On July 16, Project Access Tarrant County (PATC) held its second Salud enTus 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.
With your annual physical last week, we drew annual labs. We’ve got to discuss theseresults 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.1Increase 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.2Quit 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.
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.
BY SETU SHIROYA, MS-II TCU , WITH NEHA SOOGOOR, MS-II TCU; EDITED BY JAYESH SHARMA, MS-II TCU
Breathe in. Breathe out.
It is my first day in the clinic. My heart is racing in my white coat that I have little confidence wearing. My anxiety skyrockets, as do my feelings of not belonging.
What if my attending doesn’t like me? What if I make a mistake? What if my patient starts crying? How do I do a lung auscultation again? What does losartan do?
I can’t remember. I can’t think.
Breathe in. Breathe out.
I have been studying the whole day, my career-defining board exam is in one week, my head is throbbing, my eyelids are drooping. I am clicking through flashcards but nothing sticks. The days are merging into one; someone asked me for the day of the week, and I came up blank.
Breathe in. Breathe out. Breathe in. Breathe out.
Only one year into medical school, and everything feels like a dream. I’ve made it so far, yet the future seems so daunting. I love my life but also fear it at the same time. I want to keep going. I’m excited, but I’m nervous. Where am I in my life? Do I even belong here? Am I the only one thinking this?
Breathe in. Breathe out.
I say it to myself over and over again—my thoughts have been spiraling for days. I need to breathe. I need to calm down.
Breathe in. Breathe out.
I do belong here. I’ve made it so far in this journey; the hard work, the endless hours were not in vain. There is so much more to go and I remind myself that I am excited. I just need to take it one step at a time.
Breathe in. Breathe out.
I am going to be present for patients. I will be a doctor. One step at a time.
Breathe in. Breathe out.
The rampaging thoughts settle, my mind clears, and I open my eyes.
It’s going to be okay.
The morning alarm rings, and my first thought is always the same: “Can I sleep for five more minutes and not think about the long day ahead?” I have stressful exams to take and sometimes dread the workload awaiting me. It feels like the only quiet time I get is in the morning, when I am drinking coffee, working out, or just embracing the quietness. I try to find time to relax, but burnout feels like it is always looming over my shoulder. However, mindfulness and meditation have helped me reorient myself and develop a healthy way to process these feelings.
What does it truly mean to be mindful? To me, mindfulnessis staying grounded to what is in the present moment. It canbe easy to think of the past or try to anticipate the future.However, the only inevitability we hold is this presentmoment. Not a second before, not a second after.
How can we practice this? Mindfulness comes in many forms; some find relief in running or weightlifting, making it a point to have a constant regimen at the gym. Others find it through meditation, focusing on breathing and relaxing the mind. These share one commonality: a mental space we create where we stop thinking about the past or trying to anticipate the future, focusing instead on what is present within and around us. There isn’t one answer to seeking mindfulness; the greatest difficulty lies in knowing where to begin.
As medical students and future doctors we are expected to quickly calm ourselves after these stressful moments and proceed. Sadhguru, a guru who is the founder of the Isha Foundation, states: “Fear, anger, resentment, and stress are poisons you create in your mind. If you take charge of your mind, you can create a chemistry of blissfulness”.1 It is especially easy in a hectic and high-paced environment or period of life to get lost in our thoughts about the stressors we experience. Our thoughts are like clouds. We can either let them pass, or we can dive into them. Taking control of our mind to let the clouds pass, helping our mind become still and focus on the present, is difficult.
This is where meditation techniques can help train our mind. Meditation techniques often involve bringing awareness to a single action or sound. For example, they can be used to bring awareness to your breathing or the repetition of a few words. One method I use is called “4-7- 8 breathing.” Close your eyes. Breathe in for four seconds through your nose. Hold your breath for seven seconds. Breathe out for eight seconds through your mouth. As you inhale, stay aware of how the air flows through your body, from the tip of your nose to your navel. As you exhale, follow the air out from your navel to your mouth. Repeat this about two to three times.
At TCU Burnett School of Medicine, our Meditation and Mindfulness Student Interest Group aims to educate medical students about techniques such as 4-7-8 breathing and help them stay engaged in healthy mindful practices to avoid burnout. Our goal is to cultivate a supportive student community dedicated to mindfulness, fostering connection through monthly meditation sessions, inspiring physician guest speakers, and meaningful community volunteering.
It is going to be okay.
My mother always told me, “Take it one step at a time, oneday at a time.” As medical students, we’re often exposed topatients and situations that can take an emotional toll onour mental well-being; times such as witnessing a patient’sdeath or delivering a life-shattering diagnosis. Before wecan process what we’ve witnessed, we’re often thrownback into a fast-paced environment without a moment torest. In such a high intensity life, grounding ourselves withactivities that bring comfort and ease becomes crucial toour mental well-being. My hope is that we future physicianscan practice mindfulness early, so that we can be present forour patients. In turn, we can help our patients be mindful aswe work together throughout our most difficult moments tomaintain healthy behaviors.
IN 2019, TEXAS HEALTH RESOURCES Foundation announced a new series of grant cycles: the Texas Health Community Impact grants. These grants are available to five regions, with specific focuses for each county based on their most recent Community Needs Assessment.
These two-year awards are made to local organizations that work collaboratively to serve specific zip codes and address health disparities and socioeconomic hardships in innovative ways. Past Tarrant projects funded include community gardens, mental health access, and culinary job training.
For the 2025–2026 grant cycle, the Foundation awarded $5 million to 18 projects across North Texas. Project Access Tarrant County is honored to be among these recipients for a total award of $385,662 over two years.
Partnering with Cornerstone Assistance Network (CAN) and Mission Arlington, the project will utilize enhanced technology, education, and a shared employee to affect radical change in the care of patients with diabetes and/or hypertension in five target zip codes: 76010, 76011, 76104, 76105, and 76119.
We are proud to introduce our project, MATRIX: Medical Assessments and Technology for Inclusive Xperiences.
The Project
Since PATC offers specialty medical and surgical care, our clinic partners are vital. Most patients come to PATC from a referral made by primary care, and those who do not are required, with PATC’s assistance, to establish a connection with primary care.
CAN and Mission Arlington are among PATC’s founding partners. Both clinics serve as medical homes. CAN serves mostly patients in Fort Worth (MATRIX target zip codes 76104, 76105, and 76119), and Mission Arlington serves mostly Arlington patients (MATRIX target zip codes 76010 and 76011). Combined, PATC, CAN, and Mission Arlington provide a spectrum of primary and specialty/surgical care.
Community Health Worker
The single biggest innovation with MATRIX is the addition of a Community Health Worker (CHW). And not just a CHW—but a shared CHW. Once this individual is hired, they will travel between PATC, CAN, and Mission Arlington, having “office hours” at each location. While some patients will meet with the CHW at the PATC office, most will have appointments at their primary care clinic—a place and location where they have an existing relationship and feel comfortable.
The CHW’s activities will be tailored to each patient. The CHW may assist with one-on-one diabetic or hypertension education, help with access to prescription assistance, arrange transportation to diabetic eye exams, or complete hospital paperwork for PATC surgeries. The cadence will vary, but each patient will have individual appointments with the CHW. In total, Cornerstone plans to serve 100 patients and Mission Arlington plans to serve 750 in this manner. CAN’s and Mission Arlington’s aim is that 65 percent of all patients with hypertension will have blood pressure readings below 140/90 and that 68 percent of all patients with diabetes will have an A1c below 9 by the end of the grant period.
Education
A recent Tarrant County Physician article briefly mentioned that a TCU medical student chose PATC as her site to complete her Scholarly Pursuits and Thesis (SPT) project.1,2 Alex Koehl, MPH, MS-I at TCU, brings her public health expertise to PATC in creating a series of classes pertaining to social determinants of health (SDOH) common to PATC patients.
The first class will occur in late March. This class will empower patients to ask questions to understand their disease and treatment and to speak up if they do not understand their instructions. Patients who are seen pro bono often feel that they do not have agency to advocate for themselves and ask questions, leading to confusion and misunderstandings that eventually cause non-compliance and a lack of resolution of their health condition. The MATRIX grant allows for meals and incentives, encouraging attendance. The series will be facilitated in both Fort Worth and Arlington. Future topics include how to open a bank account (sometimes required for hospital charity applications), how to read a prescription bottle, and how to navigate a patient portal.
Technology
Enhanced technology will answer some of the barriers we face with our patients. We recently received a separate grant that will cover the cost of CareMessage, a messaging platform for safety-net organizations to “increase access to care, improve clinical outcomes, and address social drivers of health.”3
CareMessage will allow PATC to schedule appointment reminders (that include the address with a Google map link!), respond in real-time to questions or concerns, and generally allow for texting instead of playing phone tag. In addition, CareMessage can automatically translate any message into one of dozens of languages, meaning that any PATC staff member can communicate with any patient regardless of language proficiency.
CareMessage will not replace PATC’s personal touch—all initial contact and important information will be relayed by telephone. But for simple reminders and questions where a yes- or-no response is needed, a phone call is generally not necessary.
While the messaging feature is an exciting progression in PATC’s day-to- day operations, CareMessage can go much deeper and is vital to MATRIX’s future success.
CareMessage has several preloaded educational text series. Stephen Pullman, MS-I at TCU, has also chosen PATC as his SPT site. Stephen is vetting existing diabetes and hypertension modules. In addition, as training progresses, Stephen is documenting ideas for future education modules that we can create. By the conclusion of his project, we will have multiple avenues for patient education on both preventative care and chronic conditions.
The survey element is also vital to Alex’s project. With CareMessage, patients will complete pre- and post-surveys for our SDOH classes, measuring the attendees’ level of understanding before and after the material that can be reported to the Texas Health Community Impact Grant project management team. We will also use this for participant feedback to improve future curricula.
As with all innovation, this project will have adaptations, enhancements, and changes over the course of the next two years; but we know that the future is bright. With the THR Foundation’s endorsement, the collaboration with two historic partners, and the opportunity for enhanced technology, by the end of this grant period, significant change and improvement will be affected. We look forward to keeping you updated as MATRIX continues to progress.
References:
Kathryn Keaton, “Project Access Tarrant County: Growth in 2025,” Tarrant County Physician, January/ February 2025, 21–22.
“Scholarly Pursuit and Thesis: Burnett School of Medicine at TCU: Fort Worth, Texas,” Burnett School of Medicine at TCU, June 17, 2024, https:// mdschool.tcu.edu/empathetic-scholar/ scholarly-pursuit-and-thesis/.
“Patient Engagement for Improved Health Equity,” CareMessage, February 4, 2025, https://www.caremessage.org/.
In one way or another, I have always been tied to medicine by an invisible string. One of my fondest memories of my childhood was around the age of five, when I would help my mom put together goodie-baskets for the oncology patients she would be visiting the upcoming week. This was a Sunday ritual for my mother and me, one we did while simultaneously baking chocolate chip cookies in the oven. No, my mom is not a medical provider; she is a pharmaceutical sales rep who spent any extra time she had on the weekends creating those baskets to show the patients that were taking part in clinical trials for the lymphoma drug she sold that she cared about them. This was an act out of pure benevolence and servitude for those who needed it more than the average person.
In a similar light, my grandmother spent most of her nursing career as a breast cancer nurse in Buffalo, New York. Growing up, I remember Grandma always sharing her favorite memories as a nurse. She was glowing with pride when I told her that I had a similar interest in oncology. Fast forward to today—now Grandma and I share conversations and exchange information about new developments in the breast cancer world. It is truly a full-circle moment with a touch of nostalgia from my younger days. Now as a medical student, I have the immense privilege to carry the torch of my mother and grandmother into my own medical journey. Besides being introduced to this field at a very early age, oncology has piqued my interest by its very nature. The endless opportunities to become a pioneer in cancer research or navigate complex treatment options that can potentially impact countless lives is truly the epitome of medicine, and continues to be the center of my “why.”
It has always been extremely important to me that I seek out any opportunity to create an impact in this field, just as my mother and grandmother did. As the current vice president for my school’s Oncology Student Interest Group (OSIG), I have had the amazing opportunity to assist in cultivating a tight-knit community of passionate students united by a shared commitment to being a source of support and positive change for patients during their most vulnerable moments.
One of the most significant moments I have had serving as a leader of this organization was in honoring the memory of my childhood friend, Zach, who passed away from astrocytoma in the fall of 2018. I felt a personal calling to head an OSIG fundraiser in honor of Zach and in support of his charity, the Big Z Foundation. The Big Z Foundation is led by Zach’s mother and father and financially supports terminally ill children and their families around the DFW area. Just in time for North Texas Giving Day on September 19th of this year, OSIG was able to raise hundreds of dollars for the Big Z Foundation. This support will help local families by assisting with the cost of their hospital bills, treatments, and housing costs. I can only describe the feeling I experienced as true enrichment when I surprised Zach’s parents on behalf of OSIG with our collective donations for the charity. The profound gratitude they expressed is something I will forever hold near and dear.
In moments like this, sharing acts of servitude and benevolence with fellow classmates is an experience so rewarding that it is impossible to fully express in words. This journey has brought me a feeling of gratification in service that is similar to the one I reminisce about when remembering making oncology patient baskets in my childhood. As I continue on my path in medicine, it is my personal mission to continue these acts of benevolence and shed light on those around me so that the flame of my mother’s and grandmother’s torch continues to be passed forward and illuminate a new generation’s impact on the field of oncology.
Another year has come and gone, and Project Access Tarrant County is beginning its fourteenth full year of serving Tarrant County.
While a full 2024 annual report will be included in the next edition of Tarrant County Physician, we did experience growth and are excited that new relationships in our community are bringing new things for this year. Here’s what you can expect to see from us in the next twelve months.
Staffing
In February 2024, PATC hired a new full-time bilingual case manager, Karla Aguilar. Karla was not new to PATC—she originally came to us in 2021 to complete her internship for her undergraduate degree in public health. Over the past ten months, Karla has refreshed our enrollment and application process, increasing overall efficiency.
PATC also has an additional new employee starting this month. Joanna Lopez, our part-time bilingual program specialist, will be the first point of contact for all new referrals and will assist with processing referrals, prescreening patients, reviewing paperwork, and keeping up with patient communication.
Interns and Volunteers
In the fall of 2024, PATC invited freshman medical students from both the Burnett School of Medicine at TCU and UNT Health Science Center to volunteer with us. These students have been instrumental in keeping us on top of new referrals and other data entry. We will continue to have medical student volunteers and appreciate the time they give, however limited. Two incoming TCU students have chosen PATC for their four-year Scholarly Pursuit and Thesis (SPT) project—we’ll have more information on those projects in the following paragraphs.
In an exciting development, PATC recently finalized an agreement with the UTA School of Public Health that makes us a sanctioned site for undergraduate and graduate students’ internships, which are required for graduation. In January, three of these undergraduate interns will work in the Project Access office part-time. In addition to assisting with daily PATC activities, they will also each complete a special project related to improving or expanding Project Access services.
The TCMS Alliance also lent support over this year. We appreciate our Alliance volunteers that assist with data entry, appointment follow-ups, and patient communication.
Patient Education
In the May/June 2024 issue of Tarrant County Physician, the PATC article focused on ways PATC navigates social determinants of health. Since that article, Karla and a first-year medical student at TCU have written a curriculum geared toward PATC patients to address common barriers to medical care as part of this medical student’s SPT project. We plan to host the first class in March of 2025. It will address medication compliance and teach not only about the importance of taking medication for chronic diseases but also how to understand medication instructions, warnings, and other labels patients may see on their bottles. Future class topics may include basic financial literacy, applying for state benefits, and teaching patients how to ask their medical team questions in order to understand their conditions and care plans. We are coming up with incentives to encourage patient attendance, and we have every reason to believe this will be a great success.
Technology
PATC has used CareScope, a database that holds patient and volunteer information, since 2011. CareScope continues to provide what we need from a demographic and reporting standpoint; however, it is limited in its communication abilities. Fortunately, a new innovative program called CareMessage offered a grant to Project Access to use its software for two years. CareMessage will allow PATC staff to communicate with patients through text messages regarding appointments, enrollment deadlines, and post-appointment questions. In addition, we will be able to select sub-groups of our patients for reminders about preventive care, invite patients to our classes mentioned above, and distribute pre- and post-surveys needed for funding purposes. Another TCU medical student has chosen to work on CareMessage as his SPT project. He will assist with setting up the technology, integrating it into CareScope, and creating processes and content that we will be able to build on for years to come.
In addition, PATC launched a new website in September 2024, which you can visit at http://www.tcam.org. This website hosts all Tarrant County Academy of Medicine programs but focuses on PATC. We still have two developmental phases to go through before we have our fully operational website, but here, donors and supporters will be able to support us and find general information much more easily than before.
Fundraising and Capacity Building
As a recipient of the 2024 Community’s Foundation ToolBox Grant, our project was to create and implement a 12-month operational plan—think like a mini-strategic plan. We worked with a consultant, analyzed processes, met with focus groups, and wrote a month-by-month strategy for 2025 to recruit and retain volunteers and expand funding opportunities. Grant writing will continue, and individual giving will be given increased focus.
Patient Services
In addition to the above, our main day-to-day activities will remain the same. Our goal is to serve 250 patients in 2025, including performing 100 surgical procedures. We aim to fully utilize the 48 surgical cases Park Hill Surgery Center has committed to, with the other 52 cases being performed among our other hospital partners. We have strategies in place to make strides to reduce and perhaps even eliminate the general surgery and gynecology waiting lists.
Conclusion
We are excited about what this year will hold, and we look forward to sharing it with our supporters. In addition to the PATC column in the magazine, please be sure you are subscribed to our monthly e-newsletter and follow us on social media as we share our 2025 successes.
One of the most significant misconceptions about palliative care is that it’s solely focused on end-of-life care. This couldn’t be further from the truth. Palliative medicine is a specialized area of medicine that focuses on improving the quality of life for people living with serious illnesses. By addressing physical, emotional, and spiritual needs, palliative care helps patients and their families navigate difficult times with grace and dignity.
Beyond Physical Symptoms
While palliative care can certainly help manage physical symptoms like pain and fatigue, it goes far beyond that. It’s about addressing the whole person, including their emotional, social, and spiritual well-being. This might involve counseling, support groups, or spiritual guidance.
The Importance of Early Palliative Care
Many people believe that palliative care is only for those in the final stages of life. However, palliative care can be beneficial at any stage of an illness. Early palliative care can help patients and their families make informed decisions about treatment options, manage symptoms effectively, and improve quality of life.
A Growing Need
Despite its many benefits, palliative care remains underutilized. There is a significant shortage of palliative care physicians, and many healthcare providers are not adequately trained to provide palliative care. This can lead to suboptimal care for patients with serious illnesses.
A Call to Action
To address this growing need, we must increase awareness of palliative care and encourage more healthcare providers to specialize in this field. By working together, we can ensure that all patients have access to the compassionate and effective care they deserve.
A Personal Perspective
As a palliative care physician, I have the privilege of witnessing firsthand the transformative power of this specialty. By focusing on the patient’s overall well-being, we can help them live their best lives, even in the face of serious illness.
Morvarid “Mo” Rezaie, DO, HMDC, FACOI is a Palliative Medicine physician at The Center for Cancer and Blood Disorders.
In 2018, an American Academy of Medical Colleges (AAMC) report projected a national shortage of up to 121,900 physicians by the year 2033.1 Just a few months ago, that number was reduced to 86,000 by 2036.2 While the trend is moving in the right direction, this improvement is based on the hypothetical but not guaranteed increase in graduate medical education spots.3 The current number of incoming primary care physicians is simply not sufficient to replace the number who are retiring, much less to grow to meet the expanding need, and that is just among primary care physicians. Other specialties have not been studied to the same extent, but the AAMC has stated this will be researched more in the coming years.4
Unfortunately, Texas ranks forty-second in primary care physician availability5 and is predicted to be short by over 20,000 primary care physicians by 2030.6 In 2021, 249 of Texas’s 254 counties reported a shortage – including Tarrant and all of its surrounding counties.7
While current and predicted physician shortages are hot topics in the medical realm, the metroplex is also making headlines with the recent and projected population boom. The latest census shows that DFW added over 150,000 residents between 2022 and 2023, and Tarrant County ranked number nine out of ten among Texas counties with the most growth in the same time frame.8 Specifically, Fort Worth had the greatest increase in population of all cities in the state between 2020 and 2023, with a growth rate of 5.3 percent,9 and Fort Worth’s population will likely surpass one million by the end of 2024.10
The Fort Worth Chamber recognizes that “transportation, mobility, water, and energy infrastructure” need to be prioritized11 and has recently announced the new “Moving a Million” project to streamline transportation issues,12 but the looming collision of the impending physician shortage and continuing population boom seems to be unaddressed or unacknowledged – maybe even unrecognized.
“The urgency is now,” said Gerald Harmon, MD, past president of the American Medical Association, in a 2022 podcast.13 And for Fort Worth and all of Tarrant County, projections show that our healthcare access will only get worse as the physician shortage and the population growth gap widens.
Leonard Glass, MD, formerly of the University of California San Diego School of Medicine, recognized the coming physician shortage when he founded Physician Retraining and Reentry.14 In partnership with the medical school faculty, this national program has been addressing this issue since 2013 by creating an online training pathway for physicians who may have left the profession or let their license lapse. They also provide training for surgeons who may no longer be able to perform procedures but who are fully capable of performing primary care duties. The program website lists five major impacts of the physician shortage. One of those five is a growth of healthcare disparities, especially among communities who already face barriers to obtaining basic healthcare.15
Tarrant County has a well-documented network of free and charitable clinics that serve mostly uninsured patients. These clinics, along with JPS resources, bridge this gap – which is mostly primary care – in our community. But as with any charitable endeavor, resources are limited. Lori Kennedy, director of healthcare services at Cornerstone Assistance Network’s clinic, says that the organization is seeing the impact of physician and advanced practitioner shortages firsthand. “The need is up, but volunteer numbers are down,” she says. She encourages retiring doctors to hold on to their licenses for at least a year after retirement. “Sometimes after a year, doctors realize they miss seeing patients and want to do a little volunteer work.” Clinics like Cornerstone rely on volunteer physicians, and retired or almost-retired physicians make up most of this volunteer base.
Linda Siy, MD, a family medicine physician, says that the Tarrant County indigent population needs are handled through specific resources and safety net programs. “The need will grow, and the population will feel the strain,” she says, “and so will our safety net programs.”
While Ms. Kennedy and Dr. Siy share their concerns from a primary care perspective, Project Access is beginning to notice that patients across many specialties are having to wait 3–4 weeks for an initial phone call and often several more weeks before the next new patient appointment opening. This is in no way a slight to our volunteers – our dedicated volunteers and their offices treat PATC referrals in the same way they would any other funded patient.
The problem of the physician shortage and its exacerbation by our population boom has to be solved on many levels from the city and county management, healthcare infrastructure, medical education, and the business sector. The alarm bells are sounding, and hopefully healthcare access is a topic of discussion during this time of growth.
The average physician is not going to be involved in these strategic planning discussions, but you can still make a difference starting today. Our charitable clinic network is always in need of primary care volunteers, and they even take care of malpractice coverage when needed.
Of course, PATC always needs your help too. One of the beautiful things about PATC is that YOU are in control of how many patients you see per year, and you don’t have to leave your practice to see them – they are scheduled in the course of your normal workday and any surgeries are done where you are already credentialed.
We know this won’t solve all of Tarrant County’s problems. Physicians alone cannot fix this issue – this will have to be addressed by the local municipalities. Unless dramatic action is taken, physician shortages will still get worse and wait times will continue to increase as the population grows. But we as a physician-led charitable program can pave the way, showing our community that we will do everything within our power to help those in need.
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.
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?
Tarrant County Physician Online 