As an assistant professor of family medicine at UTMB John Sealy School of Medicine, Samuel Mathis, MD, knows firsthand how important guiding the next generation of physicians is.
The family physician was glad to see the Texas Medical Association doing just that and more at its 2024 Listening Tour, which he says made an impact on young residents and established physicians alike.
“It was great to have leadership there to showcase to Galveston members that TMA actually is taking a look and finds membership important, even all the way down on this little island region,” said Dr. Mathis, a member of TMA’s Council on Socioeconomics. “It was a really good mix of individuals. We had people who are very all in, 100% TMA, and then we had people who have been to a few TMA meetings, and those that have never engaged with TMA. That really helped create a good conversation.”
With more than 57,000 TMA physician and medical student members across the expanse of Texas, each facing a host of unique difficulties like financial pressures and work responsibilities, TMA leadership and staff hit the road to learn different regions’ struggles firsthand and establish connections.
The goal: hear directly from Texas physicians about what’s plaguing their practices and what TMA can do to ensure the state remains the best place to practice medicine – especially for those in medical communities frequently missing from the conversation.
Launched in February, the listening tour provided an opportunity for both members and nonmembers in nonmetro areas to become acquainted, or reacquainted, with the services TMA offers – and for TMA to collect valuable feedback about physicians’ pressing needs in areas like advocacy, payment, leadership, and wellness. The various sessions also highlighted TMA’s mission to boost membership collaboration across the state, among other initiatives now in the works following the tour’s conclusion.
Used to fielding questions from colleagues about how TMA is addressing physician matters like payment delays, complex administrative burdens, and serious obstacles to growing the physician workforce, new TMA Board Trustee Dexter Turnquest, MD, was heartened to see the tour bring answers to some of physicians’ most longstanding concerns. The Houston surgeon says these questions often arise in part because many physicians are unaware of how TMA combats practice burdens through state and federal advocacy and a myriad of association resources.
Dr. Turnquest, who attended both the Montgomery and Galveston counties listening tour stops this year, says the events opened the door for cooperation among members, prospective members, and TMA leaders.
“[The listening tour] gave TMA leadership the chance to hear what concerns physicians have and to share how TMA can help. I think it’s very important that [the association] interacts on the ground level with its membership,” he said.
The tour included five stops around the state – with some covering multiple counties each – plus a visit to Laredo at TMA’s Border Health Conference held in collaboration with the Webb-Zapata-Jim Hogg County Medical Society (www.texmed.org/BHCHighlights). There, TMA leaders joined others in organized medicine to discuss unique health care access challenges along the Texas-Mexico border.
While the tour sessions helped spark collaborative discussion between Texas’ physicians, they also served TMA’s standing goal to grow membership, says TMA CEO Michael Darrouzet, who witnessed several on-the-spot sign-ups.
The good news, he said: “We learned we’re already working on issues that [physicians] are most concerned about. We heard a lot of confirmation.”
For example, TMA President G. Ray Callas, MD, says the tour provided an opportunity for attendees to learn about services the association already provides as member benefits.
“Physicians don’t know what we do for mental health and burnout; we also can talk about your practice management and come up with ideas,” the Beaumont anesthesiologist said. Physicians also may not know that as TMA members, they can access disability and medical liability coverage through two TMA-endorsed carriers – TMA Insurance Trust and Texas Medical Liability Trust, respectively – the latter of which Dr. Callas called “one of the strongest in the U.S.”
He also acknowledged, however: “We would be foolish and naive to think our plan is ironclad and that we have all the answers. We have to be nimble and do well to continue to put physicians first.”
Lessons learned
To that end, TMA sought feedback from tour regions on what the association is doing well, what it could be doing better, and what else physicians need from the association.
These efforts mirrored other TMA endeavors to analyze its effectiveness as an association, including by tracking and rating such metrics as how willing TMA members are to promote the association via word-of-mouth advertising.
“An email isn’t as effective as a word-of-mouth score,” said Lena Banks, the association’s vice president of member experience and business intelligence. “How interested are our members in recruiting their colleagues? How happy are they with their membership or with the practice of medicine? [TMA] gauges what physicians consider to be the value of a TMA membership.”
That value was surveyed throughout the tour, during which local physicians were asked about their career experiences, including:
- What resources are unavailable to them in their practice of medicine, but would help them better care for patients or manage their careers?
- What topic worries them the most about where medicine is heading?
- What keeps them from becoming more involved with TMA or their county medical societies?
While each listening tour stop provided unique feedback, common themes surfaced regarding the need for assistance related to:
- Local community health and outreach programs sponsored by TMA or a local county medical society;
- Practice help/information services (e.g., payment resources, answers from specialists);
- More CME opportunities, both in-person and online;
- Leadership and professional development opportunities;
- News and insights about other Texas physicians and the medical profession; and
- More conferences, meetings, and events at the state and local levels.
“[TMA] learned that we need to be listening and communicating in a relevant manner to our members,” Ms. Banks said. “Much of what was asked for already exists in some form, so we learned that we need to market those resources more effectively and consider broadening them in some way.”
For example, many attendees had no idea that TMA offered help with billing and coding problems via its Physician Payment Resource Center, payer updates from its Health Plan News page, or related CME through its online Education Center. (See “I Never Knew TMA...,” page 19.)
Some members also did not know how to become involved in TMA community outreach programs, such as Hard Hats for Little Heads helmet giveaways or physician-patient Walk with a Doc events.
The challenge to connect TMA members with appropriate resources also may soon fall to TMA’s new standing Committee on TexMed Education, which will continue to aid TMA’s mission to provide accurate, relevant, and engaging information. The new committee, which reports to the Council on Member Experience, will help develop educational conferences to ensure the content reflects physicians’ needs and interests, for example by helping to select speakers and review evaluations from previous years’ TexMed events.
“I don’t think any physician is fully aware of all that TMA does,” Houston neurologist and TMA Board of Trustees member Kimberly Monday, MD, said. “I’m only aware because I’m intimately involved, but I’m awestruck most of the time about how much work is done behind the scenes.”
Advocacy of interest
The listening tour surveys also identified four top areas of concern among physicians:
- Practice settings;
- Workforce obstacles, including scope of practice creep;
- Prior authorization; and
- Augmented or artificial intelligence (AI).
Dr. Turnquest says these topics, which were cited among both physicians in private practice and those in employed settings as causes for worry, can be summed up to one concern: practice viability.
“What cuts across all of this is that physicians need help,” Dr. Turnquest said. “How can we survive?”
Dr. Turnquest says many independent physicians who attended the tour stops were worried about keeping their practices open amid economic headwinds and a heavy administrative workload. Meanwhile, physicians in employed settings were concerned that a lack of clinical autonomy would open the door for nonphysicians to encroach on medical practice without physician oversight, potentially lowering the standard of care to Texas patients.
And physicians in various practice settings listed prior authorization as a “major concern,” Dr. Turnquest said.
Mr. Darrouzet said TMA understands that practices are struggling, citing proposed Medicare payment cuts, ongoing implementation woes for prior authorization exemptions, and a host of other unique burdens as “challenges to practices everywhere.”
TMA is not shying away from those threats, however, and instead the association is “undergoing an exhaustive analysis to examine what physicians need, and what TMA can offer to them on multiple fronts,” Mr. Darrouzet said.
This includes providing localized educational opportunities and insight from specialists on topics like practice management and billing and coding to physicians and county medical societies across Texas.
Moreover, TMA currently offers comprehensive resources on both employed and independent practice settings – including a 15-member standing Committee on Independent Physician Practice that aims to identify the needs of independent physicians and the related services that TMA may develop to address those needs – and toolkits for physicians looking to shift their practice setting to, or away from, employment.
TMA also continues to work to ease payment and prior authorization burdens through advocacy. Recently, TMA recommended numerous improvements to the 2025 proposed Medicare physician fee schedule in an effort to reduce economic burdens upon physicians. Additionally, TMA continues to push for prior authorization reform ahead of the 2025 legislative session.
“TMA is working hard to fight for its members,” Mr. Darrouzet said. “We are continuing to build a [grassroots] system to identify [what] resources can help both physicians and their county medical societies thrive.”
Dr. Monday, who attended multiple listening tour sessions this year, says the topic of AI also played a role in the conversation of practice viability.
“There’s obviously a lot of concern about what’s going to happen with AI,” she said. “What’s the role of the physician? Where are the legal boundaries going to be drawn?”
However, Dr. Monday says that much of the physician concern she encountered around AI was abated by Dr. Callas, whose personal interest in the topic has led TMA to develop targeted AI resources.
Mr. Darrouzet adds the association is also considering new vehicles to share TMA member benefits with physicians, for instance via online outreach and new TMA-sponsored podcasts.
Furthermore, to connect physicians in need with important TMA tools, the association has begun to develop focused regional events in collaboration with county medical societies and to host annual events outside of Austin. The change was a direct response to members who said traveling to Austin for TMA events could be prohibitively expensive and far.
Future events will include a regional conference in Tyler in 2025 and two more in Abilene and Amarillo in 2026.
Likewise, because physicians at listening tour stops often report the same struggles and priorities TMA has identified for advocacy, Mr. Darrouzet says the association is working to connect those county medical societies with resources.
As the 2025 Texas legislative session looms, improved connections with smaller medical communities could have ripple effects, Dr. Mathis says.
“The more TMA is in the community, the more physicians are realizing just what we as an association are offering, and I think that by moving around, my hope would be that we do get more people that are engaged,” he said. “I would argue that by going to places that are maybe not the big metroplexes, we are going to see a little bit of an increase or improved advocacy effort on the home front, because a physician in a small town in a small county may have a lot more sway or may be much more personally engaged with their state legislators.”