Texas Family Physician, Q2 2019 by Texas Academy of Family Physicians

TEXAS FAMILY PHYSICIAN VOL. 70 NO. 2 2019

TEXAS FAMILY PHYSICIAN OF THE YEAR

Rodney Young PLUS:

A Look At Texasâ&#x20AC;&#x2122; Medical Schools CDC Warns Of Misapplication Of Opioid Guideline Interim Session Highlights

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INSIDE TEXAS FAMILY PHYSICIAN VOL. 70 NO. 2 2019

Cultivating excellence in care and education

A natural teacher, a caring doctor, a persuasive advocate, a devoted dad—Amarillo’s Rodney Young, MD, is all that and more. Read about your 2018-19 Texas Family Physician of the Year. By Kate Alfano

CDC warns of misapplication of its opioid guideline

The CDC recently warned that misapplication of its Guideline for Prescribing Opioids for Chronic Pain—United States, 2016, can risk patient health and safety. The guideline is intended for use solely by primary care physicians treating chronic pain in patients 18 and older.

By Chris Crawford

Texas Med Ed, 2019

In the past few years, several new medical schools have either opened or announced they will begin enrolling students soon across the Lone Star State. Here’s a rundown of the current list of schools. By Nayana Shahane

6 FROM YOUR PRESIDENT Family medicine in a time of mergers and acquisitions 10 MEMBER NEWS Siy wins C. Frank Webber Award | Report from TAFP’s CFW Lectureship and Interim Session | New behavioral health innovation competition launches 14 INTERIM SESSION HIGHLIGHTS 15 PROPOSED BYLAWS AMENDMENTS 30 PERSPECTIVE Recent challenges to a culture of patient safety

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TEXAS FAMILY PHYSICIAN VOL. 70 NO. 2 2019 The Texas Academy of Family Physicians is the premier membership organization dedicated to uniting the family doctors of Texas through advocacy, education, and member services, and empowering them to provide a medical home for patients of all ages. TEXAS FAMILY PHYSICIAN is published quarterly by TAFP at 12012 Technology Blvd., Ste. 200, Austin, Texas 78727. Contact TFP at (512) 329-8666 or jnelson@tafp.org.

OFFICERS president president-elect treasurer

Rebecca Hart, MD

Javier D. “Jake” Margo, Jr., MD Amer Shakil, MD, MBA

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Mary Nguyen, MD

immediate past president

Janet Hurley, MD

EDITORIAL STAFF managing editor

Jonathan L. Nelson

associate editor

Jean Klewitz chief executive officer and executive vice president

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Michael Conwell

CONTRIBUTING EDITORS Kate Alfano Travis Bias, DO, MPH Chris Crawford Nayana Shahane

SUBSCRIPTIONS To subscribe to TEXAS FAMILY PHYSICIAN, write to TAFP Department of Communications, 12012 Technology Blvd., Ste. 200, Austin, Texas 78727. Subscriptions are $20 per year. Articles published in TEXAS FAMILY PHYSICIAN represent the opinions of the authors and do not necessarily reflect the policy or views of the Texas Academy of Family Physicians. The editors reserve the right to review and to accept or reject commentary and advertising deemed inappropriate. Publication of an advertisement is not to be considered an endorsement by the Texas Academy of Family Physicians of the product or service involved. LEGISLATIVE ADVERTISING Articles in TEXAS FAMILY PHYSICIAN that mention TAFP’s position on state legislation are defined as “legislative advertising,” according to Texas Govt. Code Ann. §305.027. The person who contracts with the printer to publish the legislative advertising is Tom Banning, CEO, TAFP, 12012 Technology Blvd., Ste. 200, Austin, Texas 78727. © 2019 Texas Academy of Family Physicians POSTMASTER Send address changes to TEXAS FAMILY PHYSICIAN, 12012 Technology Blvd., Ste. 200, Austin, TX 78727. 6

TEXAS FAMILY PHYSICIAN [No. 2] 2019

Mergers, acquisitions, and the family physician—where do we fit in? By Rebecca Hart, MD TAFP President recently i have been hearing a lot of angst from colleagues about all the impending mergers of large retail corporations, insurance companies, and pharmacies starting up primary care clinics complete with urgent care, lab, imaging, and other amenities. My colleagues are gnashing their teeth wondering if they’ll be forced out of business by yet another corporate takeover. First the hospitals, now this. The CVS/Aetna partnership brings us HealthHUBs in CVS stores, a health care “destination” with nurse practitioners at the helm and a “care concierge” to direct the patient to CVS services. They are associated with physicians only as reviewers of the NPs, because this is required by Texas law. They are not even on the payroll, but act as consultants—a very distant role. These physicians are not involved in directing the company or directing the primary care at all. The new BCBS/ Sanitas partnership will open 10 new clinics in Dallas and Houston in direct competition with the CVS product, as well as all of us in those cities. At the same time, Walgreens has partnered with Houston-based Village MD to create a physician-led partnership to open clinics in local Walgreens stores called Village Medical at Walgreens. Meanwhile, Walmart is opening Walmart Care Clinics in their locations, with a $4 price point for Walmart health plan participants. Again, nurse practitioners are at the helm of these clinics.

In an article entitled “Disrupting Primary Care in the Lone Star State” from the April 12, 2019 Gist Healthcare report, the authors note: “Texas has become a testing ground for disruptors looking to refine their consumer-focused care offerings. Coupled with the highest number of urgent care and freestanding EDs in the U.S., the state is now the epicenter for new access and care services. Health care leaders nationwide should closely monitor the Lone Star State to see how these experiments evolve, and how they impact traditional providers.” Wow. It’s all starting here in Texas. Usually it’s great to be a trendsetter, but I’m not sure this is the trend I want us to set for the nation. What happens here over the next couple of years could be the beginning of a nationwide epidemic of corporate primary care in retail centers everyone knows. Will there still be room for us family physicians in private practice, or for that matter in regular practices or even in large groups? Is this really the future of primary care? TAFP has submitted a resolution to the TMA House of Delegates calling for a concerted effort among physician organizations to pursue a multi-year strategy of developing and supporting public policy options that assure fair business practices and enforceable protections from predatory behavior. Such a strategy would begin with a comprehensive study of developments in the Texas health care market designed to

It’s all starting here in Texas. Usually it’s great to be a trendsetter, but I’m not sure this is the trend I want us to set for the nation. What happens here over the next couple of years could be the beginning of a nationwide epidemic of corporate primary care in retail centers everyone knows.

assess how this rapid consolidation and vertical integration of health plans, health systems, and corporate health organizations affects patient choice, physician practice choice, and the economic viability of independent physician-owned practices. As a physician in a small group practice with four family doctors, I think the structure of these new models could make all the difference in whether our practices are actually disrupted or not. If these corporate entities work with existing family doctors in communities to coordinate the practices, the clinics could enhance access for patients without competing with us. They would sort of fit in as another level of care. They could hire medical directors from local doctors to head up primary care teams at the clinics. Or they could partner with existing clinics for services that go across the care spectrum from doctor to ancillary at the clinic. Or, they could use the Village Medical model and have a family doctor running the clinic located in the pharmacy. I doubt all patients will want to have their doctors located at a pharmacy or a Walmart clinic. There will always be room for that trusted doctor-patient-relationship-centered care done at our offices, or in DPC offices with 24/7 access via technology. Moreover, the number of patients needing primary care far outnumbers the number of family physicians, nurse practitioners, and physician assistants available to see them all, so we do need something new to help us meet this ever-increasing demand for our services. I wonder if these retail clinics will locate in rural areas, extending access where it’s needed most. My hope is that the corporate entities partner with us with the understanding that primary care is best delivered with each professional working at the top of his or her license. Family doctors at the helm of these teams can make a big difference in the quality of care the clinics could provide, which gives me hope that these accessible, convenient centers may be successful. But only if they do it in a way that respects the local doctors, partners with them, and works for the best interests of the communities they serve. For our patients, I say “buyer beware.” Does a corporate entity ever truly care for you as a patient rather than their bottom line? Do you really want to go to a clinic run by your insurance company? Think about it.

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NEWS BRIEF

Rich’s rules for treating chronic pain Robert “Chuck” Rich, MD, of Bladenboro, North Carolina, who participated on the CDC Core Expert Group that helped create the agency’s Guideline for Prescribing Opioids for Chronic Pain—United States, 2016, told AAFP News he follows these principles, which parallel the CDC guideline, when treating patients with chronic pain: 1. Fully understand the source of the patient’s pain and what factors have been used previously to guide the selection of future therapies. 2. Assess the impact of the pain on the patient’s level of functioning and reassess periodically and in response to changes in therapy. 3. Maximize the use of adjunctive therapies to lessen the need to use opioids or reduce the dose, if possible, in patients already taking opioids. 4. Use the lowest effective dose when starting opioids and escalate the dose slowly if dosage increases are necessary. 5. Continually reassess goals and objectives for the use of opioids in the treatment of pain with your patient. 6. Constantly monitor your patient’s response to and compliance with their opioid therapeutic regimen using tools such as functional assessment screens, periodic drug screens, data available in your state’s prescription drug monitoring program and pill counts. The AAFP offers a chronic pain toolkit that features many of these items.

WEB RESOURCE Find patient education resources on opioid addiction and many other diseases and conditions at familydoctor.org. https://familydoctor.org/ condition/opioid-addiction

TEXAS FAMILY PHYSICIAN [No. 2] 2019

CDC warns of misapplication of its opioid guideline Family physician expert offers insight on misinterpretations By Chris Crawford according to an april 24 cdc media statement, a recent commentary in the New England Journal of Medicine penned by authors of the agency’s Guideline for Prescribing Opioids for Chronic Pain—United States, 2016, warned that misapplication of the guideline can risk patient health and safety. The commentary’s authors outlined examples of how the guideline, which is intended to be used by primary care physicians who are treating chronic pain in patients age 18 and older, has been misapplied. They also highlight advice it contains that is critical for safe and effective implementation of the recommendations. As a reminder, the AAFP’s Commission on the Health of the Public and Science gave the guideline its “affirmation of value” designation in April 2016, agreeing with some of its recommendations but expressing concerns about others based on the methodology used and a lack of supporting evidence. Robert “Chuck” Rich, MD, of Bladenboro, N.C., who represents the AAFP on the AMA Task Force to Reduce Opioid Abuse and participated on the CDC Core Expert Group that helped create the guideline, told AAFP News that because the guideline’s recommendations have been incorrectly interpreted as care standards by insurers, regulatory agencies, health systems, and other organizations, and have been applied to all categories of patients with pain, the result has been inappropriate pain care management for some patients, particularly those who are already using opioids as part of their care regimen. “As a guideline with a limited evidence base, both pro and con, for the use of opioids in chronic pain, it was never meant to be interpreted as rules and standards of care for the pain patient,” Rich said. “The intent was to help the primary care professional through a shared decision-making process with their patient, determining the best

options for the treatment of chronic pain, including the use of opioids as appropriate.” POTENTIAL MISAPPLICATION Misuse of the guideline, according to CDC officials, has included applying its recommendations to patients in active cancer treatment, those experiencing acute sickle cell crises or patients suffering post-surgical pain. Various other organizations are currently working to develop guidance for treatment of pain in these subgroups of patients, Rich said. “The pain treatment requirements for the management of pain in these groups could easily surpass the 90 MME (morphine milligram equivalents) recommendation—the suggested top end of dosing in patients for chronic pain from the CDC guideline,” he said. “The circumstances surrounding pain in each of these groups is different from (those of) the typical patient with chronic pain, and each group must be considered individually for the relief of pain and suffering.” Other examples of misapplication have included instituting hard limits on, or even cutting off, opioid use in patients already prescribed higher dosages—90 MME or more per day. The agency said that its recommendation statement does not suggest discontinuation of opioids already prescribed at higher dosages. The CDC identified the 90 MME per day threshold as a soft cutoff based on data showing that the risk of accidental overdose and other complications increases exponentially after that level, Rich said. “In patients not previously exposed to opioids, this remains a goal that I fully endorse—keeping the patient to the lowest effective dose based upon an ongoing assessment of pain and function,” he said. “For those patients already taking opioids for chronic pain, many are already at or above that level, and efforts to limit those patients to 90 MME per day could easily

precipitate worsened pain and lessened functional capacity.” Furthermore, said Rich, rapid tapers or abrupt discontinuation of opioids in patients already dependent on the medication for pain control will precipitate opioid withdrawal, which is clearly painful and dangerous for patients. “In an effort to lessen the effects of withdrawal, the patient may turn to street drugs or other inappropriate medications with other unintended consequences,” he noted. One other significant misapplication of the guideline is that its dosage recommendation does not apply to patients receiving or starting medication-assisted treatment for opioid use disorder. It applies only to use of opioids to manage chronic pain. “The CDC guideline primarily focused on the treatment of chronic pain, and the subject of MAT for the treatment of opioid use disorder is a separate issue, which is better addressed by other guidelines,” Rich said. The agency said in its statement that the guideline was intended to ensure that primary care clinicians work with patients to consider all safe and effective treatment options for pain management. “The CDC encourages clinicians to continue to use their clinical judgment, base

treatment on what they know about their patients, maximize use of safe and effective non-opioid treatments and consider the use of opioids only if their benefits are likely to outweigh their risks,” said the statement. NON-OPIOID TREATMENT OF CHRONIC PAIN The CDC acknowledged in its statement that patients may encounter challenges with availability of and coverage for non-opioid treatments, including nonpharmacologic therapies (e.g., physical therapy). “Efforts to improve use of opioids will be more effective and successful over time as effective non-opioid treatments are more widely used and supported by payers,” the agency said. The use of adjunctive medications such as antidepressants and anticonvulsants, as well as nonmedication treatments such as chiropractic and acupuncture, has the potential in many cases to lessen the need for, or even surpass the efficacy of, opioids for many pain syndromes, said Rich. “While it’s true that the evidence base for many adjunctive treatments is limited, this is an area where there is active research that may better guide our treatments in the future,” he said. “I acknowledge that many

of us have experienced problems with the coverage of adjunctive treatments and medications by insurers. “But the Academy, along with other professional organizations, has actively advocated for expanded coverage of adjunctive therapies, and insurers are indeed starting to better cover those therapies.” FINAL THOUGHTS Finally, Rich said each patient currently being treated with opioids represents potential challenges and opportunities for family medicine practices and deserves patience and a full understanding of their pain processes and what led to the decision to use opioids. “That may require a significant time commitment on our part to properly care for these patients beyond just passing out a prescription for opioids or saying, ‘I don’t treat pain patients,’” he said. “In my current practice environment, I can’t think of a more challenging patient population or one more deserving of our compassion and commitment to properly relieve pain and suffering.” Source: AAFP News, May 9, 2019. ©American Academy of Family Physicians.

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CME SCHEDULE Annual Session & Primary Care Summit Nov. 8-10, 2019 Nov. 6-7: Business meetings and preconference workshops

The Woodlands Waterway Marriott Hotel The Woodlands, Texas C. Frank Webber Lectureship & Interim Session April 3-4, 2020 Renaissance Austin Hotel Austin, Texas Texas Family Medicine Symposium June 5-7, 2020 La Cantera Hill Country Resort & Spa San Antonio, Texas 10

TEXAS FAMILY PHYSICIAN [No. 2] 2019

Texas medical students honor Fort Worth FP texas medical students recognized Fort Worth family physician Linda M. Siy, MD, with the 2019 C. Frank Webber, MD, Award, for her commitment to mentoring medical students. The Texas Medical Association Medical Student Section presented the award to the doctor during TexMed, TMA’s annual conference, in Dallas. “To be recognized for doing what I truly enjoy is a gift, and I am extremely honored,” said Dr. Siy. Linda Siy, MD “C. Frank Webber was a remarkable, very accomplished family physician, and that makes this award even more special to me as a family physician.” Siy has cared for patients through the JPS Health Network since 1995 at the JPS Northeast Tarrant Medical Home and has been a TMA member for 26 years. She is a member of TMA’s Council on Legislation and represents the Tarrant County Medical Society as a delegate to the TMA House of Delegates, the association’s policymaking body. Siy is immediate past president of TCMS. She is a member of the TAFP Board of Directors and has served as TAFP president. Currently, she is president of the TAFP Foundation. She also represents TAFP as a delegate to the AAFP Congress of Delegates. Mentoring medical students is one of the things she enjoys most in her career. “To help shape our future leaders in medicine is critical to the success of the profession,” she said.

Steven Mai, immediate past president of the TMA Medical Student Chapter at the University of North Texas Health Science Center at Fort Worth Texas College of Osteopathic Medicine, nominated Siy for the award. “Dr. Siy has been a great influence for the TCOM chapter,” Mai said. “She has gone out of her way to sit in on officer meetings, find event speakers, and help us create impactful events to engage our student members in TMA and our community health society.” When she was president of TCMS, Siy increased networking opportunities between medical students and physician members of the county medical society. She also connected the students with physician speakers for a business in medicine lecture series. This has paid off locally and beyond. Siy said several TMA leaders have emerged from the “active and engaged” TCOM TMA Chapter. “The TCOM students are high achievers, very enthusiastic, and really understand the value of organized medicine,” she said. Siy earned her bachelor of arts and medical degrees from the University of MissouriKansas City School of Medicine through a combined degree program. She completed her family medicine residency at John Peter Smith Hospital in Fort Worth. Created in 1987, the C. Frank Webber, MD, Award is named after the late Texas family physician and educator C. Frank Webber, MD, former dean of The University of Texas Medical School at Houston. Dr. Webber’s efforts prompted the development of the strong student organization within TMA.

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more than 400 physicians, residents, medical students, and other health care professionals attended the 2019 C. Frank Webber Lectureship and Interim Session held Friday, April 5 through Saturday, April 6 at the Renaissance Austin Hotel. The two-day meeting included CME lectures, two KSA Workshops, TAFP business meetings, and the CFW Resident and Student Track. Diplomates of the American Board of Family Medicine had two chances to get credit for the Self-Assessment Module portion of their Maintenance of Certification at TAFP’s KSA Workshops. Attendees at Thursday’s KSA Workshop discussed coronary artery disease and at Saturday’s workshop, they discussed diabetes. Friday’s CME lectureship featured speakers on a wide array of topics, including diabetes, reproductive health, hypothyroidism, and more. TAFP commission, committee, and section meetings also began on Friday and included discussions on many aspects

of family medicine that will guide the Academy. Committees sent action items to the Board of Directors for consideration. TAFP also hosted the 2019 CFW Resident and Student Track on Saturday, teaching medical students and residents about family medicine. It began with a welcome from TAFP President Rebecca Hart, MD, followed by an interactive panel with two family physicians, Rita Schindeler-Trachta, DO, and Brian Jones, MD. Residents and students also had the opportunity to learn about advocacy in the 86th Texas Legislature from TAFP CEO Tom Banning and visit exhibitors during the Job Fair and the Residency and Procedures Fair. This year’s Annual Session and Primary Care Summit will take place in The Woodlands, Nov. 8-10 and will include more than 20 hours of CME and all TAFP committee, commission, and section meetings. Next year’s C. Frank Webber Lectureship and Interim Session will be held April 3-4, 2020, at the Renaissance Austin Hotel. Mark these dates on your calendars and we will see you then!

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TEXAS FAMILY PHYSICIAN [No. 2] 2019

tafp has launched a brand new initiative to highlight the best models for integrating mental and behavioral health into primary care practices: the Behavioral Health Integration Innovators Competition. This is an opportunity for you to inspire and lead your colleagues, showing them the way to provide behavioral health services to their patients. We are seeking simple and effective models that can be employed by a variety of practices. To emphasize the importance of this topic, TAFP will offer a $10,000 prize to the winning entries in three categories of practices: academic settings, integrated health systems, and small group and solo practices. Additionally, winning entries will be highlighted at the TAFP Annual Session and Primary Care Summit and featured in Texas Family Physician. Entry is simple. You might call this an invitation to a game you’ve already been playing because you don’t need to create

anything new to win. You just need to describe your successful model of behavioral health integration. Register for the contest on TAFP’s website. You’ll receive instructions for your submission after registering. Project submissions will consist of three parts: a narrative, short answers to a set of questions, and a demonstration of your model. For the demonstration you’ll show us what you’re doing in a way that works for you. This may be in the form of a video, a PowerPoint presentation, a chart, a research poster, however you think you can show us what is special about your entry. So consult your health care team, review the information on the TAFP Behavioral Health Integration Innovators Competition website at www.tafp.org/innovators-competition, and follow the simple steps to submit your integration model. The deadline for submissions is July 8, 2019. Good luck!

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MEMBER NEWS

Highlights from TAFP’s Interim Session • April 5-6, 2019 The committees, commissions and sections of the Texas Academy of Family Physicians met in Austin and deliberated on many important matters. Thanks to all the members who participated. Most commissions, committees, and all sections are open to guests and meet twice a year at TAFP’s Interim and Annual Sessions. You can also request an appointment by submitting a “Make Your Mark” involvement form. Contact Juleah Williams at jwilliams@tafp.org with any questions. Here are a few of the highlights from the recent meeting. All recommendations mentioned will be presented to the TAFP Board of Directors.

WORKING FOR YOU AND YOUR PATIENTS

MEMBER SERVICES AND WORKFORCE DEVELOPMENT

The meeting fell at approximately the halfway point of the 86th Texas legislative session and advocacy was a major topic of discussion. The Commission on Legislative and Public Affairs discussed the state budget and TAFP’s funding priorities including the Texas Family Medicine Preceptorship Program, the Family Medicine Residency Program, the Physician Loan Repayment Program, and Medicaid payment rates. They also discussed opioid prescribing initiatives under consideration and HB1622, which would allow physicians to dispense pharmaceuticals in their practices, and legislation that would allow nurse practitioners to practice independently in Texas.

The Commission on Membership and Member Services discussed ongoing efforts to facilitate informal discussions at TAFP meetings. TAFP members served as facilitators of three Member Community meetings at Interim Session—Early Career Physicians, International Medical Graduates, and Solo and Small Group Physicians.

The Board of Directors approved a recommendation to fund $10,000 prizes for a Behavioral Health Integration Innovators Competition. The competition will allow TAFP to highlight practices that have integrated behavioral health and identify models that could work for other members. For more information, visit www.tafp.org/ innovators-competition The Commission on Health Care Services and Managed Care discussed the recent launch of the pilot recertification examination alternative. The commission recommended that TAFP work with ABFM to address initial concerns with the program including the length of time to answer the questions and the relevance of the questions. 14

The commission provided feedback on various member services and activities including production of Texas Family Physician, educational programming, educational programming for residents and students, the Texas Family Medicine Preceptorship Program, and much more. The Commission on Academic Affairs discussed the preceptorship program, programming for residents, medical students and clerkship and residency program coordinators, and opportunities for TAFP Foundation travel funding. Dr. Adrian Billings discussed the Atlantic Fellows for Health Equity Fellowship project with the group, a program to have an underserved medicine lecture in all Texas medical school curriculums using a faculty champion at each school. Dr. Lewis Foxhall discussed the Cancer Prevention and Survivorship Rotation available for third- and fourthyear residents at the UT MD Anderson Cancer Center. PUBLIC HEALTH AND RESEARCH Anna Stelter, Public Health Policy Analyst at TMA, gave a report from the Texas Public

TEXAS FAMILY PHYSICIAN [No. 2] 2019

Health Coalition to the Commission on Public Health, Clinical Affairs, and Research. Dr. Winston Liaw, former medical director of the Robert Graham Center, presented to two commissions on the Population Health Assessment Engine Curriculum. The commission also recommended that TAFP introduce a resolution at the AAFP Congress of Delegates regarding corporal punishment. The Commission on Public Health, Clinical Affairs, and Research oversees the annual TAFP Research Poster Competition. The group voted to change the schedule for presentation and judging. Beginning this year, posters must be displayed by 1 p.m. on Friday to allow participants to travel that morning instead of the night before. Space is limited for posters and if more applications are received than space allows, the review committee will limit participation by individual and academic institution. ORGANIZATIONAL ISSUES The Nominating Committee met to identify candidates for leadership positions. In addition to nominating members for officer and delegate positions, they selected candidates for two at-large and one New Physician position on the Board of Directors. The Section on Special Constituencies and the Sections on Medical Students and Residents also have the ability to select nominees for the Board. The Member Assembly will elect members of the Board and officers at the Annual Session and Primary Care Summit in The Woodlands, November 8. Here is the proposed slate of directors and officers for 2019-20: President-elect: Amer Shakil, MD, MBA Treasurer: Mary Nguyen, MD Parliamentarian: Emily Briggs, MD, MPH Delegate to AAFP: Troy Fiesinger, MD Alternate Delegate to AAFP: Ashok Kumar, MD; Tricia Elliott, MD (partial term) New Physician Director: Mary Anne Snyder, DO

At-large Directors: Lindsay Botsford, MD, MBA, CMQ; Brian Jones, MD, CPE Special Constituency Director: Puja Sehgal, MD Resident Director: Paul Moody, MD Medical Student Director: Emily Tutt The Bylaws Committee made several recommendations that will change the way members are selected for the Nominating Committee, update the vision and mission statements with those adopted by the TAFP Board in 2018, and add the membership class of Transitional Member. The amendments will be voted on at the Annual Business Meeting during the TAFP Annual Session and Primary Care Summit in The Woodlands. The Finance Committee reviewed TAFP’s financial reports and investments. The committee also received an update on TAFP’s investment portfolio. The board appointed a work group to study current policy on TAFP leader compensation and reimbursement and make recommendations for change. The group will look at models of compensation for similar non-profit organizations. The board also asked the president to appoint a task force to look at TAFP local chapters and their operations. MEMBER HIGHLIGHTS The Nominating Committee recommended to the Board that TAFP nominate Dr. Rebecca Hart for Chair of AAFP’s Commission on Continuing Professional Development. She is in her fourth year of service on the commission. The Commission on Continuing Professional Development selected program chairs for TAFP’s educational programs for the near future. Program chairs include Ike Okwuwa, MD, and Stephanie Roth, MD, for the 2020 C. Frank Webber Lectureship; Sarah Samreen, MD, for the 2020 Texas Family Medicine Symposium; and Jennifer Culver, MD, and Mark Malone, MD, for the 2020 Annual Session and Primary Care Summit in Grapevine.

The Section on Residents held elections for officers and delegates. Arindam Sarkar, MD, from Baylor was elected chair and Paul Moody, MD, from Texas Tech Permian Basin was elected to be the nominee for the Resident Director on the TAFP Board of Directors. They elected Katie Corkill, MD, from Texas Tech Permian Basin as chair-elect and Carlos Villania, MD, from Texas Tech El Paso as secretary. The delegate and alternate to National Conference are Chiraag Alur, MD, from Texas Tech Permian Basin and Cristina Penon, MD, from Texas Tech Permian Basin. The delegates and alternates to TAFP’s Member Assembly are Austin Kadiri, MD, MPH, from Texas Tech Permian Basin; Jason John, MD, from Texas Tech Permian Basin; Michael Dakkak, DO, from Memorial; and Edward Strecker, MD, from Conroe. The TAFP Foundation Resident Advisor is Jasmeet Kaur, MD from Dell and the resident liaisons are Jean Ghosn, MD, from Memorial; Danny Joseph, MD, from Methodist Houston; Omar Mahfouz, MD, from Methodist Houston; John Maldonado, MD, from Texas Tech El Paso; Joshua Morgan, MD, from Conroe; and Jinal Patel, MD, from Texas Tech Permian Basin. The Section on Medical Students met and held elections for officers and delegates for the coming year. Emily Tutt from TCOM was elected chair and the nominee for the student director position on the TAFP Board of Directors. Marc Ghosn from UIW was elected chair-elect and Mac Light from Baylor was elected secretary. The delegate and alternate to AAFP’s National Conference are Jeremiah Lee and Maria Lopez. The FMIG coordinator is Leah Bryan from UT RGV. The delegates and alternates to TAFP’s Member Assembly are Juan Vargas from UT San Antonio, Nery Guerrero from UT RGV, Amy Luu from UT Southwestern, and Connie Cheng from UT San Antonio. Chelsea Mendonca from UT San Antonio was elected TAFP Foundation Medical Student Advisor.

PROPOSED AMENDMENTS TO TAFP BYLAWS The proposed amendments to the TAFP Bylaws are in accordance with the TAFP Bylaws, Chapter XVII, Amendment of Bylaws. An affirmative vote of at least two-thirds of the members present and voting at the annual business meeting shall constitute adoption. If you would like a complete copy of the TAFP Bylaws, contact Kathy McCarthy at (512) 329-8666, ext. 114. The Bylaws Committee and the Board of Directors recommend adoption of these amendments. Chapter XIII. Standing Committees SECTION 2. COMMITTEE DESCRIPTIONS Nominating Committee a) This committee shall consist of nine members; each with terms of three years. b) One-third of the members shall be appointed annually. c) Two members will be appointed by the President-Elect Board of Directors and the other elected by the Board of Directors Member Assembly. d) The chair shall be elected by the Committee from the Committee’s membership. e) The purpose of this committee shall be to: i) Present nominations for the office of President-Elect, Treasurer, one Delegate and one Alternate Delegate to the Congress of the AAFP. ii) Present nominations for the Board of Directors. iii) Make suggestions to the President regarding appointments to the AAFP,

Texas, and American Medical Associations, other state committees and commissions, and any other appointments, which may be requested. iv) Evaluate the job performance and attendance of elected TAFP officers and delegates. Chapter III. Vision Statement The Texas Academy of Family Physicians is dedicated to the promotion of a health care environment that values the vital role of family physicians in providing quality, comprehensive care to all Texans. The Texas Academy of Family Physicians empowers family physicians to play a robust role in health care for their patients and their communities. Chapter IV. Mission Statement The Texas Academy of Family Physicians unites the family physicians of Texas through advocacy, education and member services, to empower them to provide a medical home for all patients. The mission of the Texas Academy of Family Physicians is to promote the health of all by serving the needs of members and advancing the specialty of family medicine. Chapter VI. Classes of Membership and Election SECTION 9. TRANSITIONAL MEMBERS A transitional member shall not vote nor hold office in the Academy, but shall have the privilege of addressing the membership and serving on committees and commissions.

CHECK OUT THE TAFP CAREER CENTER WHERE TALENT MEETS OPPORTUNITY SEARCH JOBS POST JOBS POST CV ANONYMOUSLY FIND YOUR FUTURE

JOBS.TAFP.ORG www.tafp.org

JONATHAN NELSON

TEXAS FAMILY PHYSICIAN [No. 2] 2019

Cultivating excellence in patient care and education RODNEY B. YOUNG, MD Texas Family Physician of the Year By Kate Alfano Education has always played a tremendous role in the life of Rodney Young, MD, FAAFP, the 2018 TAFP Texas Family Physician of the Year. Like seeds in fertile soil, his roles as student and eventually teacher began with his salt-of-the-earth parents impressing upon him the importance of getting an education and pursuing a career where he could use his mind and not his back. It grew through his own medical education to his position as an academic family physician where he models exemplary patient care and nurtures a thriving program. It has matured further in “teaching” elected officials and policymakers the value of family medicine. And it is multiplied not only through all of the residents and medical students he has mentored, now numbering in the thousands, but also through his own two teenage daughters as they plan to pursue careers in teaching and medicine. “If you have ever met Dr. Young, even just once, you will never forget him,” says Ronald L. Cook, DO, MBA, a Texas Tech University Health Sciences Center colleague who nominated Young for the award. “He is one of the most kind, thoughtful, wise, and genuinely sincere physicians that I have ever met. His love and excitement for all aspects of medicine—teaching, patient care, and political advancement—exudes from his personality. It is his gift and he will share it with all comers.”

oung is a natural teacher, with a warm, welcoming manner and eager ear that allows him to connect with students and patients and elevate them to a new level of knowledge and understanding. He shines in his post as professor and regional chair of the Department of Family and Community Medicine at TTUHSC School of Medicine in Amarillo, splitting his time between running the department, teaching, and clinical care. “I tell people when they ask me about my job: here’s the thing that is so wonderful,” Young told the audience at the TAFP annual awards lunch as he accepted his award. “You know that moment in the morning when you wake up and it takes you a second to figure out what day of the week it is and what’s going to happen? For me, it doesn’t matter. I am just as happy Monday morning as I am on Saturday because every day I get to do this job that has been a tremendous blessing for me. I get to interact with students, residents, faculty and friends. I see my patients and I share their lives. I am tremendously grateful for the recognition for doing what I love.” Young started on the path to medicine early. He was born in Fresno, Calif., and raised in adjacent Clovis, in the heart of California’s Central Valley, an agricultural region in the middle of the state largely settled by farmers from the panhandle of Texas and Oklahoma looking for work in the years of the Dust Bowl. His dad ran an industrial safety equipment and fire protection company, his mom was a supervisor for the Internal Revenue Service, and his “retired” grandparents owned a ranch where they raised thoroughbred racehorses, though anyone who works with horses knows there’s a lot of work that goes into that kind of retirement, Young says. As a young child, he recalls getting very sick with a terrible sore throat—sick enough to warrant a doctor visit at a time when such appointments only occurred when “you were knocking on death’s door.” Young took notice of how everyone treated the doctor with respect and how the doctor, in turn, was kind, caring, and knowledgeable. The doctor examined him and gave him a shot, which made him feel better within a few hours, like magic. “It left an impression on me,” he says. “I was elementary-school age at the time but I remember thinking, ‘that’s something I could do. This doctor, people are nice to him, they appreciate what he does for them and he can really make you feel better. What could be better than that?’ It planted the seed. Going through the rest of my early years I had it in mind that being a doctor would be a good and interesting career.”

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Around junior-high age, Young’s school held a career day that required him to submit his career aspiration. He entered “family practice doctor” and out popped a paragraph description he suspects came from AAFP, along the lines of “a doctor who treats the whole family and can provide for many different health care needs.” Shortly thereafter, when he was starting to think that he may be a little too big for his pediatrician’s office where he always left with a “duckie” drawn on his arm, he had to undergo a sports physical where students were herded between different stations in the cafeteria. At the final station sat a young family practice doctor who had just completed his residency and set up in Clovis. They talked briefly and the doctor gave Young his card. He held onto it and soon after that when his mom received notice in the mail that her gynecologist was retiring, Young was struck by a bolt of inspiration. Without hesitation he told his mom that the whole family could and should start seeing this young family physician and his partner, basically pitching the paragraph from AAFP. Thirty-five years later, his parents still see this now late-career physician. When it came time to choose a college, Young decided on Abilene Christian University in part for their commitment to training students for service and their highly regarded pre-medicine program but also, he says, because a friend told him the girls were pretty in Texas. He loaded up his Honda Accord hatchback and began what he didn’t know at the time would be a permanent relocation to the state—retracing the path of his Dust-Bowl-era ancestors. Following his undergraduate education he decided he would apply to a Texas medical school like most of his ACU pre-med peers. But first he took a year off to work in Houston and establish Texas residency to save on medical school tuition. While he appreciated the impressive medical complex and even had an informal offer to attend medical school in Houston, his roots were in West Texas. “After I had visited Texas Tech, I felt so at home out there,” Young says. “Family medicine felt front and center. It really spoke to me. I remember sitting in the medical school building looking out across the street and seeing nothing but a cotton field at the time. I was thinking I don’t how many places you can get a fantastic medical education across the street from a cotton field, but this is just about my speed.” Young met his wife, Shelly, while attending medical school and they married in his fourth year. She went to graduate school at Texas Tech, obtaining a master’s in higher education administration while he was in residency there, and she taught at a community college until they had their daughter Rachel and, later, Sophie. His transition from residency to academia was seamless. “One of the best parts of medical education for me is that to some extent, with each step you take, you have some responsibility for teaching people who are junior to you. Even a fourth-year medical student will show the third-year medical student the ropes if they are on elective together. The same thing was true in residency. Upper-level residents were the principal hands-on teachers for interns. As you move along, that’s not only an expectation but it’s really a way for the programs to know that you’re acquiring the knowledge and skills for practice. If you can teach someone to do it, then you know what you’re doing.” He reflected on his experiences in residency moonlighting in small-town emergency rooms and working in busier clinics, but when the opportunity arose to teach, he says it was a real “nobrainer.” “I liked the balance. I could spend part of my time doing direct patient care and part of my time teaching other people to do a better

JONATHAN NELSON

Dr. Young with some students and residents in training at TTUHSC in Amarillo, from left: Ryan Klitgaard, MD; Elizabeth Tu, DO; Jenny Nguyen, MD; Rodney Young, MD; Lena Younes, MS3; and Sarah Wilson, MS3.

job caring for others. It sounds a bit corny from a career academic doctor but it has always made me feel very good that my career has the potential to impact lots of people, not just my patients; different people I might share something with that they might take to their patients or teach to others. There’s an opportunity for a multiplying effect; that means something to me, that’s important.” Though it certainly would be easy to be consumed with his administrative duties, Young has protected his time with patients— for his own well-being and to be a good chairman. “In my judgment, the best academic leaders are those who truly understand what their faculty are doing day in and day out,” he says. “I don’t think watching them do it, or completing performance evaluations, or negotiating contracts, or attending administrative meetings allows you to really understand those challenges in the same way that facing them yourself does.” “Furthermore, too many meetings and too much administrative work can rob you of the joy of clinical practice. I didn’t go to medical school to learn how to attend meetings or fill out forms, or even to run a business. I went to learn how to take care of people, how to listen to them, how to strive to act in their best interests, and how to help them navigate our confusing health care system.” “I do the administrative things because I hope I can help make the system better for everyone—doctors, patients, students, residents, nurses, and staff,” he says. “Those things are important, but the greatest joy of practice occurs at the bedside, in the gaze of a grateful

“I was elementary-school age at the time but I remember thinking, ‘that’s something I could do. This doctor, people are nice to him, they appreciate what he does for them and he can really make you feel better. What could be better than that?’ It planted the seed.”

www.tafp.org

TOM JONES, WILD SKIES PHOTOGRAPHY

Dr. Young strolls through downtown Amarillo with his wife (far left), Shelly Young, and their daughters (from left), Sophie and Rachel.

“One of the biggest themes in my professional life in terms of advocacy has been what can we do to create more primary care, both in terms of the number of people who are trained to do it and the ability of the system to be accessed by everyone and at the right time.”

TEXAS FAMILY PHYSICIAN [No. 2] 2019

patient who finally feels like they have found someone they can trust, someone who is listening to them and explaining things in a way they can understand, and someone who is trying to understand what they are facing. Those are the moments that really define why we joined this noble profession, and I never want to forget that or forfeit them for more meetings.” His colleague, Evelyn Sbar, MD, associate professor of family medicine and vice-chair of TTUHSC AMA-FM, says, “Dr. Young is an amazing physician because he is an amazing person. He is witty, compassionate, smart, and perpetually optimistic. Not a day goes by that he does not bring a smile to the face of colleagues and patients. He has created a bond among our faculty team unlike anything I have ever seen—one where we each rise up and support each other, and help create our collective successes. As a friend, he is kind and gentle and always full of sage wisdom. He truly brings joy and generosity to all those with whom he interacts, influencing others to do the same.” Young intentionally carves out time for involvement in organized medicine, primarily with TAFP and the Texas Medical Association. “Everybody’s busy, no one has time to get involved,” he says. “You just literally have to prioritize it, decide it’s important and that you’re going to do it.” “Most of us don’t realize that virtually all medical organizations are run by the people who show up at the meetings. Literally that’s the first step. You just have to go. These are participation-based organizations. They’re trying to find out what people’s problems are, and if you take for granted that someone else is always going to be there talking about it, you miss out on the fact that your firsthand knowledge might be able to be shared in a way that speaks volumes. Your passion really conveys the importance of the message. You also miss the opportunity to bounce your ideas off of other people who might have similar concerns and together shape your argument into something that makes a lot more sense or that’s much more viable.” “That’s my message to everyone: You need to be involved for this process to work well and you’d be surprised how easy it is to participate and to become a part of it.” That sentiment also applies to his time advocating for the specialty at the State Capitol: he doesn’t feel he has to participate, he feels that he should. Legislators rely on “people like us” to help teach them what’s important in medicine. When talking to lawmakers, he is a fierce supporter of boosting the primary care workforce, funding graduate medical education, making the state healthier, and removing the barriers to practicing medicine and access to care. “One of the biggest themes in my professional life in terms of advocacy has been what can we do to create more primary care,” Young says, “both in terms of the number of people who are trained to do it and the ability of the system to be accessed by everyone and at the right time.” In turn, some of the best teachers for the medical students and residents are his patients, he says, who have become accustomed to seeing physicians-in-training in the exam room. He often asks his patients to share advice with these young people at the dawn of their careers. Their responses are often about being a good listener or being considerate of someone’s time, but not uncommonly, they are just about being “like Dr. Young.” “It makes you feel good but it also lets the students see what an important difference a family doctor can make in someone’s life.” He is a model of joy in medicine, enriching health care now and for the future.

“It’s a wonderful thing to practice family medicine in the state of Texas, to have the opportunity to get to know our patients and their families and to take care of them. As members of the Texas Academy of Family Physicians, we don’t just care for our patients in the exam room. We take care of them at the State Capitol, too. “I’m a monthly donor for the TAFP Political Action Committee because if we want policies that are good for our patients and our practices, we have to elect politicians who understand our issues. Support TAFPPAC and make your voice heard.” Justin Bartos, MD 2016 TAFPPAC Award recipient

www.TAFPPAC.org

Your health before

all else.

I N T RO D U C I NG

You work hard to take care of your patients. The AAFP works hard to take care of you. AAFP Physician Health First is the first-ever comprehensive initiative devoted to improving the well-being and professional satisfaction of family physicians, and reversing the trend toward physician burnout. So you can stay passionate about your purpose: providing quality patient care.

Discover a wealth of well-being at

aafp.org/mywellbeing The AAFP Physician Health First initiative is made possible by your generous contributions to the American Academy of Family Physicians Foundation.

aafpfoundation.org

Texas Med Ed, 2019

YOUR MEDICAL SCHOOL FIELD GUIDE FOR A RAPIDLY CHANGING ECOSYSTEM By Nayana Shahane

new medical school is popping up in or near every major metropolitan city in Texas. New medical schools have either opened or will open soon in Dallas, Austin, San Antonio, and Houston. The surprising boom in medical schools is a response to reverse the shortage of medical professionals occurring during a population explosion in these cities and their suburbs. There are currently 12 medical schools in Texas and three more scheduled to open in the next couple of years. The most recent additions are The University of Texas at Austin Dell Medical School, which will graduate its first class in 2020; The University of Texas Rio Grande Valley School of Medicine, which opened in 2016; and the University of the Incarnate Word School of Osteopathic Medicine, which opened in 2017. Texas Christian University and the University of North Texas Health Sciences Center School of Medicine—awarded preliminary accreditation—is scheduled to open in July 2019 with a starting enroll-

ment of 60 students and anticipated growth to 240 students by 2022. Two more schools, Sam Houston State University Proposed College of Osteopathic Medicine (seeking pre-accreditation from the Commission on Osteopathic College Accreditation) and University of Houston College of Medicine are planning to open in 2020. According the Association of American Medical Colleges 2017 Physician Workforce Data Report, there were 7,632 medical or osteopathic students and 7,997 residents in Texas. Those numbers reflect a better ratio of students to graduate medical education slots than in previous years. However, as additional medical schools open and student enrollment grows in the next few years, it’s increasingly likely that Texas won’t have enough residency slots to accommodate its newly minted MDs and DOs in coming years. The state is at risk of losing a significant investment in the education of medical students [cont. on 25] www.tafp.org

NPI 2019 SCHEDULE JUNE 20 - 23, 2019 | AUSTIN

Sheraton Austin Hotel at the Capitol 701 E. 11th Street Austin, Texas 78701 (888) 627-8349 $179 per night

SEPTEMBER 12 - 15, 2019 | HOUSTON

JW Marriott Houston Galleria Hotel 5150 Westheimer Road Houston, Texas 77056 (800) 228-9290 $119 per night

DECEMBER 12 - 15, 2019 | SAN ANTONIO

Hyatt Regency Hill Country Resort and Spa 9800 Hyatt Resort Drive San Antonio, Texas 78251 (800) 233-1234 $139 per night, plus $10 resort fee For complete course information and to register, visit NPI online at www.NPInstitute.com or call (866) NPI-CME1 today.

Contraceptive Womenâ&#x20AC;&#x2122;s Health and Vasectomy Procedures

June 20-21

$1,495

Dermatologic Procedures

June 20-21

$1,495

Hospitalist Procedures

June 20-21

$1,495

Allergy Testing and Immunotherapy for Primary Care Physicians

June 21

$850

Headache Procedures

June 22

$850

Exercise Stress Testing

June 22-23

$1,095

Joint Exam and Injections with Ultrasound Guidance

June 22-23

$1,495

Mastering Protocols for Optimization of HRT

June 22-23

$1,295

Colonoscopy

Sept. 12-13

$1,495

Dermatologic Procedures

Sept. 12-13

$1,495

Hospitalist Procedures

Sept. 12-13

$1,495

Mastering Protocols for Optimization of HRT

Sept. 12-13

$1,295

Allergy Testing and Immunotherapy for Primary Care Physicians

Sept. 14

EGD (Gastroscopy)

Sept. 14-15

$1,495

EKG Interpretation

Sept. 14-15

$1,095

Joint Exam and Injections with Ultrasound Guidance

Sept. 14-15

$1,495

X-Ray Interpretation

Sept. 15

Dermatologic Procedures

Dec. 12-13

$1,495

Hospitalist Procedures

Dec. 12-13

$1,495

Joint Exam and Injections

Dec. 12-13

$1,495

Ultrasound: Office, Hospitalist, and Emergency with MSK Scanning

Dec. 12-13

$1,495

Aesthetic Procedures

Dec. 14-15

$1,295

Exercise Stress Testing

Dec. 14-15

$1,095

Joint Exam and Injections with Ultrasound Guidance

Dec. 14-15

$1,495

Musculoskeletal Ultrasound

Dec. 14-15

$1,495

$850

Texas Medical Schools—15 and counting With all the new schools coming on line, here’s a snapshot of the Texas medical school roster as it stands today. [cont. from 23]

as they struggle to match to a residency position. Most physicians put down roots near their residency location and if Texas doesn’t have the positions, those doctors will pursue residency training in other states. In 2017, the Legislature passed a law that new publicly-funded medical schools must have a plan to ensure there are an adequate number of first-year residency positions for their expected number of medical graduates. Senate Bill 1066 by Sen. Charles Schwertner, R-Georgetown, was one of a number of investments lawmakers have made in recent years to expand GME positions, but at the rate the state is adding medical schools, offering enough residency slots is still a major concern. There’s no question the state needs more doctors. Texas’ growing population is outpacing the production of new physicians. Other problems include the shortage of physicians in rural and impoverished communities, and the anticipated number of physicians retiring from the workforce in coming years. According the Association of American Medical Colleges 2017 Physician Workforce Data Report, Texas ranks 41 out of 50 states with 219.4 active patient care physicians per 100,000 population. Of particular concern is the potential shortage of primary care physicians. The same AAMC report ranks Texas 47th in the country with 65.4 active patient care primary care physicians per 100,000 population. All the new and proposed medical schools seek to address these problems in various ways. For example, UIW School of Osteopathic Medicine is in one of San Antonio’s poorest neighborhoods. They plan to open a student-run medical clinic and implement a “case management program,” which pairs students with families on Medicare, Medicaid, or the federal health insurance exchanges. The newest public medical school, the University of Houston College of Medicine will be the first new medical school in the Greater Houston area since 1972. The school is dedicated to increasing primary care physicians for Houston and its surrounding urban and rural areas, especially the underserved communities. Their goal is to have 50 percent of their gradu

Baylor College of Medicine Location: Houston Degree: MD Date of origin: The school opened in 1900 in North Texas. In 1903 it became affiliated with Baylor University. In 1943 it joined Texas Medical Center in Houston. In 1969 it separated from Baylor to become independent. Total number of students: 723 Public/private: Private GME: 80 residency and fellowship programs Mission: “Baylor College of Medicine is a health sciences university that creates knowledge and applies science and discoveries to further education, healthcare and community service locally and globally.” Fun fact: Community Health Programs, part of Baylor College of Medicine’s Family and Community Medicine Department in Houston, is “committed to being a force for health in the community and establishing a patient-centered medical home for patients.” Their faculty group partners with community-based organizations to provide high quality, evidence-based care to underserved areas and to help promote wellness initiatives in neighborhoods near community health centers.

Texas A&M Health Science Center College of Medicine Location: Bryan-College Station, Dallas, Houston, Round Rock, Temple Degree: MD Date of origin: 1977 Total number of students: 700 at 5 campuses Public/private: Public GME: Programs located throughout the state Mission: “We were created to boldly serve. For more than 40 years, this mission has not wavered. Our purpose is to treat those among us with the greatest need, and in areas often forgotten by others. We’re challenging age-old beliefs about how medicine is delivered, where it’s delivered. Connected by our values and staunch desire to do more, we’re leading the way for a better future for all.” Fun fact: The Texas A&M Health Science Center A&M Rural and Community Health Institute is a health extension center offering programs that promote safe, effective health care practices. The mission of ARCHI is to improve access to health care and reduce disparities in health status and outcomes by improving the quality and safety of health care.

Texas Tech University Health Sciences Center School of Medicine Location: Lubbock, with regional campuses in Amarillo, El Paso, and Odessa Degree: MD Date of origin: 1969 Total number of students: 729 Public/private: Public GME: 33 programs across Lubbock, Amarillo, and Permian Basin Mission: “As a comprehensive health sciences center, our mission is to enrich the lives of others by educating students to become collaborative health care professionals, providing excellent patient care, and advancing knowledge through innovative research.” Fun fact: In 1969, 19 of the counties surrounding Lubbock had no physicians. The area had only one-third of the national physicians-to-patients ratio and 23 of the surrounding counties had no hospital. Today, TTUHSC has graduated more than 28,000 health care professionals. Of those, 24 percent remain in the 108-county service area. The school is the first in the nation to offer a three-year family medicine accelerated track.

www.tafp.org

Texas Tech University Health Sciences Center Paul Foster School of Medicine Location: El Paso Degree: MD Date of origin: 1973 as a regional medical campus for Lubbock 3rd and 4th year medical students. In 2009 it opened as a 4-year program with preliminary accreditation. In 2013 it became a fully accredited and independent institution. Number of students per class: 100 Public/private: Public GME: 9 residency programs with openings for approximately 205 residents Mission: “The mission of the Texas Tech University Health Sciences Center El Paso Paul L. Foster School of Medicine is to provide an outstanding education and development opportunities for a diverse group of students, residents, faculty and staff; advance knowledge through innovation and research; and serve the needs of our socially and culturally diverse communities and regions.” Fun fact: As part of its curriculum, the PLFSOM requires all students to learn medical Spanish language skills. It is the only medical school in the U.S. with this requirement.

The University of Texas Medical Branch School of Medicine Location: Galveston Degree: MD Date of origin: 1891 Number of students per class: 230 Public/private: Public GME: 23 residency programs; 36 fellowship programs Mission: “UTMB will strive to create tomorrow’s medicine today by discovery and application of new knowledge, and by inspiring lifelong learning and clinical excellence. We will accomplish this mission through innovative leadership and a steadfast commitment to scholarship and service excellence by: Educating and inspiring skilled physicians and scientists who are dedicated to lifelong learning and reflect the diversity of the people whom we serve. Enhancing the well-being of our global community by expanding the frontiers of our basic and applied scientific knowledge and its translation from the bench to the bedside. Improving the health of all individuals by providing outstanding evidence-based, compassionate, culturally fluent patient care, which recognizes the utmost importance of human interest, values and dignity. Sharing our talents to form partnerships with others—individuals, communities, governments, foundations, schools/universities and industries—in the service of our community, our state and the world.” Fun fact: UTMB was the first medical school in Texas. The Ashbel Smith building is the oldest medical school building in Texas. Nicknamed “Old Red,” it is listed on the National Register of Historic Places and marked with a Texas Historical Commission placard.

The University of Texas Health Science Center at Houston McGovern Medical School Location: Houston Degree: MD Date of origin: 1969 Number of students per class: 240 Public/private: Public GME: 28 residency programs; 100 fellowship programs Mission: “To educate a diverse body of future physicians and biomedical scientists for a career dedicated to the highest ideals of their profession; to provide outstanding patientcentered care; and to conduct innovative research that benefits the health and well-being of the population of Texas and beyond.” Fun fact: In August 1982, James “Red” Duke, MD, professor of surgery, aired the first televised program that would eventually evolve into an internationally syndicated health segment for television.

TEXAS FAMILY PHYSICIAN [No. 2] 2019

ates pursue primary care. A portion of the school’s funding was approved by the Texas House of Representatives and they are awaiting approval from the Senate. The university has already formed a partnership with Lone Star Circle of Care and opened a new health clinic on UH-COM campus in April 2019. LSCC is a Federally Qualified Health Center and a registered nonprofit that provides high-quality care to uninsured and underserved patients in Central Texas. Plans for residency positions are detailed in their 2018 College of Medicine Report. UH has joined as an academic affiliate partner with Hospital Corporation of America Gulf Coast Division, to develop eight new residency programs and 103 new first-year residency positions by 2020, with anticipated further growth in first-year and total residency positions. SHSU Proposed College of Osteopathic Medicine will be located in Conroe, about 40 miles south of the main campus in Huntsville and is pending pre-accreditation from the Commission on Osteopathic College Accreditation. SHSU-COM has not requested any state funding, and was approved by the Texas Higher Education Coordinating Board on that premise. Although SHSU is a public university, the proposed college of medicine will be privately funded. The land has been donated by the Johnson Development Corporation and the first three years of operating expenses have been covered by private donation. UIW and SHSU are osteopathic medical schools and have chosen their locations to connect with underserved populations. Both schools have proposed plans for providing and increasing residency positions. The new medical schools have ambitious plans to increase the state’s physician-to-patient ratio and access to primary care for underserved Texas residents. It may be several years before that long-term vision is actualized. In the meantime, the population and the need for primary care physicians in Texas continues to grow.

The University of Texas Southwestern Medical School Location: Dallas Degree: MD Date of origin: 1943 as Southwestern Medical College. In 1949 it became part of The University of Texas system. Number of students per class: 230 Public/private: Public GME: 20 residency programs Mission: “Promoting health and a healthy society that enables achievement of full human potential. We: EDUCATE physicians, scientists, and caregivers optimally prepared to serve the needs of patients and society. DISCOVER research that solves for unmet needs by finding better treatments, cures, and prevention with a commitment to ensuring real world application. HEAL best care possible today, with continuous improvement and innovation for better care tomorrow.” Fun fact: The school has graduated 6 Nobel Prize recipients since 1985.

University of North Texas Health Science Center at Fort Worth/Texas College of Osteopathic Medicine Location: Fort Worth

The Joe R. and Teresa Lozano Long University of Texas School of Medicine at San Antonio Location: San Antonio Degree: MD Date of origin: 1968 Number of students per class: 225 Public/private: Public GME: More than 80 specialty or fellowship options Mission: “The mission of the Joe R. and Teresa Lozano Long School of Medicine is to provide responsive and comprehensive education, research and service of the highest quality in order to meet the health-related needs of the citizens of Texas.” Fun fact: The Long School of Medicine is part of UT Health San Antonio. It is one of the few universities with a cancer center funded by the National Institutes of Health, an NIH-funded aging center, and an NIH-funded clinical trials center. Only a dozen institutions in the country have all three.

Degree: DO Date of origin: 1970 Number of students per class: 230 Public/private: Private GME: 4 residency programs; 2 fellowships Mission: “Create solutions for a healthier community by preparing tomorrow’s patientcentered physicians and scientists and advancing the continuum of medical knowledge, discovery, and osteopathic health care.” Fun fact: TCOM is a leader in training physicians skilled in comprehensive primary care and rural medicine. Over 60 percent of TCOM’s graduates practice primary care medicine. TCOM was recently honored by TAFP as the only medical school in Texas to place at least 25 percent of 2018 graduates in family medicine. It was the 20th year TCOM received the honor, which the Academy created in 1993 to encourage medical schools to increase the number of graduates entering family medicine residencies.

The University of Texas at Austin-Dell Medical School Location: Austin Degree: MD Date of origin: 2016 First graduating class: 2020 Number of students per class: 50 Public/private: Public GME: 13 residency programs; 8 fellowships Mission: “Revolutionize how people get and stay healthy by: Improving health in our community as a model for the nation; evolving new models of person-centered, multidisciplinary care that reward value; accelerating innovation and research to improve health; educating leaders who transform health care; and redesigning the academic health environment to better serve society.” Fun fact: The Housing Authority of City of Austin is partnering with Dell Medical School at The University of Texas at Austin to launch the Health Catalyst Pilot Program. The program will care for more than 200 low-income families and individuals living at the Pathways at Booker T. Washington Terraces in East Austin, one of HACA’s largest subsidized housing properties.

The University of Texas Rio Grande Valley School of Medicine Location: Edinburg, Harlingen, Brownsville Degree: MD Date of origin: 2016 First graduating class: 2020 Number of students per class: 50 Public/private: Public GME: 7 residency programs with 3 more coming soon Mission: “Educate a diverse group of medical students and future biomedical scientists. Develop physicians who will serve across all disciplines of medicine. Bring hope to patients and communities by advancing biomedical knowledge through research. Integrate education and research that advances the quality and accessibility of health care. Engage with the Rio Grande Valley communities to benefit Texas and the world.” Fun fact: As a part of a grant from United Health Foundation, the School of Medicine purchased its Unimóvil mobile clinic to bring comprehensive primary care to people living in underserved communities who struggle with access to health care. Unimóvil also provides another opportunity for medical students, medical residents, and students in the UTRGV College of Health Affairs to train and serve the community.

www.tafp.org

University of the Incarnate Word School of Osteopathic Medicine

Sam Houston State University Proposed College of Osteopathic Medicine

Location: San Antonio

Location: Conroe

Degree: DO

Date of origin: 2017

Date of origin: 2020*

First graduating class: 2021

First graduating class: 2024*

Number of students per class: 162 in opening class

Number of students per class: 75 to start, with increase to 150 over several years*

Public/private: Private GME: 5 residency programs are in development with the Texas Institute for Graduate Medical Education and Research. Mission: “UIWSOM’s mission is to empower all members of the medical education community to achieve academic, professional and personal success and develop a commitment to lifelong learning through excellence in learner-centered, patient-focused education, justice-based research and meaningful partnerships of osteopathic clinical service across the spectrum of undergraduate, graduate and continuing medical education. The development and application of osteopathic principles of medicine across four years of physician training will promote culturally, linguistically, and community responsive care for all patients to enhance patient safety and improve patient outcomes.”

Public/private: Public, although 100% self-funded Mission: “The mission of the Sam Houston State University Proposed College of Osteopathic Medicine is to prepare students for the degree of Doctor of Osteopathic Medicine with an emphasis toward primary care and rural practice, to develop culturally aware, diverse and compassionate physicians, who follow osteopathic principles, that are prepared for graduate medical education, and will serve the people of Texas with professionalism and patient-centered care.” *All class sizes and potential start dates are contingent upon final approval from the Commission on Osteopathic College Accreditation.

Fun fact: Every first-year medical student earns an emergency medical technician certification. That allows members of San Antonio Street Medicine, a volunteer student organization at UIWSOM, to provide basic medical care such as dressing wounds and taking vitals for San Antonio’s homeless residents.

University of Houston College of Medicine Location: Houston Degree: MD Texas Christian University and University of North Texas Health Sciences Center School of Medicine Location: Fort Worth on both campuses Degree: MD Date of origin: 2019 pending accreditation First graduating class: 2023 Number of students per class: 60 in first class; 240 by 2022 Public/private: Private Mission: “Our mission is to transform health care by inspiring Empathetic Scholars. Our graduates will be compassionate, empathetic and prepared to discover the latest knowledge in medical care and equipped with the tools to ask and answer the medical questions of the future. Along with the ability to ‘walk in a patient’s shoes,’ these physicians will excel in the science of medicine. Outstanding communicators and active listeners, empathetic scholars are life-long learners and highly valued as physicians, colleagues, leaders and citizens in their community.” Fun fact: The curriculum is wholly centered on the patient, allowing students to retain the empathy with which they start medical school. During Week 1 they begin seeing patients and have one-on-one mentoring with physicians. Physician Development Coaches will foster a coaching relationship that will contribute to student professional identity formation while providing an additional layer of support toward the student’s academic success.

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Date of origin: 2020 contingent on accreditation First graduating class: 2024 Number of students per class: 25 to 30 in first class with plans to grow to 480 by 2027 Public/private: Public GME: Arrangement with Hospital Corporation of America to serve as academic affiliate in plan to develop 8 residency programs and 103 new first-year residency positions by 2020. Plan to have 309 total residents by 2024 Mission: “The UH College of Medicine will be accountable for improving the overall health and health care of the population of not only Greater Houston but also other urban and rural areas of Texas that face significant doctor shortages by: Educating a diverse group of physicians who will provide compassionate, high-value (high quality at reasonable cost) care to patients, families and communities, with a focus on primary care and other needed physician specialties, such as psychiatry and general surgery. Conducting interdisciplinary research to find innovative solutions to problems in health and health care. Providing integrated, evidence-based, high-value care delivered to patients by inter-professional teams. Engaging, collaborating with, and empowering patient populations and community partners to improve their health and health care.” Fun fact: Health Matters is a radio series produced by the University of Houston College of Medicine empowering listeners to lead healthy lives. Host and founding dean, Dr. Stephen Spann, along with doctors from the medical school, provide practical health care information to the community.

Achieve healthier outcomes—for everyone. In its first major development for The EveryONE Project, the AAFP compiled an in-depth toolkit to help physicians recognize and respond to social factors that impact the health of patients. The EveryONE Project toolkit is validated, intuitive, action oriented, and free. Utilize it to: • Raise awareness about the effects of social determinants of health. • Discover specific health risks in patients of all backgrounds. • Understand and manage potential biases that may exist. • Connect patients with essential resources in their area. Reveal and address the unseen health hurdles your patients face every day. Start using The EveryONE Project toolkit now.

aafp.org/EveryONE/tools

The EveryONE Project Advancing health equity in every community

PERSPECTIVE

Recent challenges to a culture of patient safety By Travis Bias, DO, MPH a culture of patient safety built over the past 20 years is encountering roadblocks. Policies and recent events that defy both research and initiatives geared towards strengthening health care safety, whether intentional or not, must be highlighted to ensure we continue to move the ball in the right direction. Recently a New York Times story highlighted the “culture of secrecy” that protects hospitals from disclosing their name when an outbreak of a drug-resistant bug occurs within their walls. Defenders of the policy argue this encourages hospitals to promptly report these outbreaks to the Centers for Disease Control and Prevention without fear of negative publicity. Just two days before this, a viral video of Washington State Senator Maureen Walsh circulated on social media. Senator Walsh was promoting an amendment to exclude smaller, critical access hospitals from a bill that would protect paid rest and meal breaks for nurses. She rounded out her remarks with some off-hand color commentary that nurses in these more rural hospitals “probably play cards” during their (seemingly, to her) prevalent down time. Her focus on the financial costs of those breaks morphed, incredibly, into the derision of the profession viewed as the most honest and ethical in our society for the last 17 years in a row. Ironically, members of Congress (likely to include state legislators) ranked lowest on this list. Finally, over the past year, we learned about the Vanderbilt nurse being prosecuted criminally for the 2017 death of a patient due to a medication error. While the story is not yet complete, this represents not only the mistakes of an individual, but the failure of the system around her. This sets a concerning precedent that, instead of encouraging timely reporting of systemic issues or threats to safety, may very well discourage individual health workers from quickly raising concerns to hospital leadership. These three stories have a common theme: They are microassaults on a culture of safety in health care institutions. Medical errors are a leading cause of death in the United States. Two decades of efforts to build a culture of safe care were sparked by the 1999 Institute of Medicine report, “To Err is Human.” This culture shift— badly needed, yet not adopted overnight—eventually birthed checklists, quality committees, and alerts built into electronic health records. These solutions are only starting to mature to meaningfully move the needle. Secrecy, overstretched staff, and incentives leading to under reporting or delayed reporting of potential precursors to or catalysts resulting in avoidable mistakes, all begin to move us backward. We need more information and transparency in health care—not less.

We must rebalance the interests at stake, immediate costs or pull to hold someone accountable, relative to the overall systemic goal. Following an airplane crash, investigators’ first order of business is to find the “black box.” More accurately known as the flight recorder, this device, alongside the cockpit voice recorder, can offer critical insight into the detailed events that led to a catastrophe. What follows is an attempt to objectively piece together process issues, performance errors, or even software deficiencies, as in the case of the recently grounded Boeing 737 Max, that may have contributed to the event. Corrective action is then taken, through addressing the root cause of the disaster, perhaps accompanied by bolstered training for all involved through simulation exercises. All of this has laid a reliable foundation and infrastructure upon which to build an industry that is highly regarded for safety. What if, rather, the first step following airline disasters was to question the flight attendants on board? Or what if the next plane crash resulted in the arrest of individual pilots? What if the Federal Aviation Administration hid the safety statistics of individual airlines? What if we went back to fatigued pilots? Airline industry practices were invoked while debating limiting the work hours of young physicians in training. The comparisons are not perfect but taking a page out of the industry’s book may indeed inform our quest for safer patient outcomes. The three short-sighted policies or reactive solutions described in this article will negatively affect health delivery and care safety in the United States. Before we find ourselves two decades in the past, the priorities of the system as a whole need a stronger advocate. Health policies ought to encourage transparency and the sharing of information. Human resources for health policies ought to ensure the wellness of frontline health workers. Health providers and systems ought to be appropriately held accountable for their performance, supporting their staff as necessary. The conveners of future discussions surrounding health care quality and safety will do well to focus on the ultimate party responsible (the system) in service to the ultimate beneficiary (the patient).

Two decades of efforts to build a culture of safe care were sparked by the 1999 Institute of Medicine report, “To Err is Human.” This culture shift—badly needed, yet not adopted overnight—eventually birthed checklists, quality committees, and alerts built into electronic health records. These solutions are only starting to mature to meaningfully move the needle.

TEXAS FAMILY PHYSICIAN [No. 2] 2019

Travis Bias, DO, MPH, is a family physician and clinical transformation consultant within the Performance Matrix team at 3M Health Information Systems. This article was originally published on the Inside Angle blog from 3M Health Information Systems, www.3mhisinsideangle.com.

FAMILY MEDICINE FACULTY OPPORTUNITIES Houston, Texas

Baylor College of Medicine has opportunities for clinical faculty who are board certified/eligible in Family Medicine and interested in providing inpatient services. In addition to joining an outstanding group of faculty who are dedicated to the care of a variety of populations, our faculty enjoy opportunities to participate in academic activities including medical student education and resident education.

APPLY ONLINE: https://www.bcm.edu/careers

This position includes a faculty

FOR FURTHER INFORMATION CONTACT

appointment at a competitive salary with excellent benefits and the opportunity to join a distinguished institution.

ROGER J. ZOOROB, MD, MPH, FAAFP RICHARD M. KLEBERG SR. Professor and Chair DEPARTMENT OF FAMILY & COMMUNITY MEDICINE 3701 Kirby Drive, Suite 600 • Houston, TX 77098 Roger.Zoorob@bcm.edu • 713.798.2555 https://www.bcm.edu/departments/family-and-community-medicine/

APPLY ONLINE: https://www.bcm.edu/careers

Position #: 206796, 211758, 215737, 218426, 219313, 250359 Baylor College of Medicine is an Equal Opportunity/ Affirmative Action/Equal Access Employer

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Austin, TX Permit No. 1450

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By volunteering to precept a Texas medical student, you can open a door to a new world for the next generation of family doctors. QUESTIONS? Give us a call at (512) 329-8666 or send an email to Juleah Williams, jwilliams@tafp.org.

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