Cheerful, warm, and pleasant are all adjectives that could come to mind when you run into the Texas Medical Association’s next president, Magnolia emergency physician Diana Fite, MD.
But don’t let that fool you. Get Dr. Fite started on some of today’s physician struggles, and she sounds ready to live up to her last name.
Like when she gets going on the “ridiculous” Medicare quality measures that discourage emergency physicians like herself from prescribing antibiotics for bronchitis.
“They’re dictating how you should practice medicine, and we’re sitting there working around it to try to satisfy these criteria. Because the company you work for in emergency medicine, if you don’t reach the highest [scores] on your quality measures, then the company doesn’t get paid as much. They want to be paid every speck they can be. Oh, it makes me so mad!”
Similar feelings pour out of Dr. Fite if you ask her about Medicaid physician payments and the “dangerous point” she says Texas is reaching on that front; or about electronic health records (EHRs) and their intrusions on patient care. And she’s not just venting; she’s a seasoned physician advocate who’s spent years engaging legislators and other key figures on finding solutions to medicine’s biggest problems.
Starting in May, she’ll have her biggest pulpit yet as TMA’s 155th president. So when Dr. Fite says: “I’m going to be very forceful about the issues that we have, and hope to be able to make a difference,” you can believe she’s prepared to fight to make that happen.
A woman in medicine
Dr. Fite entered into medicine at a time when the field was predominantly men. A misconception people have about the Amarillo-born physician is that she became a doctor because her father was one; he immigrated to the U.S. from England as a neurosurgeon to escape socialized medicine.
“But he told me and my brother, ‘Don’t ever become physicians, because it will be socialized medicine someday, and that’s not the best way to practice by any means.’ Not to mention he didn’t think women should be physicians,” she said. “So, I never expected to be [one] based on him.”
For a long time, she didn’t expect to be one at all, and her eventual inspiration was a bit unusual. While attending West Texas State University, she thought she might become a legal secretary. But at one of her college jobs, a coworker’s husband was a premed student.
“As I got to know them, I realized he didn’t seem like he was that studious, or what I thought a doctor should be like. And I thought, ‘Well, if he can do it, I certainly can,’” she recalled. “Well, it turned out he did not become a doctor. But I, being ignorant back then … if you’re premed, I assumed you’re going to be a doctor, so that’s actually what made me decide to be a doctor.”
This was in the early 1970s when few women were medical students as she pursued her degree, which she eventually earned from what is now the McGovern Medical School at UTHealth (formerly the University of Texas Medical School at Houston). She encountered sexism as a medical student, and one particular incident sticks out: A resident got furious with then-student Dr. Fite because he believed the increasing number of women getting medical-school spots had previously “forced” him to go to medical school in Mexico.
“A lot of young men were getting deferments from the military by staying in school in some manner … even though their reasoning wasn’t because they wanted to be a doctor as much as it was they wanted to get a deferment from the military,” she recalled.
“But that physician, I’ll never forget, was so angry that he said, ‘For all I know, you’re the one that took my spot in medical school in the United States, and forced me to do this and this, and you had no right to do that.’ That kind of thing, I did face. But I just kind of felt sorry for him and said, ‘Sorry. I guess this is the way it was supposed to be.’”
When she finally earned her medical degree in 1978, her father – who had once told her that women becoming physicians didn’t make any sense – celebrated the achievement with her.
“It was just so many years ago; it just wasn’t the way he looked at things,” Dr. Fite said of her father’s opposition to women in medicine. “I don’t think it was meant to be mean, or thinking that a female could not be smart enough to be a physician. But it just wasn’t the way it was back then. I think he was very surprised. He was still alive when I graduated from medical school, and said, ‘Congratulations, and welcome to the club.’”
Dr. Fite takes the reins of TMA at a time when the advancement of Texas women in medicine is at the forefront. In June, Fort Worth allergist/immunologist Susan R. Bailey, MD, will vault into a position of prominence when she becomes president of the American Medical Association. And TMA’s Women Physicians Section, formed in 2019, will continue working toward strengthening female physicians’ representation and engagement in organized medicine.
Dr. Fite is mindful of the unique difficulties female physicians face and says the Women Physicians Section is an important tool to amplify their voices on those issues, including equal pay, and accounting for pregnancy and breastfeeding needs while at work.
“A very dangerous point”
Dr. Fite has spent years reaching and representing physicians across Texas, as evidenced by her long history of activity and leadership in organized medicine, including stints as the president of the Harris County Medical Society; president of the Houston Academy of Medicine; and chair of TMA’s Board of Trustees.
Because there were no residency programs for emergency medicine in Texas at the time she graduated, Dr. Fite started her career training as an obstetrician-gynecologist. Today, she primarily works at four offsite Memorial Hermann Health System emergency facilities and one independent freestanding facility, Katy Main Street ER.
From busy trauma centers to very small rural hospitals, “there are all sorts of needs in Texas,” she said, “and I experienced a lot of them. … I feel like I can relate to physicians in various practices for that reason.”
With the 2021 session of the Texas Legislature on the horizon, Dr. Fite wants to make it clear to lawmakers that increasing physician payments in Medicaid is her top priority.
TMA asked for $500 million from the 2019 legislature to improve Medicaid payments, but lawmakers granted no new funding on that front. Dr. Fite believes medicine must better emphasize the problem to legislators, who she says may be under the impression the situation in Medicaid is better than it is.
“Yes, they hear complaints, but [they think] overall their constituents are fairly healthy, or their medical problems are being taken care of – because [physicians are] taking care of them the best we can,” she said. “In some respects, it’s not as well as it could be, because the patient doesn’t have coverage, or there’s only three doctors in town out of 200 that take that particular Obamacare or Medicaid that they’re on. But the legislators don’t understand what a disadvantage they’re beginning to put their constituents in.
“We need to be able to keep offices open to run our practices, to pay employees to help us with our practice. We need to make enough money to do those things. We need to make enough money to pay back loans for taking many, many years out of our lives to go to medical school and then residency. And we need to do a better job of getting the legislators to understand that they can’t just assume we’ll continue on like it is, because it’s getting [to] a very dangerous point.”
She also plans to use her platform to clamp down on the interferences that continue to steal time and resources away from patient care and contribute to physician burnout.
Take those EHRs, for instance: “It’s unbelievable the amount of time it takes, especially when you’re in a busy emergency department. It’s made it so hard for us to practice in a way that’s good for the patients.”
And she still has plenty to say about the intrusion of those quality metrics that can put physicians in a bind. On the one hand, doctors risk a bad rating if they can’t meet them. On the other hand:
“The administrators or the people making money off of the physicians … want you to follow these metrics that make you see so many patients per hour, and you don’t have time to find out what the patient wants, and you certainly can shortchange your evaluation of the patient in a way that is not good for the patient. I think those should be absolutely not allowed.”
Specific to her experiences as an emergency physician, Dr. Fite wants to see health plans follow the “prudent-layperson standard” for what constitutes an emergency and not refuse to pay for services if a patient follows that standard when checking into an emergency department.
Health plans need “to cover what they have told their clients that they will cover,” she said.
The same goes for limiting their use of prior authorization overall, she adds, a big TMA initiative going into the 2021 legislative session.
Dr. Fite previously served as chair of the Committee on Government Relations for the Texas College of Emergency Physicians, which allowed her to build relationships with legislators. She says she’ll stress to physicians that getting involved in organized medicine is a way to prevent the burnout that plagues many of her colleagues today. Concentrating on what other physicians are experiencing throughout the state or the nation can give you “a different appreciation” for what doctors in different specialties are experiencing, she says.
“If you are just simply involved with your own practice, you get so focused on just that and trying too hard to be successful, that it does contribute to burnout. Somehow, that’s going to be one of my issues as well, is trying to stress how I think that being involved like this does prevent burnout. I really feel strongly about that.”
Her guiding voice
Although she’s mindful of other physicians who may not emphasize religion in their lives as much as she does, Dr. Fite also feels strongly that becoming a physician was God’s purpose for her. When she’s not practicing medicine, this mother of six girls and two boys (one of her daughters is deceased) usually can be found spending time with her children and grandchildren, most of whom live in the Houston area.
“Everything I did just worked out. Even if it seemed like it wasn’t going to, it worked out in that direction. And so many times when I’ve been taking care of a patient in an emergency department, there’s this little voice inside me, which I feel like is [the voice of] God, tells me, ‘You need to check something else. You need to go back and do this to this patient.’ Just little things, and as long as I pay attention to that little extra voice, it’s worked out well. And if I try to ignore it, it did not work out well. I feel that that is part of the reason that it rings true that this was my purpose.”
Tex Med. 2020;116(4):18-22
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