August 2024 Dallas Medical Journal

AUGUST 2024 | DALLAS COUNTY MEDICAL SOCIETY

DCMS FAMILIES IN MEDICINE

THE HARD TRUTH ABOUT MEDICAL SCHOOL DEBT

August 2024

Vol. 110 No. 08

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PRESIDENT’S PAGE

Families in Medicine: Legacies of Caring

EXECUTIVE VICE PRESIDENT & CEO

Jon R. Roth, MS, CAE

E D I TO R I A L S TA F F EDITOR, PRINT & WEB CONTENT

Lauren S. Williams

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All in The Family

ADVERTISING DCMS BUSINESS DEVELOPMENT

COMMUNICATIONS COMMITTEE Michelle Caraballo, MD, Chair Drew Alexander, MD Ravindra Bharadwaj, MD Joy Chen, MD

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Ann Leitch, MD

HOUSE CALL

Families in Medicine

Ravina Linenfelser, DO David Miller, MD Sina Najafi, DO Erin Roe, MD, MBA

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H E A LT H A L L I E S

Current State of Mammography in the State of Texas

BOARD OF DIRECTORS Deborah Fuller, MD, President Shaina Drummond, MD, President-Elect Gates Colbert, MD, Secretary/Treasurer Donna Casey, MD, Immediate Past President Neerja Bhardwaj, MD Sheila Chhutani, MD Philip Huang, MD, MPH Anil Tibrewal, MD

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Rajeev Jain, MD EDITORIAL

The Hard Truth About Medical School Debt

M O N E Y M AT T E R S

Investing in Residential Real Estate: A Path to Financial Freedom for Medical Doctors in Dallas

Raghu Krishnamurthy, MD Aekta Malhotra, MD Marcial Oquendo-Rincon, MD

Articles represent the opinions of the authors and do not necessarily reflect official policy of the Dallas County Medical Society (DCMS) or the institution with which the author is affiliated. Dallas County Medical Society does not endorse or evaluate advertised products, services, or companies nor any of the claims made by advertisers.

Claims made by any advertiser or by any company advertising in the Dallas Medical Journal do not constitute legal or other professional advice. You should consult your professional advisor. ©2022 DCMS. According to Tex. Gov’t. Code Ann. 305.027, all articles in Dallas Medical Journal that mention DCMS’s stance on state legislation are defined as “legislative advertising.” The law requires disclosure of the name and address of the person who contracts with the printer to publish legislative advertising in the DMJ: Jon R. Roth, MS, CAE, Executive Vice President & CEO, DCMS, PO Box 4680, Dallas, TX 75208-0680. Dallas Medical Journal (ISSN 0011-586X) is published monthly by Dallas County Medical Society, 140 E. 12th St., Dallas, TX 75203. (214) 948-3622. Postmaster - Send address changes to: Dallas Medical Journal | PO Box 4680 | Dallas, TX 752080680. Periodicals postage paid at Dallas, TX 75260 and additional post offices.

August 2024 • DALLAS MEDICAL JOURNAL | 1

PRESIDENT’S PAGE

Families in Medicine: Legacies of Caring

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Deborah Fuller, MD

hether in the corridors of hospitals or the confines of private practices, the legacy of medicine often transcends generations.

Being part of a medical family, in which parents, children, and sometimes even grandparents share the same profession, is a testament to the enduring appeal and a reflection of values that define being part of a profession that cares for others. These familial ties within the medical field serve to create a unique environment in which knowledge and dedication to caring are passed down, influencing not only family members but also the communities they serve.

Historically, in many cultures, it has been common for the practice of medicine to be handed down from generation to generation. In ancient Egypt, the title of “Chief of Physicians” was often passed from father to son, ensuring that medical knowledge remained within the family.

In medieval Europe, many prominent medical families trained their children as apprentices, creating a lineage of healers who served their communities for centuries to follow.

Today, the tradition of families in medicine remains strong. Across the United States and around the world, it is not uncommon to find families with multiple members working in various fields of healthcare. These families often share not just a profession but a deep, personal connection to the calling of medicine.

Dallas has several well-known medical families. The Haley family has thirteen family members practicing medicine.

Another Dallas medical family is the Fine family. Just as many of us practicing medicine have our own stories of why we chose medicine as a profession, the Fine family, Dr. Robert Fine, and his daughter, Dr. Lauren Fine, have their story to share.

Dr. Robert Fine

I did not grow up in a medical family as much as a medically adjacent family.

My father was an organic chemist who collaborated with physicians at the FDA and who had a cousin who was an orthopedist at Johns Hopkins.

My mother’s father was a country doctor in the Bootheel of Missouri, her brother a hospital administrator, and her cousin a surgeon at Washington University in St. Louis. Both my parents spoke highly of physicians and, from an early age, encouraged me to become one.

As for myself, in high school, I wanted to become a professional musician, but I was completely deaf in one ear, and my doctor suggested being around loud music was not a particularly good idea.

So how did I become an internist/ geriatrician/ethicist/palliativist? As an undergraduate at UT Austin (1970–73), I had given up music and enrolled as an English major, but I also liked the sciences (especially microbiology and virology) and, in deference to parental nudges, met all the pre-med requirements. During my second year when I explained to my father that I could graduate in three years, he asked my plans. I told him I planned to pursue a PhD in English.

My father was unhappy and gave me “the talk,” which, in retrospect, has blessed me to this day. A child of the depression and survivor of World War II, my father was an imminently practical man. My father spoke of the difference between an avocation and a vocation. He argued that thinking about literature was an avocation and that I needed a vocation.

Meanwhile, I had two older sisters, one with a master’s in English who was working as a paralegal and another pursuing a PhD in the humanities who expressed worry about the job market for those in such fields.

Pragmatism won. I enrolled at UT Southwestern in 1974. At that time, it certainly was not the right school for me,

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an English major, which is really philosophy for people who like plot and character development. I was so unhappy that first year that I took the LSAT and planned to leave for law school. That changed, however, when I started seeing patients in my junior year.

I realized that every patient had a story—a story of life, a story of disease, a story of suffering. Medicine suddenly seemed more than a vocation. It was a calling. The challenge of diagnosis led me to internal medicine, through which I fell in love with geriatrics. As a young practitioner in the early eighties working with both seriously ill elders and young men dying from AIDS, I found myself thinking more critically about medical ethics—not just what we could do but what we should do in the face of mortality. I participated in the evolution of clinical ethics consultation, serving as an ethics consultant at Baylor, other hospitals, and the largest hospice in the country. That combination then led to early involvement in what would become palliative medicine and significant involvement in writing the Texas Advance Directives Act of 1999. As I look back and think about “the talk” with my father who sent me to medical school, I recognize I have not had an avocation or even a vocation so much as an advocation.

Dr. Lauren Fine

“It wasn’t normal.” This was the refrain from my sisters and I, reminiscing about the dinner table, growing up in our household.

“Normal” families talked about the weather

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The Dallas County Medical Society and the UT Dallas Alliance for Physician Leadership Program (APL) are offering a year long, physician leadership certificate that will cover timely and important topics in today’s everchanging healthcare environment. The certificate program covers areas of focus such as physician wellness, leadership skills, value-based contracting, quality performance, emerging IT opportunities, revenue and financial management. The program is cohort style and will adapt to industry trends and the needs/topics of interest to the physician attendees.

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or sports. Our dinner table conversations often consisted of ethical dilemmas for us to solve and discussions about the end of life. While I am quite sure this was not guidance from any of Dr. Spock’s books on parenting, it worked for us.

From an early age, I knew I either wanted to be a doctor, like my father, or a musician. Both paths were inspired by him.

The difference is, whereas his father suggested to him that avocations did not make for viable career options, my father suggested that all I had to do was write one big hit. And so instead of matriculating from college into medical school, I was inspired (and supported) to try my hand at being a professional musician.

I moved to Austin, where I worked several jobs and played open mics as many nights per week as I could. I got over my stage fright (thank you propranolol and an occasional shot of whisky). I recorded and released two albums during that time.

And while I crossed paths with musicians who would go on to win Grammys, I never did write that one big hit. It was during this time that I realized I deeply missed what drew me back into medicine: a fundamental need to feel like I was helping people.

I was lucky enough to attend the University of Pennsylvania for medical school, where I decided my passion was emergency medicine. I wanted to be the person who could respond “yes” to the question, “Is there a doctor onboard?” I wanted to take care of everyone without having to ask about the ability to pay.

I wanted to be of service to all regardless of means, and the ER would allow me to do that. You can imagine that telling my internist, geriatrician, and palliative care father that I was going into emergency medicine was not met with jubilation, but he eventually came around to see how much good I could do in this field and, also, what a good field it was for me.

These days, I am lucky to serve my community in many capacities. Along with my husband, Dr. Benjamin Morrissey, I teach as a core faculty member of the emergency medicine residency at Baylor University Medical Center (BUMC), where we recently graduated our first outstanding class of emergency medicine residents. I serve as the medical director for BUMC’s

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Sexual Assault Nurse Examiner (SANE) program, which I also helped launch. I also serve as the physician liaison for community engagement, helping connect our medical students and residents to community outreach projects; inspiring the next generation of doctors at high schools throughout Dallas; and helping medical students and residents gain a deeper understanding of the local social determinants of health, which have the greatest impact on the health of our patients, so that we can better help our patients live longer, healthier lives.

For the Fine family, medicine is the pluripotential stem cell of careers: full of infinite possibilities. For both of us, it has been a way to practice “tikkun olam,” a way to mend the world. But most importantly, not only has medicine been a career—it has been a calling.

Conclusion In an era in which medicine is becoming increasingly specialized and technology-driven, the human connections that define the profession are more important than ever. Medical families play a crucial role in preserving these connections.

As long as there are families such as the Fine family, who are willing to dedicate their lives to caring for others, the legacy of medicine will continue to thrive, shaping the future of medicine for generations to come. DMJ August Happenings: August 1: Play Ball Day August 2: National Water Balloon Da August 3: Sandcastle Day August 6: National Wiggle Your Toes Day August 7: Regatta Day August 10: National Lazy Day August 17: International Geocaching Day August 18: Serendipity Day August 23: Cheap Flight Day August 27: International Lottery

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August 2024 • DALLAS MEDICAL JOURNAL | 5

EV P/C EO LETTER

All in The Family Jon R. Roth, MS, CAE

O

ne of the most interesting and fun aspects of working for Dallas County Medical Society (DCMS) is to understand the myriad familial relationships among physicians across Dallas. DCMS is fortunate to have many physician leaders who are married or have generational ties and have volunteered for a leadership role in which they contribute their time and talent to organized medicine and the residents of Dallas County. Some of the names are unmistakable hallmarks of a legacy of our local physicians. Think of names like Haley, Casey, Parnell, Osborne, Khetan, Snyder/Hall, Chung, Patel, Pritchett, Pollock, Fine, Johnson, Weprin, and so, so many more. There are, quite literally, too many to mention.

While it is impossible to exactly determine the influence of family members or spouses in a physician’s decision to enter the medical field, there is some data available. Studies indicate that having a family member in the medical profession can significantly impact one’s choice to pursue a career in medicine.

One study found that experiences with healthcare, including the medical care received by family members, play a role in shaping individuals’ attitudes toward the profession. This influence can be both positive and negative, depending on the quality of care and the overall experience. Logically, positive experiences can inspire trust and admiration for the profession, encouraging individuals to follow in their family members’ footsteps. Likewise, increased rates of professional stress and burnout can have the oppositive impact and deter children and other family members from entering the profession.

Interestingly, other research highlights the complexities and potential conflicts that can arise when physicians treat their own family members. This dynamic often stems from the personal connection and trust that family members have in their physician relatives, which can influence career decisions. These family ties can provide a sense of security and familiarity with the medical environment, making the profession more appealing. Furthermore, anecdotal evidence

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and expert insights suggest that the presence of a physician in the family can lead to better understanding and support for the rigorous demands of a medical career. This support system can be crucial for individuals during their medical education and practice, reinforcing their decision to enter the field.

In this month’s edition of DMJ, we look at some of the family ties in Dallas and DCMS. Enjoy reading about your colleagues and their unique perspectives on why they chose to follow in their families’ footsteps or marry a fellow physician. DMJ

Jon R. Roth, MS, CAE DCMS EVP/CEO

LEGAL CORNER

Hospitals Facing Scrutiny Over NDA Usage in Medical Malpractice Lawsuits

By Shaw & Wiar, Attorneys at Law

I

n a recent NBC News article titled “How a Major Public Hospital Is Protecting Doctors by Silencing the Patients Who Accuse Them,´” Lewis Kamb tells the story of a young college student who was tragically injured and removed from a heart transplant list because of alleged malpractice by Dr. Nahush Mokadam at the University of Washington Medical Center (UWMC) in Seattle. Though the case settled, the hospital required the student’s family to sign a non-disclosure agreement (NDA) stating that the family was “not to publicize the names or identities of the defendants” with “any description of their conduct.”

While NDAs are ubiquitous in every line of work, according to Kamb, many question whether they are proper for a public hospital to use against alleged victims who have allegedly been injured by the hospital or its doctors. Kamb rightly points out that these cases are discoverable anyway because the hospitals are public entities.

So why do hospitals even use them? Well, presumably for the same reason anyone would have someone sign an NDA—to protect the entity as much as possible, whether from loss of trade secrets or from bad press.

Hospitals may want to reconsider this approach, however. Had UWMC not insisted on the families of alleged victims signing NDAs, the families would perhaps have felt freer to tell their stories, but those stories would likely have stayed within their social networks.

Because the hospital insisted on trying to hide them, their stories are now very public in an article on a top news website—and not only

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one story from one family. The article lays bare UWMC’S history of settlements: • “A newborn who suffered severe brain damage because doctors allegedly failed to properly monitor his heart rate during childbirth ($14 million).

• A man who died after doctors allegedly misdiagnosed and improperly treated a cancerous mass in his face and neck ($6 million).

• A girl left with permanent cognitive disabilities after a doctor who operated on her face allegedly left bone fragments behind in her skull, causing a catastrophic stroke ($11 million).”

This presents real problems for public hospital systems: On one hand, do they just leave the door open and let information flow freely? Or do they continue looking like bullies? There is no real win for them; however, the use of NDAs at UWMC clearly backfired and produced the opposite of the intended effect. Hospitals should stop to consider that.

Finally, there is the moral question of whether it is right to force alleged victims of catastrophic injuries to sign NDAs and a public policy concern as to whether NDAs protect bad medical providers. These are likely best answered on a case-by-case basis, but people generally have a sense of what is right and wrong, so hospital leadership should consider, what if this were my family? Answering that question honestly would likely avoid a lot of PR problems, and also, it’s what should be asked anyway. DMJ

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If you are interested in submitting an article for consideration, or have additional submission questions, please email Lauren Williams at lauren@dallas-cms.org.

August 2024 • DALLAS MEDICAL JOURNAL | 7

HOUSE CALL Families in Medicine

By Lauren Williams, DCMS AVP Publications & Digital Communications

M

edicine is often described as a calling, one that requires dedication, sacrifice, and continuous collaboration. For families deeply rooted in healthcare, like those who are part of the Dallas County Medical Society (DCMS), medicine transcends profession—it becomes a shared legacy. The intertwining of family and medicine is not only a source of strength but also a driving force behind patient-centered innovation and collaborative care. This month, we are highlighting generations of physicians who are dedicated to impacting patient care, mentoring young physicians, and shaping the future of healthcare in Dallas through their involvement with DCMS.

A Legacy of Medicine: The Parnell Family’s Inspiring Journey Few stories are as heartwarming and impactful in the profession of medicine as those of Dr. Winfred Parnell and his daughter, Dr. Wendy Parnell. Together, they have forged a legacy of dedication and compassion, demonstrating the profound bonds that can arise when family and medicine intertwine.

Dr. Winfred Parnell, a seasoned obstetrician-gynecologist, has dedicated his life to

serving his patients and his community. His journey into medicine was not just a career choice but a reflection of his personal values, which he passed on to his children.

“Both of my kids watched what we did,” he recalls. “Being an OBGYN requires constant attention day and night, and while I was away from home a lot, they saw the essence of our dedication.”

This sense of purpose clearly resonated with his daughter, Wendy, who chose to follow in his footsteps. For Wendy, her decision to become a physician was a natural extension of the values instilled in her. “I saw how my parents balanced their professional lives with family life,” she reflects.

“It deeply influenced me. When I decided to pursue medicine, it was not just a career — it was a calling."

One of Winfred’s most cherished moments was when Wendy decided to pursue obstetrics and gynecology, the same specialty he had devoted his life to. A particularly memorable milestone was when Wendy began her training at Parkland Hospital, exactly 30 years to the day after he had started there. “Seeing her walk into the same environment where I built my career was surreal,” he fondly recalls.

This shared experience did not end with Wendy’s training. For over a decade, father and daughter practiced together, creating a unique bond as both colleagues and family members. Working side by side in the

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operating room brought them immense joy. “The synergy in the operating room was unparalleled,” says Winfred. “We had a great relationship, and it was exciting to see the patients’ reactions when they realized we were father and daughter.”

Wendy recalls one unforgettable experience involving her father. “During a complex surgery, the patient became unstable.

I called my dad, and without hesitation, he rushed in to assist. Together, we worked

“My father’s words often resonate with me: ‘At the end of the day, it’s about making more differences than dollars.’

No matter how health care evolves, we never deviate from that principle,” said Wendy. through the night and stabilized the patient. This interdisciplinary collaboration was not only a testament to our family’s dedication to patient care but also a memorable display of our shared commitment to helping others — on his birthday, no less!”

Their collaboration also extended beyond clinical practice. Both Winfred and Wendy have been deeply involved in the

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August 2024 • DALLAS MEDICAL JOURNAL | 9

Dallas County Medical Society (DCMS).

Winfred’s leadership roles within the organization set the example for Wendy, who took on many of her own leadership positions within the society. Wendy recalls growing up in a family of physicians, in which being part of the DCMS was a tradition, which significantly shaped her approach to medicine and patient care.

“From the moment I joined our practice, I was encouraged to be part of the DCMS — not just for networking but also for the society’s commitment to advocating for physicians and serving the Dallas community,” said Wendy. Much like the family bond I share with my father, I feel a connection with my DCMS colleagues, trusting them with the care of my patients and cherishing the moments we come together.”

One of their most notable experiences together came in 2005, when they volunteered at the makeshift hospital set up at the Dallas Convention Center to help Hurricane Katrina refugees. “That experience was incredibly rewarding,” Winfred recalls. “It was special to work alongside my daughter in helping those in need.”

Wendy echoes her father’s sentiment.

“Working with my dad during such a highpressure situation was a powerful moment.

It reinforced the values of teamwork and selflessness that we strive to embody in our practice.”

Throughout Winfred and Wendy’s journey, compassion has been a central value in their practice. Winfred has always emphasized the importance of empathy and integrity in patient care. “It’s one thing to practice medicine, but it’s about caring for people,” he notes. This message has influenced Wendy, who carries this approach in her practice.

“Our family practice operates with a

simple yet profound motto,” she says. “Care for our patients like we want our own families cared for.” Despite changes in health care, such as the merging of practices into larger entities, the Parnells have maintained an independent private practice and credit their sustained success to this patient-centered approach, which prioritizes making a difference over financial gain. “My father’s words often resonate with me: ‘At the end of the day, it’s about making more differences than dollars.’ No matter how health care evolves, we never deviate from that principle,” said Wendy.

Looking to the future, Wendy shares her hope that the next generation of their family continues to appreciate the sacrifices made by her father and others in establishing a respected practice and hopes they will remain committed to providing quality care and continue to contribute to the DCMS and the broader Dallas community, both in and out of the office.

“The DCMS has played an instrumental role in my development, personally and professionally,” said Wendy. “Through my involvement, including serving twice on the Board of Trustees, I have gained insights into aspects of medicine that go beyond clinical training. DCMS has opened doors to leadership opportunities within the Texas Medical Association and beyond. I am forever grateful for the support the DCMS has provided to me and my family, helping us grow as leaders and maintain our legacy of service to Dallas County’s medical community.

As Winfred looks back on his career, he is filled with pride, knowing that his legacy of healing and compassion lives on through his daughter. “The most important thing I wanted to pass on was the spirit of compassion and adaptability,” he says.

“Medicine is always evolving, but the core values of empathy and care should remain constant.”

Together, the Parnell family’s story is one of commitment, tradition, and a deep love for medicine. Their shared values and dedication to both their patients and each other have created a lasting legacy, not just of medical excellence but of true compassion and integrity. Theirs is a journey that continues to inspire and leave a

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profound impact on the community they serve.

The Influence of Family and Community in Medicine: The Story of Drs. Rajeev and Mamta Jain In the medical field, the synergy of knowledge, collaboration, and support is pivotal for patient care and innovation.

For Drs. Rajeev and Mamta Jain, both members of the Dallas County Medical Society (DCMS), the intersection of family and community involvement has profoundly shaped their approach to medicine and patient care.

Being part of a family of physicians offers a unique blend of insight and shared experiences that shape professional approaches. The Jains emphasize how being embedded in both a medical family and the DCMS has influenced their practice.

They believe that "the importance of a community of doctors" lies in collaboration. Specialists from different fields often need to work together to achieve optimal patient outcomes. DCMS, by fostering collegial interactions, advocates for both physicians and patients, strengthening the local medical network.

Having family members who understand the pressures and sacrifices involved in medicine brings a sense of solidarity to DCMS doctors. Dr. Mamta Jain, for instance, frequently collaborates with her husband, Rajeev, in cases that overlap their respective fields. "We use each other's specialties to improve patient care," Mamta explains. A notable example includes Mamta advising her infectious disease fellows on new colon cancer screening guidelines, while Rajeev consults her on selecting antibiotics for complicated cases. This dynamic allows for innovative solutions and improved patient outcomes.

The Jain family boasts a long lineage of physicians, with roots stretching across two continents. Dr. Mamta Jain's father and uncle, both accomplished physicians, have had a profound influence on her medical career. In their generation alone, the family produced seven physicians, spread between the U.S. and India.

The Jains hope this legacy continues with their children. Their older son, who has expressed interest in medical school, could carry on the tradition of service in the Dallas medical community. Their family legacy is one of mentorship, education, and caring for the people of Dallas—values Rajeev and Mamta hope will be passed on to future generations.

Being part of the DCMS has brought the Jains opportunities for professional growth and personal satisfaction. Mentoring firstyear medical students is one of the ways they give back to the medical community, and the couple says they appreciate the way DCMS-sponsored events provide

them with a sense of both personal and professional fulfillment.

Rajeev's involvement in DCMS has also encouraged Mamta to become more active, leading her to attend mixers with medical students and gala events. These gatherings have not only allowed the couple to reconnect with familiar faces but also introduced them to new colleagues within the vibrant DCMS community.

Mamta particularly cherishes the sense

of unity she finds in these events. "It has been wonderful to gaze around and see all the talented people who are part of DCMS. The diversity of members and the enthusiasm at these events are truly remarkable."

As they look to the future, the Jains see their family’s legacy evolving within the local medical community. They recognize that medicine is more than a profession—it's a way to make a lasting impact on society. Their participation in DCMS,

coupled with their commitment to mentorship and patient care, exemplifies the power of community and collaboration in shaping the future of health care.

For Drs. Rajeev and Mamta Jain, the intersection of family, medicine, and community continues to drive their passion for innovation and excellence in patient care.

Their contributions to the Dallas medical landscape are both a tribute to their familial legacy and a testament to the strength of collaborative medicine. DMJ

Letters to the Editor

Outlining your concerns and suggestions for the future of the medical industry, DCMS members can now submit Letters to the Editor for the DMJ. With your collective expertise and experience, your input is sure to be valuable in shaping the direction of medicine and culture in the years to come.

Send your submissions for review to communications@dallas-cms.org.

August 2024 • DALLAS MEDICAL JOURNAL | 11

H E A LT H A L L I E S

Current State of Mammography in the State of Texas

By Shaw & Wiar, Attorneys at Law

A

s we inch closer to October, millions of Americans have the frolics of fall on their minds: football, the holidays, and cooler weather. But intertwined with the festivities is the sad diagnosis known as breast cancer. People acknowledge it, wear pink, and do their best with its ignoble imposition upon otherwise happy times. Most everyone agrees everything that can be done should be done to fight this terrible disease; most also agree that early detection is the best tool in doing that. So why would some technicality in law be trying to get in the way?

The staffing shortages are severe regarding radiologic technologists in the state of Texas as well as concerning communications from the Texas Department of State Health Services (DSHS), which is making the practice of mammography harder. Why would anyone want to do that?

According to the American Society of Radiologic Technologists (ASRT) Radiologic Sciences Staffing and Workplace Survey, vacancy rates for all medical imaging disciplines increased substantially in 2023.1 Vacancy rates represent the number of unfilled positions that are actively being recruited. According to the ASRT 2023 survey, mammography technician vacancies increased from 4.3% in 2021 to 13.6% just two years later.2 For background, mammography is a critical tool in the early detection of breast

cancer. Breast imaging radiologists, specialists in breast health, play a pivotal role in this process. Traditionally, mammogram examinations have been performed by radiologic technologists, with radiologists interpreting the results.

The issue is that the Texas DSHS has stated that doctors should not be performing breast examinations and that technicians should oversee these exams.

Certainly, you can see the dilemma.

What is a doctor to do when their technician calls in sick—cancel their whole day of appointments? What happens when a tech takes a new job at an established hospital? Should a doctor be forced to close their entire practice, denying continuity of care to their patients until another technologist is available to work? Why would a board-certified radiologist, who possesses more qualifications than that of a technician, not be allowed to perform mammography examinations on equipment that is only capable of being bought by licensed radiologists?

Radiologists are trained to identify subtle and complex breast abnormalities that may not be immediately apparent to a radiologic technologist. The radiologist is also the one who directs the technologist on what views to acquire. The direct involvement of a radiologist in performing mammogram exams can lead to a higher degree of diagnostic accuracy. This, in

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turn, reduces the chances of missed or misdiagnosed breast cancers and facilitates early intervention, which is crucial for patient outcomes. The importance of early detection through mammography screenings cannot be overstated, as it significantly improves survival rates and treatment outcomes. However, the scarcity of radiologic technologists in the mammography workforce is creating substantial barriers to the provision of timely and accurate mammograms, ultimately jeopardizing patient care. If the technician is not able to perform the exam, the doctor can’t do anything, and the patient has to wait—something that is deadly in treating cancer. This shouldn’t be.

Interpreting radiologists undergo extensive training and possess in-depth knowledge of medical imaging and interpretation, which aligns closely with the tasks typically carried out by radiologic technologists. Below is a chart discussing the educational certification requirements for both an interpreting radiologist and a radiologic mammography technologist: Mammography is regulated by both state and federal law. The DSHS is the state regulatory authority. The federal law is the Mammography Quality Safety Act of 1994 (MQSA). Section 900.12(a)(ii) of the MQSA states that “all mammographic examinations shall be performed by radiologic technologists.” However, to be qualified as

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a radiologic technologist, an individual must meet the following requirements: (i) General Requirements (A) Be licensed to perform general radiographic procedures in a State; or (B) Have general certification from one of the bodies determined by FDA to have procedures and requirements adequate to ensure that radiologic technologists certified by the body are competent to perform radiologic examinations (The FDA recognizes radiologic technologists certified by the following organizations: American Registry of Radiologic Technologists (ARRT) and American Registry of Clinical Radiography Technologists if the technologist is currently registered with the ARRT.); and (ii) Mammography requirements. Have, before April 28, 1999, qualified as a radiologic technologist under paragraph (a)(2) of this section of FDA’s interim regulations of December 21, 1993, or completed at least 40 contact hours of documented training specific to mammography under the supervision of a qualified instructor. The hours of documented training shall include, but not necessarily be limited to: (A) Training in breast anatomy and physiology, positioning and compression, quality assurance/quality control techniques, imaging of patients with breast implants.

(B) The performance of a minimum of 25 examinations under the direct supervision of an individual qualified under paragraph (a)(2) of this section (radiologic technologist); and (C) At least 8 hours of training in each mammography modality to be used by the technologist in performing mammography exams; and Under Texas law, Texas Occupations Code Chapter 601 governs medical radiologic technologists and specifically addresses the issues at hand. To perform a radiologic procedure in the state of Texas, one must hold a certificate such as the one issued by the ARRT. However, Subchapter D of Tex. Occ. Code 601 specifically lists exemptions from the certification and registration requirements. The exception is as follows: (1) Section 601.151 states that a person is not required to hold a certificate issued under this chapter to perform a radiologic procedure if the person is a practitioner and performs the procedure in the course and scope of the profession for which the person holds a license.

Because an interpreting radiologist qualifies as a practitioner under Tex. Occ. Code Section 601.002(7) and mammography examinations are within the scope of the profession, a radiologist does not need to hold a separate ARRT license to perform a mammography examination. Of note, Section 401.424 of the Texas Health & Safety Code does not require a certified radiologic technologist for a facility to receive accredi-

tation (like it does for a medical physicist).

Therefore, all signs indicate that a licensed radiologist can perform mammography examinations, such as a technician does, if they are also complying with federal law.

Thus, why would the Texas DSHS indicate that a radiologist cannot perform the examination that they have experience interpreting and, ironically, experience in teaching technicians how to perform?

Allowing radiologists to perform their own mammogram examinations provides the patient with a range of benefits, including continuity of care and one-on-one interaction with the interpreting physician. The 20-year high vacancy in tech positions only supports the need for these qualified radiologists to perform their own exams. By law, any medical doctor (internist, family practitioner,

14 | DALLAS MEDICAL JOURNAL • August 2024

cardiologist, orthopedic surgeon, ob-gyn, oncologist, and the list goes on) can perform a CT scan, bone density scan, fluoroscopy, or routine chest X-ray in their office and does not need an ARRT license, nor do they require a radiology residency. Yet DSHS has indicated that if a radiologist does not have an ARRT certification, she cannot perform their own mammograms. DMJ

References:

1. https:/ /www.asrt.org/main/news-publications/news/article/2023/05/08/ asrt-staffing-survey-shows-increase- inmedical-imaging-vacancy-rates-aligning-with-overall-health-care-professiontrends 2. Id.

DESIRE TO

SERVE

Dallas County Medical Society’s success is rooted in the physician leaders who selflessly give of their time and talents as volunteers to the organization. DCMS seeks physicians from all corners of practice to help advance organized medicine in Dallas County. Please consider volunteering for a term beginning January 2025.

ELECTED POSITIONS: DEADLINE TO APPLY IS SEPTEMBER 13, 2024.

BOARD OF DIRECTORS The elected DCMS Board of Directors is the governing body for the Society charged with overseeing the long-term planning and execution of the organization.

COMMUNICATIONS COMMITTEE Oversees communication strategies for DCMS and outreach to members, and provides feedback on communication tactics and tools for disseminating information to members.

COMMUNITY EMERGENCY RESPONSE COMMITTEE In a public health emergency, the DCMS CERC partners with the Dallas County HHS to engage medical volunteers to DCMS DELEGATION TO TMA HOUSE OF DELEGATES strengthen public health, improve emergency response, and Elected DCMS physician representatives join physicians from across Texas annually for the TMA House of Delegates; the policy- build community resiliency. making body for organized medicine in Texas.

DALLAS COUNTY MEDICAL SOCIETY PAC Committee members meet with local and state legislative NOMINATING COMMITTEE Members are elected to serve on this committee and are candidates to educate them about important issues in charged with identifying and slating candidates for elected medicine and make decisions regarding political contributions positions within DCMS, while also overseeing the elections to candidates. process.

WOMEN IN MEDICINE FORUM This forum focuses on issues and opportunities for women APPOINTED COMMITTEE POSITIONS: DEADLINE TO APPLY IS physicians in the areas of academia, private practice, health NOVEMBER 5, 2024. system employment, public health, and medical education.

LEGISLATIVE AFFAIRS STEERING COMMITTEE PHYSICIAN WELLNESS COMMITTEE Set out priorities for the legislative session. Members meet with Offers structure and support, as well as serving as an advocate, legislators and attend candidate and incumbent functions. for impaired physicians. The committee meets with physicians LEGISLATIVE AFFAIRS GRASSROOTS in recovery and helps them chart their path back to practice.

ADVOCACY SUBCOMMITTEE Members of this subcommittee contact state and federal AD HOC COMMITTEES / TASK FORCES representatives regarding legislation of interest to physicians, If you are not sure where you would like to serve, consider patients and organized medicine. adding your name to our list of Ad hoc committee volunteers.

These assignments are short-term projects that DCMS requests MEMBERSHIP COMMITTEE in response to a specific need.

Review and discuss DCMS member services and membership benefits, membership events, and recruitment and retention tactics.

APPLY TODAY:

SOCIOECONOMICS COMMITTEE This committee is divided into two Subcommittees: medical economics and small/solo practice. Based on the practice characteristics, needs, and challenges, the committees explore the role and relevance of physicians in an evolving healthcare landscape.

Apply for an Elected Position:

Apply for an Appointed Position:

CONTACT DCMS: (214) 948-3622 info@dallas-cms.org

www.dallas-cms.org August 2024 • DALLAS MEDICAL JOURNAL | 15

EDITORIAL

The Hard Truth About Medical School Debt

T

By Angela Pham, MD Candidate, Class of 2025, Texas A&M University College of Medicine

he same annoying icon announcing how severely full my computer storage is graces my screen yet again. Instead of diving headfirst into studying for my shelf exam, I spend the next 30 minutes finding random photos from ninth-grade formal and from biochemistry lectures in college to delete as I try to free up a fraction of a gigabyte of storage. What I used to think was a unique human experience turned out to be an annoyance that several of my classmates faced. While we desperately want and need more storage for our

experience.

As the future of medicine diversifies and welcomes students of diverse backgrounds, including socioeconomically, it is imperative to keep in mind the financial obstacles that these young professionals may face. According to the Education Data Initiative, the average debt from medical school alone was $202,453 in 2023 in the United States.1 When including undergraduate and other educational debts, this number jumped to $250,995.1 Approximately 73% of medical school graduates had some degree of debt from their education.1 With the extended

from private medical schools.1 Aside from tuition, students often pay out-of-pocket for study materials and registration for standardized tests, such as the Medical College Admission Test and their board exams, and for medical school and residency applications. On top of the grueling demands that pursuing a career in medicine can have, these growing costs can be the final weights of the growing pressures to be successful.

Accumulating debt can greatly impact students’ lives for years or even decades, and students must be aware of these

laptops, we avoid the unnecessary costs of paying for additional space or a new computer altogether. I remember feeling so frustrated during these moments. Despite how desperate I was to start learning a new lecture and download the PowerPoint slides to go with it, especially with the time constraints of medical school, I could not afford to do so with the limited money delegated for miscellaneous expenses. As a medical student who grew up in a lowincome household whose parents worked as nail technicians, I often forget that delaying registration for a $700 board exam and hoarding free snacks from events are everyday habits that are not a universal

time and schooling necessary to become a doctor, a medical school graduate has on average of more than six times as much debt as a college graduate.1 What exactly is the cause of these astronomical numbers? The most significant contributor and the most often-cited reason for these costs is the tuition.2 Aside from a handful of programs that offer their students a tuition-free education, such as New York University Grossman School of Medicine, applicants must consider factors such as location, in- or out-of-state status, and whether the medical school is public or private. Graduates from public medical schools owe about $15,000 less than those

potential effects throughout their educational journeys. The most obvious and often lasting impact is on students’ mental health.

The burden of carrying tens or hundreds of thousands of dollars in debt can be terrifying, no matter how much rationalization and logic is used to justify the costs with the anticipation of a high return on investment.

The feelings of anxiety and stress, which are expected for any medical student, can intensify for those who must take on debt to afford their education. With nearly half of medical students experiencing burnout during school, there appears to be an increased likelihood of suicidal ideation in students with higher amounts of debt.3

16 | DALLAS MEDICAL JOURNAL • August 2024

The same an-

As circumstances, and even desires, change throughout medical school, the fear of being unable to pay off the debt is often a significant reason to finish the degree rather than pivoting to a different career. Additionally, the presence of significant debt may influence a future physician’s career choice—whether they pursue primary care or specialize in higher-paying fields, whether they practice in a county hospital with underserved patients or in private practice, or whether they settle in a rural area with fewer physicians or in a city with a higher saturation of doctors.4 Lastly, students may be offered federal loans that do not adequately cover their cost of living for a variety of reasons.5 They may turn to private loans, which often have higher interest rates, if they qualify for them to afford their daily living during school.5 On the other hand, students may find themselves in vulnerable positions, such as facing food insecurity.6,7 While these individual sacrifices may appear minute, they can culminate in a drastic hit to a medical student's quality of life.

For medical students and recent graduates who are feeling the weight of these loans— remind yourself to take a deep breath and recognize that this is an investment in yourself.

Just like others may buy into stocks or purchase homes to rent to others, you are using whatever amount of money you can to ensure a quality medical education that will result in a career with promising returns. Understandably, however, these words alone rarely appease anxieties regarding debt. Instead, let us review some tips for what to do next. First and foremost, budgeting is essential. Learning what is a necessity versus what is a fun treat will help prioritize essentials in the context of minimizing the amount of debt to take on. Although it may be difficult to shuffle responsibilities, some medical students may also look to side gigs to help with minor expenses. This may look like tutoring programs that will allow students to refresh their own knowledge while earning

money.

Additionally, evaluating whether residency programs allow moonlighting can also be important. Although it may be difficult with an already arduous workload, depending on the specialty and hospital system, anywhere between 10% and 50% of residents have been reported to moonlight to help with debt repayment.8 Many medical schools have employed financial advisors who are knowledgeable about financial planning in the specific context of hefty loans and resident and, later, attending salaries. Consulting these experts may help with creating a strategy for paying off these debts. It is important to take the time to truly understand the various loan repayment plans and which option will be best suited for your individual circumstances, whether that is the income-driven repayment plan or graduated repayment plan. Additionally, if your interests and values align, exploring the loan forgiveness programs available may be of great reward. This includes the Public Service Loan Forgiveness (PSLF) and the National Health Service Corps (NHSC) programs.9 Students try their best to mitigate the cost of their medical education, the Association of American Medical Colleges (AAMC) is also striving to reduce the financial challenges for students. For the first time, the AAMC Fee Assistance Program will give a 60% discount on Electronic Residency Application Service (ERAS) applications to up to fifty students in the 2024–25 cycle who qualified for the Fee Assistance Program while applying to medical school.10 While this is just one step, it is still in the direction of reducing the financial burden for particularly vulnerable future physicians.

Lastly, be kind to yourself—if that $6 latte brings you enough joy to get you through the long day, then go for it. As contradictory as that might sound, self-care is also a form of investing in yourself that will only help ensure you are well enough to practice medicine in a way that is safe and efficient. DMJ

References

1. Hanson M. Average Medical School Debt.

EducationData.org2023.

2. Hussain K. How Much Does It Cost to Attend Medical School? Here’s a Breakdown. students-residents.AAMC.org: AAMC Students & Residents.

3. Dyrbye LN, Thomas MR, Massie FS, et al.

Burnout and suicidal ideation among US medical students. Annals of internal medicine.

2008;149(5):334-341.

4. Rosenblatt RA, Andrilla CHA. The impact of US medical students’ debt on their choice of primary care careers: an analysis of data from the 2002 medical school graduation questionnaire. Academic Medicine. 2005;80(9):815-819.

5. 7 Options if You Didn’t Receive Enough Financial Aid. studentaid.gov: Federal Student Aid. 6. Thorman A, Dhillon H. No food for thought: documenting the prevalence of food insecurity among medical students at one Western University. Journal of hunger & environmental nutrition. 2021;16(5):643-649.

7. DeMunter J, Rdesinski R, Vintro A, Carney PA. Food insecurity among students in six health professions’ training programs. Journal of Student Affairs Research and Practice.

2021;58(4):372-387.

8. Lin CC, Semelsberger S, Al Saeed A, Weiss J, Navarro RA, Gianakos AL. Perception of Debt During Resident Education—A Systematic Review. The Permanente Journal. 2023;27(3):99.

9. and UDoH. NHSC Loan Repayment Program.

US Department of Health and Human Services Health Resources and Services Administration. https:/ /nhsc.hrsa.gov/loan-repayment/nhscloan-repayment-program 10. AAMC Fee Assistance Program Expanding with 60% ERAS Application Discount. Association of American Medical Colleges. https:/ / students-residents.aamc.org/fee-assistanceprogram/aamc-fee-assistance-programexpanding-60-eras-application-discount

August 2024 • DALLAS MEDICAL JOURNAL | 17

18 | DALLAS MEDICAL JOURNAL • August 2024

M O N E Y M AT T E R S

Investing in Residential Real Estate: A Path to Financial Freedom for Medical Doctors in Dallas

By Monty Felts, Originating Branch Manager, CrossCountry Mortgage, LLC

A

s medical doctors, your careers are often characterized by long hours, demanding work, and the gratifying sense of saving lives. However, the financial rewards of your profession, while substantial, can be further enhanced through strategic investments. One of the most promising avenues for wealth building is investing in residential real estate, particularly in a vibrant and growing market like Dallas, Texas.

The Dallas Real Estate Market: A Prime Opportunity

Dallas, Texas, is one of the fastestgrowing cities in the United States, boasting a robust economy, a diverse population, and a high quality of life. The city’s real estate market is particularly appealing due to its strong appreciation rates, steady rental demand, and favorable investment climate. For medical doctors looking to diversify their incomes and build wealth, the Dallas residential real estate market presents a compelling opportunity.

The Benefits of Real Estate Investment for Doctors

1. Passive Income: Real estate investments can provide a steady stream of passive income, allowing you to earn money without actively working for it. This can be especially beneficial for doctors who want to secure their financial future while focusing on their medical practice.

2. Tax Advantages: Real estate investments come with numerous tax benefits, including deductions for mortgage interest, property taxes, and depreciation. These can significantly reduce your taxable income and increase your overall return on investment.

3. Appreciation: Properties in growing markets like Dallas appreciate over time, offering substantial capital gains. This leads to significant wealth accumulation as property values increase.

4. Leverage: Real estate allows you to use leverage to maximize your investment. By securing a mortgage, you can control a large asset with a relatively small initial investment, amplifying your potential returns.

The Role of A Creative and Driven Loan Officer

To fully capitalize on the benefits of real estate investment, it’s crucial to partner with a creative and driven loan officer. They can help you navigate the complexities of financing and identify the best loan products to meet your investment goals. A skilled loan officer will understand the unique financial situation of medical doctors, offering tailored solutions that maximize your borrowing power while minimizing risk.

For example, some lenders offer specialized loan programs for medical professionals, including higher loan-to-value ratios, lower down payment requirements, and more favorable interest rates.

A knowledgeable loan officer will guide you through these options, ensuring you secure the most advantageous financing for your investments.

Partnering With A Top-Tier Realtor

Just as medical doctors undergo extensive and rigorous training to excel in their field, the best realtors invest heavily in their education and development.

Partnering with a realtor who has undergone extensive and expensive training from the nation’s wealthiest and most successful realtors can make a significant difference in your real estate investment journey.

A top-tier realtor brings invaluable expertise, market knowledge, and negotiation skills to the table. They can identify high-potential properties, provide insights into market trends, and help you make informed investment decisions.

Their advanced training ensures they are equipped with the latest strategies and tools to maximize your investment returns.

Why The Team Matters

Combining the expertise of a driven loan officer and a highly trained realtor creates a powerful synergy that can dramatically enhance your investment outcomes. The loan officer ensures you have the optimal financial structure in place, while the realtor leverages their market acumen to identify and secure the best properties.

Conclusion: Your Path to Financial Freedom

Investing in residential real estate in the Dallas market offers medical doctors a lucrative path to financial freedom.

By partnering with experts in mortgage and real estate, you can navigate the complexities of the market with confidence and maximize your returns. Just as you have dedicated years to becoming a leader in your medical field, aligning with experts in the field of real estate will help you achieve excellence in your investment endeavors.

As you consider diversifying your income and building long-term wealth, remember that real estate investment is not just about purchasing properties—it’s about making strategic decisions that align with your financial goals. With the right team by your side, your real estate investment journey in Dallas can be both profitable and rewarding. DMJ This article if for informational purposes only. The views and opinions expressed in this article are those of the author and are not necessarily the official position of Dallas County Medical Society (DCMS).

DCMS does not endorse or assume any responsibility for the accuracy or completeness of the information contained in this article. Readers are encouraged to conduct their own research and seek professional advice before making any investment decisions.

August 2024 • DALLAS MEDICAL JOURNAL | 19

SPONSORED

TMA Members: New $5,000 Monthly Disability Benefit Now Available TMA Insurance Trust

S

tarting now, TMA members can apply for a long-term disability monthly benefit of up to $5,000 without verifying their incomes or submitting any financial information.

Imagine dedicating years of your life to education and refining your medical expertise only to face a sudden health setback that prevents you from practicing. The financial consequences may be as daunting as the health challenges themselves. Unfortunately, confronting the fear of the unknown is a reality even the most resilient physicians must face. Thankfully, TMA Insurance Trust has introduced a new benefit to the TMA Member Long Term Disability Insurance Plan, issued by The Prudential Insurance Company of America, providing you with a reliable financial safeguard during times of uncertainty.

•

• •

•

•

New $5,000 Monthly Benefit for TMA Members Explained TMA Insurance Trust recognizes that your professional skills and ability to work are the foundation of your family’s financial well-being. That’s why, effective immediately, we have increased the amount of our long-term disability coverage to $5,000 per month, which TMA members can apply for without the need for income verification (additional coverage is available with additional underwriting). This streamlined approach simplifies access to essential insurance income protection and helps ensure you can secure the necessary financial support swiftly.

Why Is Long-Term Disability Insurance Essential for Physicians?

Long-term disability insurance is vital for replacing a portion of your income if you cannot work due to a prolonged illness or injury. While many physicians rely on employer-provided plans, these often fall short of covering the full extent of your financial needs. The TMA Member Long Term Disability Insurance Plan stands out from other disability policies because it includes benefits that are usually costly add-ons, offering significant added value such as: • Own Occupation Coverage: You will receive benefits if you cannot perform the duties specific to your

•

•

•

medical specialty, ensuring that your specialized skills are protected.

Partial/Residual Benefit: This feature provides financial support if you’re able to work only part time, helping your income remain stable during recovery.

No Offsets: You receive benefits regardless of other insurance payouts, maximizing your financial security.

Catastrophic Coverage: This coverage automatically increases your benefit by 20% if you cannot perform two or more activities of daily living (ADLs), offering additional support when needed most.

Future Increase Option: This option allows you to boost your coverage as your income grows without further underwriting, enabling you to adapt to your evolving financial needs.

Student Loan Reimbursement: This provision adds 25% to your benefits (up to $250,000) to help manage your education loans, relieving the debt burden during tough times.

25% Savings Credit: This credit reduces your premium payments, potentially saving you thousands over the life of your policy and making coverage more affordable.

Affordable Premium Rates: Premiums are tailored to fit your budget, offering comprehensive coverage without financial strain.

Simplified Underwriting: The simplified process eliminates the need for income verification, making obtaining coverage easier.

The TMA Member Long Term Disability Insurance Plan is an ideal solution for young physicians seeking an affordable option that allows for coverage growth as their incomes increase. It also serves as a practical choice for active physicians looking to boost their existing coverage while keeping budget needs in mind.

A Legacy of Trust and Reliability

The TMA Member Long Term Disability Insurance Plan was launched in 1969 and has consistently demonstrated its reliability and trustworthiness. Over the decades, it has never canceled or nonrenewed a covered member, highlighting a steadfast commitment to providing Texas physicians unwavering support and valuable insurance income protection.

20 | DALLAS MEDICAL JOURNAL • August 2024

Now is the time to take advantage of our new long-term disability plan benefit, available only to TMA members. To speak directly with a TMA Insurance Trust advisor for a disability insurance consultation, call 800-880-8181, Monday through Friday, 8:00 AM to 5:00 PM CST. We can help you preserve the financial stability you’ve built in your medical career with the insurance income protection that long-term disability insurance provides. DMJ

For over 65 years, TMA Insurance Trust advisors have been serving Texas physicians, their families, and their staff. TMA Insurance Trust prides itself on offering unbiased information and strategies to members, along with exclusive group rates on a range of the highest-rated plans in the industry.

TMA Member Long-Term Disability and Short-Term Disability coverages are issued by The Prudential Insurance Company of America, a Prudential Financial company, Newark, NJ. The Booklet-Certificate contains all details, including any policy exclusions, limitations, and restrictions that may apply. Contract Series: 83500.1081655-00001-00

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Dallas County Medical Society (DCMS) does not endorse or evaluate advertised products, services, or companies nor any of the claims made by advertisers.

Claims made by any advertiser or by any company advertising in the Dallas Medical Journal do not constitute legal or other professional advice. You should consult your professional advisor.

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Sleep Medicine Rajiv M. Joseph, MD Board Certified in Neurology & Sleep (Since 1997)

Phone: (972) 712-4141 • Fax: (972) 712-4555 www.MD4SLEEP.com (for online referral) 7920 Preston Road, Ste. 100 Plano, TX 75024 August 2024 • DALLAS MEDICAL JOURNAL | 23

Skytale Group is a leading management consulting firm and investment bank offering a range of strategic and financial advisory services to healthcare businesses nationwide. Skytale Management Consulting provides services centered on evidenced-based strategies for growing healthcare organizations, while Skytale Investment Banking consists of licensed investment bankers who have extensive experience in mergers and acquisitions and private capital advisory capabilities within healthcare. Together, we are committed to helping growth-minded business owners in the healthcare industry by equipping them with the advice, information, and perspectives needed to achieve lasting value.

Founded in 2018 and headquartered in Dallas, Texas, Skytale

Group has a national presence providing guidance and perspective to clients across multiple healthcare specialties. At Skytale, we treat our clients’ businesses like they’re our own, and we are dedicated to becoming a trusted partner by delivering tailored solutions designed to grow, scale, or sell your business.

Our team of financial professionals and C-level executives have decades of hands-on, industry experience and are equipped to take your business to the next level. Using the intersection of business intelligence and your personal goals, our team can help guide your business to meet your vision.

For more information, visit skytalegroup.com.

Huntington Bancshares Incorporated is a regional bank holding company headquartered in Columbus, Ohio, with $196 billion in assets. Founded in 1866, The Huntington National Bank and its affiliates provide consumers, small- and middle-market businesses, corporations, municipalities, and other organizations with a comprehensive suite of banking, payments, wealth management, and risk management products and services. Huntington operates approximately 970 branches in 11 states, with certain businesses operating in extended geographies.

Huntington Bank is proud to be the #1 SBA lender in the nation for the past six years by number of loans closed. With a proven track record of helping business owners get the capital they need to open, acquire, or expand a business through an SBA loan program, you’ll have an experienced lender to help you through each stage of the process.

Huntington is committed to doing the right thing for customers, colleagues, shareholders, and communities in order to: • Provide competitive products and services and deliver a superior customer experience, always striving to earn the trust of our customers.

• Equip colleagues to be the best at looking out for customers, continuously improving the workplace and ensuring

Huntington’s ongoing success.

• Contribute to the economic strength of local communities by investing in business growth and partnering and volunteering to make a difference where we live and work.

• Up to 100% financing for medical start-ups, owner-occupied real estate, equipment financing, and acquisition financing.

Jeremiah “JJ” Johnson is the Vice President of SBA Medical Financing for Huntington National Bank and is located in Dallas, Texas. With over 14 years of experience in healthcare financing, JJ would be honored to discuss all the capabilities that SBA financing can bring to your practice. †SBA loans subject to SBA eligibility. Huntington is #1 in the nation in the number of SBA 7(a) loans from October 1, 2017, to September 30, 2023. Huntington was the #1 SBA 7(a) lender in the region made up of Illinois, Indiana, Kentucky, Ohio, Michigan, West Virginia, and Western Pennsylvania from October 1, 2008, to September 30, 2021, and the region made up of Illinois, Indiana, Kentucky, Ohio, Michigan, West Virginia, Pennsylvania, Minnesota, Colorado, and Wisconsin from October 1, 2021, to September 30, 2023. Source: U.S. Small Business Administration (SBA).

Loans subject to credit application and approval.

24 | DALLAS MEDICAL JOURNAL • August 2024

Protecting your income is worth a conversation

Have you thought about what would happen if you could not practice due to a serious illness or injury?

Our advisors have been helping Texas physicians protect their incomes for generations.

When was the last time you talked with an advisor about how you can protect your income?

And their guidance is provided at no cost. They receive no sales-based commissions so you can be assured that their advice and recommendations are provided without bias or obligation.

It may be time to have that conversation.

Start a conversation by calling toll-free 800-880-8181 Monday to Friday, 8:00AM to 5:00PM. It will be our privilege to serve you.

Dementia CME for Primary Care Providers

Help your patient and their family make the best-informed decisions.

Earn free online Continuing Medical Education (CME) credits developed by the Texas Department of State Health Services and physician experts on Alzheimer’s disease and related dementias. These courses will keep you up to date on the latest validated assessment and screening tools, help you direct patients to community resources, and reinforce your role in helping patients and their families manage symptoms throughout the disease process.

Courses coming soon at dshs.texas.gov/alzheimers-disease/provider