Dallas cardiologist Rick Snyder, MD, certainly knows what makes a patient’s heart beat.
The long-time champion of organized medicine also knows how vital physician advocacy is to the heartbeat of the profession.
But like most of us reluctant to take preventive medical advice until it hits close to home, Dr. Snyder acknowledged: “The value of advocacy was not demonstrated to me until it had an impact on me.”
That moment came in the summer of 2000 when the cost of medical liability insurance was so sky high, specialists could afford it only on a day-to-day basis. Patients in need of critical heart surgery were left in limbo.
“It became a real access-to-care issue,” Dr. Snyder recalled. “And it had nothing to do with science or our education or ability, and everything to do with advocacy.”
That defining moment for Dr. Snyder also led to a defining moment for the Texas Medical Association in galvanizing an army of physician advocates who helped win passage of the state’s landmark medical liability reforms in 2003.
Since that experience, Dr. Snyder can be found in legislative chambers and regulators’ offices just as regularly as in exam and operating rooms. The reverse is also true thanks to all the relationship-building he’s done over the years: It’s not uncommon for some of those lawmakers to visit him at his practice for input on of-the-moment health care issues.
“As clinicians, we treat one patient at a time. But as a physician-advocate, we can treat a whole county, state, and country all at once. Because of that, we need to make the capitol buildings in Austin and [Washington,] D.C., as familiar as our own hospitals. We need to make some of the legislators and regulators as familiar as our own patients.”
Dr. Snyder now carries that mantra into his role leading the country’s largest state medical association this month. As TMA’s 158th president, he wants his fellow physicians to transplant that mantra into their own DNA.
“[Advocacy] is not an innate part of our culture coming out of medical school. But it needs to be.”
Alongside that belief, Dr. Snyder carries with him a love for numbers and almost always has a spreadsheet or a study handy reflecting the economic headwinds facing physicians today – health care consolidation, dwindling Medicare payments, and the rise of value-based care among them.
Those trends make advocacy for the profession all the more timely and important, he says. And equally vital is TMA’s support in helping physician practices stay viable so they can be there for their patients.
“We need to make sure that the professional needs and the financial viability of our physicians is preserved so they can serve that role no matter what they are,” Dr. Snyder said. “We need to make sure that our corporate practice of medicine statutes are being abided by. We need to make sure that there’s clinical autonomy for our physicians. It doesn’t matter if it’s a private equity model, an independent model, or an employed model.”
Dr. Snyder’s very personal and early exposure to the health care system demonstrated how medicine “can make a huge impact on someone’s life” – his own.
It’s what attracted him to a medical career in the first place.
He spent a lot of time on the other side of the patient-physician relationship when he was young. The gauntlet of childhood illness and injuries he ran included haemophilus influenzae pneumonia, a heart murmur he grew out of, and strep throat that left him temporarily deaf and led to tubes in his ears. On top of that, a childhood accident that severed all the nerves in his hand had to be repaired – successfully – by a skilled surgeon.
While attending high school at Jesuit College Preparatory School of Dallas, Dr. Snyder fulfilled the school’s 100-hour volunteering requirement by running errands for medical residents at Parkland Memorial Hospital’s emergency department. After graduating from high school, he worked at Medical City Dallas hospital – where he works today – as an anesthesiology tech in the operating room, refilling and moving the anesthesia carts for physicians. This gave him the opportunity to observe many different surgeries, including open heart bypass.
Though he started off in internal medicine at UT Southwestern Medical School in Dallas, Dr. Snyder decided while there to pivot to cardiology, drawn to the broad impact the specialty can have.
With those numbers he loves so much, he notes that heart disease is the leading cause of death in the U.S., to the tune of more than $300 billion in annual costs – more than any other medical condition.
“With cardiology, this is something that impacts almost everyone, and almost everyone is potentially at risk of having a problem,” Dr. Snyder said of his early interest in the specialty.
The impact the disease had on one patient in particular now drives him to champion what he describes as meaningful access for patients to “timely, high-quality, cost-effective health care. You have to have all three.”
Despite having insurance coverage, a patient in cardiogenic shock referred to him for an emergent transplant died because the hospital refused the transfer; the insurance plan’s network did not include all the specialists required to care for the patient.
“That really made an impression on me,” Dr. Snyder said. “Coverage is not the same thing as access, and access to a waiting list is not the same thing as access to health care.”
As he encourages his colleagues to do, Dr. Snyder took his personal stories and message to state lawmakers – in this case Reps. Tom Oliverson, MD (R-Cypress), and Julie Johnson (D-Farmers Branch) – and successfully advocated for network transparency legislation in 2021.
He got an early introduction to the powerful impact of organized medicine in Washington through the American College of Cardiology, where he served as president of the Texas Chapter and on the Board of Governors, and through TEXPAC, TMA’s political action committee, where he served as a board member. Dr. Snyder and his wife, cardiologist Shelley Hall, MD, regularly host TEXPAC fundraisers in their home.
Recounting a trip to the nation's capital, he uses his wife as an example of how taking those first small steps into advocacy can have ripple effects. Intimidated at first, by the end of their rounds on federal legislators, she was jumping into his conversations and taking the lead.
Dr. Hall is now serving a three-year term as president of the Texas Chapter of the American College of Cardiology. Together, the physician couple has five grown children – the youngest is 26 – which has allowed them to focus more time on organized medicine.
“I reminded her that the legislators are likely more intimidated by us than vice versa,” he recalled of those early advocacy days. “Just by getting out there and doing it, you begin to form those relationships. And if you don’t have [support], TEXPAC can bring folks to be your wingman.”
Over the past decade, Dr. Snyder has served in numerous other leadership roles, as president of the Dallas County Medical Society (DCMS) and on TMA’s Council on Legislation and Board of Trustees.
When Dallas became the epicenter of the nation’s West Nile virus outbreak in 2012 during his DCMS presidency, his leadership and advocacy skills were battle-tested. From pulling together local infectious disease doctors and data, to delivering presentations to media and federal, state, and local representatives, Dr. Snyder helped coordinate support for aerial spraying to kill infected mosquitoes and quell the outbreak. And it worked.
“As soon as we sprayed, deaths dropped. … Without a doubt, it was a team effort,” he said of organized medicine’s success.
Dr. Snyder’s leadership led to his appointment to the Dallas County Health and Human Services Public Health Advisory Committee by Dallas County Judge Clay Jenkins. All those relationships came in handy when Dallas later experienced the refugee crisis from Hurricane Katrina and panic over an Ebola outbreak, and some of the lessons learned gave TMA a baseline of sorts for writing an entirely new playbook when the COVID-19 pandemic hit.
Now in the wake of the pandemic, many physician practices still grapple with its financial fallout and other economic forces they may feel hostage to, such as the rapid consolidation of health care, Dr. Snyder says.
For instance, between 2019 and 2020, more than 48,000 U.S. physicians left independent practice, according a study by the Physicians Advocacy Institute (tma.tips/PAIPhysicianEmployment). Nearly half of those physicians made the switch after the onset of the COVID-19 pandemic, which has only accelerated the shift toward employment underway for years (tma.tips/AMAPhysicianEmployment). Meanwhile, the transition from fee-for-service to value-based care also has challenged smaller, under-resourced practices that lack the capital or the scale to keep pace.
TMA has taken steps to study such trends and develop resources to help physicians keep their doors open, no matter their practice setting. TMA has formed an Ad Hoc Committee on Independent Physician Practice and a Task Force on Alternative Payment Models, for example. In addition, Dr. Snyder represents TMA on the Texas All-Payor Claims Database Advisory Group. The database will collect public and private health insurance claims with the goals of improving price transparency, reducing cost variation, and supporting a more competitive marketplace.
Medicare, for instance, currently pays hospitals more and physician practices less for providing some of the same services – a discrepancy that gives hospitals an incentive to acquire medical practices because those hospital-owned practices can collect the higher fees, Dr. Snyder explains. That, in turn, pressures private physician practices to merge in order to better compete.
Once again, Dr. Snyder puts forth hard numbers with a hard truth:
“If my group, if just HeartPlace alone – and we have 53 physicians – if we were bought by a [hospital system], the very next day the increase to the Medicare system would be $16.7 million … on an every-year basis for just three codes.” he said.
And once again, he’s putting his physician advocacy skills to work to convince lawmakers of the need for change. In this case, Dr. Snyder is already moving the ball on Medicare payment reform, working with members of Congress to adopt “site-neutral” payment policies that could generate $471 billion in savings over 10 years, according to a study by the Blue Cross Blue Shield Association (tma.tips/BCBSASiteStudy).
Dr. Snyder points to plenty of other opportunities for physicians to speak up as complicated health policy decisions are made, as with what he calls the “outmigration” of care from hospitals to outpatient settings like ambulatory surgical centers during the pandemic and how to care for an aging generation of baby boomers requiring more medical care.
“We need to be at the center point of that helping to guide that. These are all [advocacy] opportunities for us as physicians,” he said. “And not just in the legislative arena, but equally so in the regulatory and judicial sectors, as we demonstrated with our successful No Surprises Act federal lawsuits. We should not be apologetic for wanting to preserve physician viability in the health care system. On the contrary, we need to always be the tip of the spear, boldly empowering physicians and the patient-physician relationship.”