidrap.umn.edu/covid-19/1-4-us-healthcare-workers-report-mental-distress-during-covid-survey-suggests.
  4. Latoya Hill et al., Physician Workforce Diversity by Race and Ethnicity, Kaiser Family Foundation, July 22, 2025, https://www.kff.org/racial-equity-and-health-policy/physician-workforce-diversity-by-race-and-ethnicity/.
  5. Daniel Saddawi-Konefka, Christine Yu Moutier, and Jesse M. Ehrenfeld, “Reducing Barriers to Mental Health Care for Physicians: An Overview and Strategic Recommendations,” JAMA 334, no. 10 (2025): 987–995, https://doi.org/10.1001/jama.2025.12587.
  6. Hirsh Makhija et al., “National Incidence of Physician Suicide and Associated Features,” JAMA Psychiatry, published online February 26, 2025, https://doi.org/10.1001/jamapsychiatry.2024.4816.

What We Carry: Reflections of Tomorrow’s Physicians

TCOM Student Article

By Jean Nie, OMS-II

This article was originally published in the September/October 2025 issue of  Tarrant County Physician.

While weaving through the Oculus in New York City, I found myself drawn to a small storefront with walls covered in handwritten notes. The space, The Strangers Project, invited passersby to pause and read the anonymous stories of others—fragments of lives laid bare in ink. I wandered slowly, absorbing confessions of heartbreak, illness, hope, loss, and quiet resilience. As I read, I was reminded that every person is carrying something—often invisible, often unspoken—and how unjust it is to reduce a person to a single narrative, a surface impression, when human beings are anything but simple. Despite the many ways we might differ, I felt a deep familiarity with their words. Suddenly, in a city that often feels vast and indifferent, the room felt like a heartbeat—small, warm, and profoundly human.

Fast forward to my first year of medical school. That experience stuck with me, and I found myself trying to recreate a version of that space—this time in the halls of my own school. I organized a “reflection wall” for SOMA, a student-led advocacy organization, not knowing how it would be received. Nevertheless, I wanted this reflection wall to serve as a space for medical students to share their feelings and thoughts in the midst of a seemingly never-ending study session. Over the course of the day, I watched as students came in, some in waves, some peeping their heads in out of curiosity. Some students I knew, others I had only smiled at in passing. But gradually, the wall became filled with notes. Some were long, taking up the entire allotted half page, while others left short yet equally impactful single liners. The vision for this wall was to provide a space for students to pause in the middle of the relentless pace, to process what we often suppress, and to speak without needing a response—only to be heard.

There were papers written with bubbly letters that matched bubbly attitudes. Several students wrote about the moment they knew they wanted to enter medicine: a family member that was saved, a compassionate healthcare worker who made an exception to hospital policy so a patient could say goodbye to a loved one, and personal anecdotes of healthcare saving the writer. These stories echoed familiar themes of wanting to make a difference, to help people feel seen, to be a source of hope during dreary times. Many mentioned that despite the difficult journey, they are reminded of the privilege it is to be in this position, and by expressing gratitude, they are able to see the light at the end of the tunnel, even during the late nights.

But alongside the gratitude, the wall became a fuller picture. Many of the students were tired—beyond tired. Not just from studying, but from what feels like a constant negotiation between who they are and who this profession demands them to be. There were reflections that whispered of burnout and others that screamed of it. There were fears that ran deeper than fatigue—fears that this profession might not deliver on its promise of fulfillment and that a patient’s care would be determined by billing codes and insurance coverage rather than sound clinical judgment. Some reflections expressed fear of the future as well as scars from the past, especially moments where the healthcare system abandoned them or a family member physically or fiscally.

But the pain extended beyond the personal. Threaded through many reflections was a sense of despair about the system itself. Students wrote about the deep inequities they had witnessed: how wealth shapes not only who becomes a doctor but who gets to see one. How poverty, often the root of illness, remains beyond the reach of prescriptions. How medicine tends to treat symptoms while the structural causes—housing, food insecurity, systemic injustice—go untouched. One note captured a particularly painful irony: that even physicians, trained to heal others, often struggle to care for themselves.
I stood in front of the wall in silence, letting each emotion resonate with a part of me that’s felt it before. Like those notes in the Oculus storefront, the ones we wrote were acts of vulnerability—honest, unfiltered moments that revealed the beating heart beneath the white coat. That tension between inspiration and injury felt like the core of the wall. I realized that in creating this space for my classmates, I found myself reconnecting with the essence of why I chose medicine: to confront, to share, and to bear witness to the human experience alongside others. Because at its core, medicine is not just a discipline of diagnoses and treatments—it is a deeply human endeavor. It asks us not only to learn but to listen. Not only to act but to bear witness. Science may guide our hands, but it is our humanity that allows us to truly heal.

The fears expressed by my peers are real, and some will undoubtedly come to pass, if they haven’t already. But within the fatigue and frustration, I felt a reprieve. It’s in these moments of reflection, both quiet and collective, that I find the thread connecting all of us—not just as students or future physicians but as human beings. If we can protect that thread and create space for our own humanity as fiercely as we do for our patients’, then perhaps we won’t merely endure this profession; we’ll have a hand in reshaping it.

Project Access Tarrant County

Salud en Tus Manos:
Medication
Management

By Kathryn Keaton

This article was originally published in the September/October 2025 issue of  Tarrant County Physician.

On July 16, Project Access Tarrant County (PATC) held its second Salud en Tus Manos class. For those unfamiliar with it, Salud en Tus Manos (“Health in Your Hands”) is a new initiative under PATC that addresses the social drivers of health (SDOH) faced by many of our patients. These classes, provided through Texas Health Community Hope as part of our Community Impact Grant, are designed for patients with diabetes and/or hypertension who live in one of five priority ZIP codes: 76010, 76011, 76104, 76105, and 76119.

The July class, “Managing Your Medications,” guided participants through the entire prescription process—from the doctor’s visit where a medication is prescribed to understanding labels, following directions, and knowing how to request refills.

Why This Curriculum Matters
Medication adherence is a challenge nationwide, especially for chronic conditions like diabetes and hypertension. When compounded by SDOH such as language barriers, limited formal education, or financial insecurity, the consequences can be severe.

In fall of 2024, PATC saw this firsthand. A 39-year-old woman had waited more than a year for gynecological surgery. When she finally received a surgery date, her pre-op testing revealed dangerously uncontrolled diabetes. Records showed she had not returned to her primary care provider since her initial PATC referral, and she admitted she skipped follow-ups because she “felt fine.” Without those visits, she never received medication refills. Her surgery was canceled, delaying treatment another five months. Though she eventually had a successful procedure, her experience underscores the importance of consistent care and medication compliance—the very issues Salud en Tus Manos seeks to address.

Who We Reached
Our July participants were foreign born with a median age of 45. All had lived in the United States for at least 18 years. The highest level of formal education completed was eighth grade, with 75 percent of the attendees’ education taking place outside the United States. Every participant had hypertension, and half also managed diabetes. All reported attending medical appointments every three to six months.

While all participants felt “extremely confident” in understanding their medications, half believed they could take prescriptions however they wished as long as the medication was prescribed, and all believed they could not receive their medications in their preferred language.

Encouragingly, the post-survey showed significant improvement: 100 percent of participants correctly recognized the importance of taking medication exactly as prescribed.

Hands-On Learning
The class combined instruction with interactive activities. Participants identified warning labels, practiced interpreting dosage and timing instructions, and learned when and how to request refills—not only for their chronic condition medications but for all prescriptions.
Like our first class in March, participant satisfaction scores reflected both engagement and impact. The curriculum is clearly filling an important knowledge gap and helping patients feel more confident in managing their health.

Looking Ahead
Medication management is a crucial step toward improving long-term health outcomes, and Salud en Tus Manos is proving to be a meaningful resource for patients navigating barriers to care. With every class, PATC and its partners continue working toward healthier futures for our community.
Our first class, “How to Communicate with Your Doctor,” gave patients the tools to ask questions and advocate for themselves during medical visits. This September, we will be offering that class again—this time with two sessions, one in English and one in Spanish. The program will continue to grow. The next planned class, “Food as Medicine,” specifically requested by half of past Salud en Tus Manos attendees, will explore how nutrition choices can support patients in managing chronic conditions and improving their overall well-being. Together, these classes are building a foundation for healthier lives—one step, one conversation, and one patient at a time.

The Last Word

Lifestyle Modifications

By Hujefa Vora, MD, Publications Committee Chair

This article was originally published in the September/October 2025 issue of  Tarrant County Physician.

With your annual physical last week, we drew annual labs. We’ve got to discuss these results today. Your cholesterols need better control. Your total cholesterol is greater than 200 mg/dL, but to really understand these results, we’ve got to look at the breakdown. Your HDL, your “good” cholesterol, should be higher than 40 mg/dL. It looks like we have some work to do on this.

No, you don’t need to increase your cholesterol intake. To raise your HDL level, you need to increase your aerobic exercise. You need to make some lifestyle modifications. Your LDL, your “bad” cholesterol, is markedly elevated, and this is not a good thing. This combination of low HDL and high LDL can dramatically increase your risk for cardiovascular disease. I want to finish reviewing these lab reports, and then we will take a few minutes to circle back to this issue. Let’s see here. Your kidney and liver function tests are normal. Your fasting blood sugar is a little higher than expected. Your blood counts, red blood cells, white blood cells, platelets—all look good, which means your inner factory is working. The implication here is that your nutritional status is good. Your body has all of the raw materials it needs to produce all of these cell lines. Your thyroid appears to be functioning at normal levels. Finally, and most importantly, there is the matter of your glycosylated hemoglobin level. This has nothing to do with the blood counts and hemoglobin we reviewed earlier. It is actually also called hemoglobin A1c. This is a measure of your average blood sugar level over the past three months. And your A1c is just a tad on the higher side here. The World Health Organization defines diabetes as an A1c of 6.5 percent or greater. Your numbers landed in the prediabetes range. So now we’ve really got some more issues to talk about.

Alright, no time to panic. I want us to relax and really understand what it is we are talking about here. Prediabetes is like a warning shot. Your body is telling us that if we don’t take action in the here and now, then you are at significant risk of developing diabetes.

No, you are not diabetic. I understand that you feel fine, that you don’t feel diabetic. The thought I want to stress to you is that this is a preventative visit. Our goal is to prevent the complications of low HDL, high LDL, and borderline hemoglobin A1c. Those complications include heart attacks, strokes, kidney disease, vision disturbances, all ultimately negatively affecting your quality of life, possibly even your quantity of life.

No, these levels are not fatal, but if we let these things go long enough without addressing their root cause, the complications can be detrimental to your overall health. The most effective ways to lower your risk of developing diabetes when you are prediabetic are by losing weight, increasing physical activity, and eating a healthy, well-balanced diet. I don’t expect you to go out and run a marathon (although that would be amazing!) but rather just make some modest lifestyle modifications. If you are able to effectively make lifestyle modifications, then we may be able to avoid full-blown diabetes. We may not necessarily need to prescribe medications right off. Lifestyle modifications most certainly can help to decrease your risk of heart attacks and strokes.

Lifestyle modifications. That’s a buzzword that we talk about in our offices all the time. I’m going to give you some food for thought at this point. Lose excess weight. For people who are overweight, losing just 5 percent to 7 percent of your body weight can reduce your risk of developing type 2 diabetes by over 50 percent.1 Increase physical activity. The CDC recommends getting at least 150 minutes of moderate-intensity aerobic exercise per week.2 This can include activities like brisk walking, cycling, or water aerobics. Regular exercise helps your body use insulin more effectively. Combine cardio with strength training. Incorporating strength training for all major muscle groups at least two days a week further improves insulin sensitivity and glycemic control.2 Quit smoking. Smoking can increase insulin resistance, making it harder for your body to manage blood sugar. Get enough sleep. Poor sleep is linked to insulin resistance and weight gain. Aim for seven to nine hours of quality sleep per night. Manage stress. Chronic stress can increase blood sugar levels. Find healthy ways to cope, such as meditation, yoga, or deep breathing exercises.

Lifestyle modifications also include making dietary changes. Focus on whole foods. Emphasize a balanced diet rich in vegetables, fruits, whole grains, and lean proteins and low in saturated and trans fats. Choose high-fiber foods. Fiber-rich foods, such as vegetables, fruits, and whole grains, slow down digestion and prevent rapid blood sugar spikes. Limit refined carbohydrates, processed foods, and added sugars. Avoid or limit sugary drinks, processed foods, and refined carbohydrates like white bread and pasta, which can cause blood sugar levels to spike. Drink more water. Water is the best choice for hydration and helps to maintain healthy blood glucose levels.

In the American medical system, we don’t emphasize preventative medicine as much as we emphasize reactionary medicine. We are taught to take care of the problems, treat the complications of underlying symptom-free subclinical metabolic issues. As primary care physicians, our role is to work to prevent disease, keeping you healthy so as to avoid illness. Most of what I discuss with my patients in clinic was not given to me through books in medical school but rather acquired through years of experiential learning, caring for the healthy, and teaching them to avoid disease. Lifestyle modifications don’t always get into our medicine textbooks but they should. The point of my diatribe today? Make sure that all of you are going to see your primary care physicians. Make sure that you are taking care of your health, so that all of us can better understand and serve our patients. My name is Hujefa Vora, MD, and this is my Last Word.

References:

  1. “Diabetes Prevention: 5 Tips for Taking Control,” Mayo Clinic, March 12, 2025, https://www.mayoclinic.org/diseases-conditions/type-2-diabetes/in-depth/diabetes-prevention/art-20047639.
  2. U.S. Afsheen Syeda et al., “The Importance of Exercise for Glycemic Control in Type 2 Diabetes,” American Journal of Medicine Open 9 (June 2023): 100031, https://doi.org/10.1016/j.ajmo.2023.100031.

The Magic in Medicine

by Justin Choy, MS-III

A five-year-old boy sat nervously on the exam table at Cook Children’s Neighborhood Health Center on McCart Avenue, his small hands gripping the crinkled paper as his wide eyes darted anxiously around the room. His mother murmured reassurances, but the unfamiliar setting left him frozen with apprehension. Noticing his unease, I reached into my pocket and pretended to pluck something from the air—only to reveal a bright, red sponge ball between my fingers. His eyes flickered with curiosity.

“Wait, where did that come from?” he whispered, his guarded expression beginning to soften.

As I continued, I gently tapped his ear and produced another sponge ball from its depths. His nervousness gave way to delight. A hesitant giggle escaped as he reached out to touch the impossible object. Weaving magic into the physical exam, I guided his gaze with each sleight of hand, subtly assessing his eye tracking and coordination. By the time I placed my stethoscope on his chest, his fear had vanished, replaced by eager anticipation for what trick might come next. In that moment, I saw how magic could do more than entertain—it could transform the clinical experience, turning fear into fascination and apprehension into engagement.

Bringing magic into pediatric care was never something I consciously planned. It began organically—during a clinical rotation, I encountered a young patient anxious about an upcoming procedure. Hoping to provide a distraction, I performed a simple card trick. To my surprise, her face lit up with delight, her fear momentarily replaced by curiosity and laughter. That single moment sparked a realization: magic could be more than just a hobby. It could be a tool for healing, a way to build trust, and a means of humanizing the hospital experience.

As my training progressed, I began incorporating magic into patient interactions regularly. I witnessed how it eased not only the children’s anxiety but also their parents’ worries. A simple trick could transform a tense clinical encounter into one of warmth and engagement, shifting the dynamic from apprehension to familiarity. This newfound approach allowed me to connect with families instantly, making medical visits less intimidating and more inviting.

Recognizing the profound impact of these moments, I sought out ways to bring magic to children in more meaningful ways. I started volunteering at the Dialysis Unit at Cook Children’s Hospital, performing tricks for kids as they received treatment. These sessions became transformative—not just for the children, but for me as well. I watched withdrawn patients brighten with curiosity, asking to see another trick, then another. Parents, often weary from the emotional toll of chronic illness, smiled as they watched their children experience moments of joy amidst their challenges.

Medicine is as much about connection as it is about science. Patients do not care how much we know until they know how much we care. A patient may not recall the specifics of a physical exam, the precise words a physician used, or even the exact diagnosis. But they will remember how they felt—whether they were comforted or dismissed, reassured or anxious. This is why, while medical knowledge and technical skill are essential, the ability to connect with patients on a human level is just as critical. A patient who feels at ease and trusts their provider is more likely to engage in their own care, leading to better outcomes. Just as a magician carefully crafts an experience that leaves a lasting impression, physicians must be intentional about creating clinical encounters that prioritize empathy, understanding, and connection. Whether it’s taking an extra moment to offer reassurance, explaining a procedure in a way that alleviates fear, or simply engaging with a patient on a personal level, these efforts make all the difference.

Magic serves as an unexpected yet powerful bridge in this dynamic. When a child sees a physician not merely as an authority figure but as someone who brings joy and wonder, the clinical setting becomes less intimidating. This principle extends beyond pediatrics into all areas of medicine.

As I continue my journey in medicine, I will carry these lessons forward, striving to cultivate human connection in every patient interaction. I encourage my fellow medical students and physicians to bring their passions into patient care—to find ways to forge deeper connections with patients. Whether through music, art, storytelling, or something as unexpected as magic, these personal touches can transform a hospital experience, offering comfort in moments of uncertainty. Medicine, after all, is about more than just curing illness—it is about nurturing hope, fostering connection, and proving that even in difficult times, moments of magic can still exist.

Reflections at the Conclusion of a Longitudinal Preceptorship

By Yun Tran, MD, MPH; Assistant Professor, Burnett School of Medicine at TCU; Staff Physician, Department of Family Medicine at JPS Health Network

On the last day of practice with the medical student whom I had been precepting for over two years, I couldn’t help but become emotional as I reflected on how the relatively new model of medical education called Longitudinal Integrated Clerkship (LIC) has reignited my passion for medicine.

Three years ago, I resigned from a primary care physician position in a large healthcare system. I was burned out and ready to give up medicine altogether. I enrolled in a Masters of Public Health program, thinking that I would transition away from direct patient care.

Then a phone call came just as I was in the midst of grappling with biostatistics and epidemiology. The chair of the family medicine department at TCU’s Burnett School of Medicine was looking for a course director for the first-year medical student clerkship. My name came across his desk because I had expressed interest in precepting a medical student when I was still working at the aforementioned healthcare system, which had an affiliation agreement with the new medical school. He saw that I was trained at the JPS Family Medicine residency and talked to the program director, who recommended me for the course director position.

Although I had years of experience teaching residents and medical students in the past, I had only a vague understanding of what the duty of a course director at this new medical school entailed. The medical school was two years old at the time and only provisionally accredited. However, with this position, I could see patients on a part-time basis at a county clinic. This would do beautifully while I worked on my MPH degree.

So I jumped in.

The learning curve that followed was steep and difficult, but it was also one of the most rewarding journeys I have taken in my life.

First, I had not considered fully the responsibility of crafting the course curriculum, which involved much more than simply sending students to clinics to learn from their preceptors. I was tasked to develop learning objectives, curate educational materials, and create written assignments to assess students’ learning. Fortunately, the course director before me had a curriculum that I could use as a blueprint to redesign and improve.

Second, the medical school has built based on an LIC, a concept that was foreign to me. In an LIC, throughout the first year, the students are paired with a primary care physician in the community. They go to clinic approximately every other week for a year to learn how to take a history, conduct a physical exam, and practice clinical reasoning, oral presentation, and documentation. The students concurrently take all of their other courses, including clinical skills with standardized patients. My job is to help prepare the students so that they can successfully transition into the second year, where they will have both inpatient and outpatient rotations in their eight core specialty clerkships that are longitudinal.1

Those were formidable challenges on their own, but the most intimidating prospect of my new position, in fact, was having to precept a medical student.

Recall that I was a burned-out and possibly somewhat cynical physician at the time. My fear was that I was going to discourage my student just as she started her first year of medical school. As much as I was unsatisfied with my career in medicine, I understood the need for developing the physician workforce and I still cared about people. I did not want my student to decide medicine was not for her after having me as her preceptor.

So with apprehension, I started this new phase of my career with my brand-new medical student, whose enthusiasm on her first day in the clinic motivated me to be on my best behavior. I took extra care to be a better listener when my patients talked, remembered to ask open-ended questions and wait for them to finish speaking without interruption, and summarized their problems and the plan of action while making sure that I had answered all their concerns. When my student asked me a question I was not too sure about, I acknowledged my ignorance and encouraged her to find the answer and teach me. One of her activities that day was to shadow a patient from their check-in to check-out to gain the patient’s perspective, and during her debriefing, she described how I had helped put the anxious patient at ease during the visit, and she hoped to learn to do the same.

Little did she know that her comment had put me at ease. I had not corrupted her view of medicine on her first day in the clinic. More importantly, I was not faking compassion with the patients. I truly relished being there for my patients and advising them to the best of my ability. I enjoyed the practice of medicine again!

Over the following year, my student grew to be someone who could conduct a full history and physical exam. She could also present her assessment and propose management plans. And by pending orders and having a useful chart note for me, she made me a more efficient clinician. I was also able to evaluate our course curriculum from the perspective of a preceptor. Being an MPH student at the same time also gave me a unique perspective about the needs of students, particularly adult learners. Both roles helped me tremendously as I worked to enhance the curriculum. The clinic itself also went through a transformation. At first, the nurses and medical assistants were inexperienced in navigating the intricacies of having a medical student who would be there long term, but they adapted and grew to value the partnership with the medical student as well.

When my student returned in her second year to complete her family medicine clerkship, she quickly grew to function at a sub-intern level. The patients appreciated having a medical student that they knew and frequently gave her compliments, which boosted her confidence in her ability to become an empathetic physician. I also benefited. As I witnessed my student’s development, her curiosity and eagerness to acquire knowledge, and her caring attitude, I was able to learn much more from her than information on the most up-to-date medicine that she obtained from concurrent clerkships. I also gained a sense of immense fulfillment, knowing that I had a part in putting forth into the world a physician who will be trustworthy, patient-centered, and always in pursuit of continuing education and self-improvement.

On my student’s last day with us, there was a Thanksgiving potluck at the clinic. As she was saying thanks to the staff members who had been her colleagues over the last couple of years, a surge of mixed emotions overcame me. My student would not return after that day, so there was sadness. There was also pride in how “grown up” she was. She was no longer green and unsure. Rather, she was confident, mature, responsible, while still compassionate, humble, and driven to explore and learn. Above all, there was gratitude. After two and a half years of having the privilege to serve as my student’s preceptor, not only had I not ruined her outlook on medicine, but I had also been gifted with a renewed commitment and a purposeful future.

There are many people for me to thank: My program director who recommended me; my chair, who trusted me to learn on the job and perform; and the senior leaders at the medical school, who guided me as they allowed me the freedom to put my vision of what a first-year clerkship could be into reality. I participated in the process that resulted in full accreditation of our avant-garde school, and I witnessed the construction of our school building near the historic grounds of what was once Fort Worth Medical College, the school that had graduated Dr. Frances Daisy Emery Allen, the first woman to complete medical school in Texas. I am thankful to be connected to this exciting part of Fort Worth history as our school is making history again with innovative and progressive initiatives in medical education.

I thank my medical student. She made me a better physician, a better educator, and a much better person altogether. As I have also completed my MPH degree at the same time as this transition, it feels as if I am being propelled into a new phase of my career while she begins the next step in hers. I am full of hope and optimism. I have no doubt I will feel sadness for each subsequent medical student when their time with me is concluded, but I also know that I will feel pride and gratitude over and over and that will serve as fuel for me to continue my work in healthcare.

Notes:

1. This experience changed my career and could also impact yours. Please reach out if you are interested in learning more. An LIC student in their second year may be in the pediatric clinic one morning, the psychiatry clinic in the afternoon, and the operating room the next day. For each core clerkship, they are paired with a preceptor, and they go to each clerkship every week for nearly a year. Hence, it is longitudinal, and the idea is that the student will integrate knowledge and skills from concurrent clerkships to make them better-rounded physicians, and they will not forget information like they might in block rotations. This is a curriculum design known as interleaving. Another component of LIC is for each student to have a panel of patients that they follow over many months to strengthen their ability to deliver empathetic, patient-centered care in addition to learning about disease progression over time. Patients often value these relationships with the medical students and feel more satisfied with the quality of their care.

My Journey to DREAM

by Jackson Tobler, OMS-I

When I first met Alex in high school, I never anticipated that we’d become life-long friends. Alex has an intellectual and developmental disability (IDD), and we met through Best Buddies—an organization that promotes inclusion and friendship for individuals with disabilities. Alex and I developed a good friendship in high school, and we still maintain it today. We talk on the phone each week, and he participates in my family’s March Madness bracket pool each year. He lives in a different state now, but I was recently able to fly out to visit him and his family. His face lit up when I surprised him at his door, and we enjoyed spending a few days together. I am grateful for my long-lasting friendship with Alex and that I have gotten to know him beyond his intellectual disability. Meeting Alex in high school is what first sparked my desire to serve the IDD community—a desire that grew during college and has continued into medical school.

As an undergraduate student, I expanded my involvement with the IDD community by becoming president of my university’s Best Buddies chapter. I got to connect students to community members with IDD and plan fun events celebrating inclusion. Some of our biggest events were a talent show, a bowling night, and a Halloween party. I was moved when one of the parents told me how much our program meant to her adult son with Down syndrome. She shared that her son sometimes felt lonely or excluded, but our events provided him a welcoming environment where he felt he could belong. This experience showed me the power of inclusion.

When I began medical school at TCOM, I was excited to discover the DREAM student organization. DREAM, which stands for Disability Rights, Education, and Advocacy in Medicine, has allowed me to merge my interest in the IDD community with my career in medicine. DREAM’s mission is to advocate for individuals with disabilities and to prepare future health professionals to care for their unique needs. I attended the first meeting and was inspired by the story of DREAM’s faculty advisor, Brandie Wiley. Brandie is the mother of three adopted children with disabilities. She shared some of the challenges that her children have faced when receiving healthcare, such as barriers in accessibility and communication. She also detailed the qualities she saw in the physicians who were best able to interact with her daughter. Hearing Brandie’s experiences strengthened my desire to advocate for patients with disabilities.

I became a first-year representative on DREAM’s leadership team, which we aptly call “the DREAM team.” We began planning DREAM’s main event of the year, Project Dream Big. In collaboration with Special Olympics Texas and the Fort Worth ISD Boulevard Heights School and Transition Center, we arranged to host over 50 individuals with intellectual disabilities on campus. We planned to pair them with medical student volunteers for an afternoon of games, crafts, physical exams, and a multi-specialty provider panel. The goal of the event was to help medical students learn inclusive healthcare principles and to help the individuals with IDD become more comfortable around medical professionals.

After months of planning, the event successfully came together. As the Special Olympics athletes arrived, it was rewarding to watch them mingle with the medical students and bond at the cornhole and coloring stations. When the physical exam portion began, the medical students were instructed by physician faculty on how to properly obtain consent from individuals with IDD. It was a valuable experience to practice our bedside manner and physical exam knowledge on a different demographic, one that we get little exposure to in the normal curriculum. Connecting with the individuals in both a casual and a clinical setting that day was impactful for everyone. This exposure is helping us become compassionate future physicians and equipping us with the tools to provide quality care for our friends with IDD.

From high school to medical school, advocating for individuals with intellectual disabilities has been a meaningful part of my journey. Each experience—from developing a friendship with Alex, to leading my college’s Best Buddies chapter, and now being involved with DREAM—has reinforced the importance of inclusion, empathy, and advocacy for individuals with IDD. Each step has influenced the kind of physician that I aspire to be. As I continue my medical training and involvement with DREAM, I look forward to more opportunities to help create a healthcare environment that is compassionate, inclusive, and equitable for people with intellectual and developmental disabilities.

The Cost of Providing Care:A Case for Support

By Kathryn Keaton

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

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

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

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

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

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

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

Here’s where the magic happens!

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

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

• Increased Donations: Streamlined online donation process and targeted campaigns

• Enhanced Visibility: PATC will have increased visibility

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

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

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

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

TMA Poster Session: Shaping Research and Health Policy

Student Article

 by Naimah Sarwar, MS-IV

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

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

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

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

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

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

TexMed 2024: Education Outside of the Classroom

Student Article

by Ashley Taylor, OMS-I

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

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

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

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

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

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