By Emma Freer and Sean Price
There’s no question the Texas Medical Association’s membership is diverse. And TMA’s six member sections capitalize on that as microcosms of the association itself, offering participants a chance to stand up for physicians and to improve patients’ health through professional development, policymaking, and advocacy.
The sections represent members serving international medical graduates, women physicians, young physicians, residents and fellows, medical students, and the LGBTQ community. With one exception, sections automatically include any TMA member physician who meets their demographic. (Member physicians must opt into the LGBTQ Health Section.) As a result, the sections represent wide swaths of Texas physicians.
Each section has a leadership body, which serves as a vital training ground for organized medicine’s future movers and shakers. Justin Bishop, MD, a Dallas physical medicine and rehabilitation physician who chairs the Young Physician Section, sees this as his most critical responsibility.
“What’s important is trying to create leaders within TMA, trying to bring people [together] who are busy, trying to help them and support them,” he said.
Each section is allocated representatives to TMA’s House of Delegates and to a corresponding section at the American Medical Association, where they are able to push policies at the state and national levels. Traditionally, sections meet in conjunction with TMA’s three annual conferences. Since the onset of the COVID-19 pandemic, many have transitioned to virtual meetings, which members say have helped broaden their reach.
Here’s a look at each of TMA’s six member sections.
In addition to TMA’s sections, the American Medical Association and several county medical societies across Texas have debuted section-specific initiatives in recent years. For more information, visit each section’s webpage.
IMG Section: Connection and Diversity
International medical graduates (IMGs) “share this common trajectory that is different from physicians who were born here and raised here and do their medical school here,” said Dallas pediatrician Marcial Oquendo Rincon, MD, chair of TMA’s IMG Section. “That is something that binds us together.”
For instance, many IMG physicians – including Dr. Oquendo – work with populations facing very specific needs.
“I’m in a practice where I would say 95% of all patients are Venezuelan,” said Dr. Oquendo, a native and medical school graduate of the country. “I take care of them and their unique needs and differences in not only cultural but economic and legal and immigration status and absence of care.”
The IMG Section does not just represent physicians who were born and went to medical school in foreign countries, he says. It also represents American-born physicians who went to medical school in countries other than the U.S. “We try to address [all IMGs’] issues and [provide] a place where they can connect and recognize their impact in the U.S.,” he said.
For example, physicians who attend medical school outside the U.S. are automatically at a disadvantage to those attending U.S. medical schools, no matter how well educated or talented they are, Dr. Oquendo says. Many face language and cultural barriers. And foreign medical schools are not geared toward addressing U.S. medical licensing exams, which means students attending foreign medical schools frequently have to spend a significant amount time after medical school studying to pass those exams.
Foreign medical school graduates also face high hurdles in obtaining residency positions in the U.S.
Some residency programs bluntly tell medical students they don’t accept anyone from a foreign medical school – something that happened to Dr. Oquendo in his search for a residency.
That approach goes directly against TMA policy, which states that the association “supports and promotes the right of every licensed physician to be treated meritoriously without discrimination based on national origin or geographic location of medical school.”
IMGs as a group face an increasingly difficult landscape in trying to obtain residencies, making it one of the section’s top issues.
IMGs also are working to address another pressing problem in U.S. medicine – the lack of diversity among physicians, Dr. Oquendo says.
“[IMGs] bring perspectives that other medical graduates from our own universities don’t have,” he said. “The more varied experiences you bring to a residency program or a practice, I think the better the practice is, the better the residency program is.”
Women Physicians Section: Looking Toward the Future
TMA’s Women Physicians Section debuted in 2019 in response to growing demand from female member physicians, who were searching for camaraderie and support in the face of professional obstacles such as the gender wage gap, workplace sexual harassment, and a lack of leadership opportunities.
The section aims to strengthen female physicians’ engagement and representation in organized medicine through the development of relevant policy, programming, and services. It is open to all TMA member physicians, and female physician members are automatically included.
Although medicine remains a male-dominated field, women physicians are growing in number and influence. In Texas, women accounted for just over one-third of active physicians as of September, more than double their share 25 years ago, and they now outnumber men among Texas medical school enrollees, suggesting they may make up most of the physician workforce in coming decades.
In the past, women physicians rebuffed the notion of their own section, worried it would further silo them. But attitudes have changed, and women physicians are now more vocal about the specific challenges they face in the workplace.
“There’s some validity to that [concern], but at the same time, we’re not the same [as male physicians],” said Tina Philip, DO, a family physician in Round Rock and chair of TMA’s Women Physicians Section. “We don’t all have the same issues or the same obstacles that are affecting us day to day.”
Since its formation, the section has developed a list of priorities, including increasing the number of women physicians involved in organized medicine; supporting mentorship and sponsorship opportunities to close the gender gap at the leadership level; and advocating for policy changes, such as gender pay parity and paid parental leave.
“In the past, so much of the focus was on fixing the women,” said Elizabeth Rebello, MD, a Houston anesthesiologist and the section’s inaugural chair. “But really the focus needs to be on fixing the system.”
This approach has proven fruitful. Women physicians have attended the section’s events in droves and provided positive feedback. Between April 2018 and April 2020, the percentage of women members participating in TMA increased 6.2%.
There’s also a role for male physicians to play in this work, Dr. Rebello adds. Research shows that women physicians are more likely than their male peers to scale back to part-time work or leave medicine entirely because of family demands. This so-called leaky pipeline robs medicine of desperately needed physicians and leads to starker gender disparities at the leadership level. But male leaders can help seal these leaks by recognizing talented female colleagues, serving as mentors, and providing opportunities for them to earn more visibility and status.
“It’s really a combined effort,” Dr. Rebello said.
Young Physician Section: Support in Early Career
The transition from medical resident to full-fledged, practicing physician can be tricky, like transforming from a puppet into a real boy, says Justin Bishop, MD, a physical medicine and rehabilitation physician in Dallas and chair of TMA’s Young Physician Section. So, finding peers who are navigating the same waters is a welcome lifeline for physicians in flux.
TMA’s Young Physician Section, which represents members who are in their first eight years of practice, offers just that while also providing advocacy experience, leadership opportunities, and a social outlet.
Section participants network and share resources. They pose questions, such as how to establish an LLC as an independent physician contractor, how to determine the best strategy for paying off student loans, and how to hire medical assistants in a tight labor market. (See “Pinch Points,” page 40.)
“I like the friendliness of this section,” Dr. Bishop said. “It feels like there’s some safety about asking questions that maybe, if you were older, you would feel a little bit silly about.”
This niche also helps inform the section’s policy goals, which straddle the idealism of aspiring physicians and the sense of frustration that can come from decades of experience. As a result, the section’s advocacy tends to dovetail with TMA’s broader policy goals, and the section’s endorsement is often sought out by others that represent young physicians as part of their demographic.
Whether discussing impending Medicare pay cuts or pandemic safety protocols, the section aspires to ideological diversity. Dr. Bishop says the goal is to amalgamate as many different opinions as possible into one compromised opinion that is scientific, vetted, and persuasive – even if it may be shot down later by the House of Delegates or state lawmakers.
“We want the complete opinion to be heard,” he said.
The section also is a breeding ground for future leaders in organized medicine. Since 2010, the TMA Leadership College has graduated more than 250 young physicians across a wide range of specialties and practice settings (www.texmed.org/LeadershipCollege). The nine-month program prepares participants for future leadership positions at the county and state levels, closing the divide between physicians and health care policymakers.
Leadership college alumni often tout the program at Young Physician Section meetings. “They chime in and say, ‘Y’all need to do this,’” said Dr. Bishop, who was convinced to enroll in the college earlier this year.
Resident and Fellow Section: Community for New Physicians
Like most other physicians, residents and fellows are pressed for time. But given the famously long hours residents and fellows are expected to work on a regular basis, the time crunch frequently is much worse for the physicians going through this professional rite of passage.
Members of the Resident and Fellow Section take part in all types of Texas Medical Association community initiatives, says Temple internist Patrick Crowley, DO, who chairs the section. But professional obligations become so intense that many TMA members active as medical students often see their participation decline during residency and then go back up once they face the issues of working in private or employed practice.
“In residency, more than anywhere else, you have to decide very judiciously what you’re going to do with your time,” Dr. Crowley said. “It comes down to focusing on one or two things you’re really passionate about.”
That’s why activism within the Resident and Fellow Section frequently focuses on issues like work conditions. Given their long hours, residents and fellows are greatly concerned about keeping duty hours from being too onerous. Many residents feel cornered into signing contracts they are unfamiliar with, and that have provisions they are uncomfortable with.
“They’re very wary of that sort of thing and want to make sure they can start off their practice on a good foot,” Dr. Crowley said.
Residents and fellows also tend to be outspoken about making sure patients are able to access medical care, Dr. Crowley says.
“Most people, when they train, they’re in more inner city and more underserved areas than when they’re actually in practice,” he said. “Being able to see that and being young enough in your training that you’re not jaded and accustomed to seeing it, that’s very motivating for residents and fellows to say, ‘This is wrong. It shouldn’t be like this.’”
As with members in other sections, those in the Resident and Fellow Section look forward to the eventual lifting of COVID-19 restrictions and enjoying the camaraderie of in-person TMA meetings, Dr. Crowley says.
“A big aspect of being in the section is that you’re able to meet with people at a similar station in life, people who are similar to you,” he said. “[It’s important] to finally hear that you’re not alone as a resident or fellow and that there are other people in the state who are passionate about it and be able to see that we’re a community.”
Medical Student Section: Representing Medicine’s Newest Members
The Medical Student Section provides the Texas Medical Association with the perspective of future physicians and allows them to develop their voice for advocacy, says Ryan Wealther, a fourth-year medical student at UT Health San Antonio Long School of Medicine and chair of the section.
“Medical students are the future leaders of the TMA, and it’s important to have us involved in advocacy early in our training,” he said, adding that the section introduces students to organized medicine and helps show them the ropes about how to attain leadership positions.
“One of the best things about being in the TMA is that you get to meet people and make connections throughout Texas,” Mr. Wealther said.
Although the COVID-19 pandemic has made those efforts more difficult, it has not stopped the section from advocating on issues they know best, like medical education, he says. “We’re experiencing how medical education affects us and how best we could improve on specific issues.”
For instance, the governing organizations for medical licensing exams recently canceled the skills portion of their tests in part because of long-standing advocacy by medical students and medical educators nationwide. The exams were widely seen as too expensive for students and – with a more than 90% pass rate – did little to identify problems. (See “Skipping a Step,” November 2020 Texas Medicine, pages 36-40, www.texmed.org/SkippingaStep.)
In addition, medical schools often are associated with county hospitals or have school-sponsored free clinics where students interact directly with patients and have observations to contribute from those experiences, Mr. Wealther says. And many are involved in TMA community outreach activities such as Vaccines Defend What Matters, Walk With a Doc, and drives to collect personal protective equipment.
The section also has begun a program of writing blog posts and articles for TMA publications like Texas Medicine and Texas Medicine Today to address issues important to students.
When it comes to certain topics like payment and insurance coverage, Mr. Wealther acknowledges that Medical Student Section members frequently have a different take on medical issues from practicing physicians, a difference that typically reflects where they are in their careers. He also acknowledges that the idealism many students share on a topic may be tempered later by experience. n
LGBTQ Health Section: Advocates for the Marginalized
The LGBTQ Health Section was created specifically to address the unique health needs of Texans who have traditionally faced stigma in medicine, says Maria Monge, MD, chair of the section and adolescent division director in the department of pediatrics at The University of Texas at Austin Dell Medical School.
“One of the things we know about [LGBTQ] adults is that they’re less likely to receive preventative health services,” she said. “They’re also much more likely to have been discriminated against in a health care setting. They report not seeking health care for acute illnesses because of that discrimination.”
Research shows that people who are sexual minorities also have higher adjusted rates of asthma, cancer, heart disease, chronic obstructive pulmonary disease, hypertension, kidney disease, obesity, smoking, and stroke than people who identify as heterosexual, according to a Feb. 5, 2021, report in the Morbidity and Mortality Weekly Report put out by the Centers for Disease Control and Prevention.
LGBTQ patients need more advocates in health care in part because they experience higher levels of poverty, food insecurity, homelessness, lack of health insurance, and unemployment compared with non-LGBTQ populations, Dr. Monge says. Recent studies have shown that COVID-19 exacerbated these existing issues as well as health care problems faced by LGBTQ populations.
The LGBTQ Health Section welcomes all Texas physician members, not just those who identify as LGBTQ, Dr. Monge says. She describes herself as an “ally” who works with LGBTQ patients and says many more allies are needed to promote education and advocate for healthy changes in LGBTQ health care.
“Allies, percentage-wise, are going to be the ones providing a lot of the care,” she said. “Anyone is welcome to join.”
Allies also are needed to help educate and advocate on LGBTQ health policymaking, Dr. Monge says. For example, several bills proposed in the most recent session of the Texas Legislature would have negatively affected LGBTQ health but did not pass in part due to TMA advocacy done in conjunction with other specialty societies.
“There is a lot of behind-the-scenes education and advocacy work that our section is doing about those issues,” Dr. Monge said.
And one of the section’s top priorities in coming years will be continuing to educate fellow physicians and policymakers about LGBTQ health care.
Tex Med. 2022;118(1):34-39
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