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JULY 2026 | DALLAS COUNTY MEDICAL SOCIETY

NAVIGATING THE NEXT CHAPTER A Physician’s Guide to Taking a Hands-Off Approach to Identity, Purpose, and Financial Confidence

INCLUDES THE PHYSICIAN BEYOND THE WHITE COAT: RECLAIMING IDENTITY AT THE THRESHOLD OF RETIREMENT THE PHYSICIAN’S RETIREMENT ROADMAP

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JULY 2026

Vol. 112 No. 07

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

Stephanie Jennings DESIGNED BY Morganne Stewart

ADVERTISING DCMS Business Development COMMUNICATIONS COMMITTEE Ravindra Mohan Bharadwaj, MD, Chair Sumana Gangi, MD Jawahar Jagarapu, MD Dylan Jacob Kruse Ravina R. Linenfelser, DO Sina Najafi, DO Erin D. Roe, MD, MBA Katelyn Williams, MD BOARD OF DIRECTORS Gates B. Colbert, MD, President Vijay V. Giridhar, MD, President-elect

Sheila Chhutani, MD, Secretary/Treasurer Shaina M. Drummond, MD, Immediate Past President

HOUSE CALL

Kimulique Harkley Allen, MD

Carrying Purpose Forward

Justin M. Bishop, MD Max I. Galvan, MD Nazish Saeed Islahi, MD

IN EVERY ISSUE

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Riva Louise Rahl, MD Thomas Schlieve, 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

H E A LT H & W E L L N E S S

The Physician Beyond the White Coat

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company advertising in the Dallas Medical Journal do not constitute legal or other professional advice. You should consult your professional advisor. ©2026 DCMS. According to Tex. Gov’t. Code Ann. 305.027, all articles in Dallas Medical

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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 75208-0680. Periodicals postage paid at Dallas, TX 75260 and additional post offices.

July 2026

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Physician’s 22 The Retirement Roadmap

DALLAS MEDICAL JOURNAL | 1

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PRESIDENT’S PAGE

Physician Advocacy in the Face of Medicare Cuts Gates B. Colbert, MD 2026 President, Dallas County Medical Society THE SUMMER OF 2026 HAS BEEN NOTHING SHORT of remarkable in DFW. The city came alive as the FIFA World Cup brought nine thrilling matches to “Dallas Stadium,” drawing together friends, neighbors, and communities in celebration. Unusually, the relentless Texas heat held off; temperatures didn’t reach 100 degrees until late July, a welcome reprieve for those of us less fond of sweltering days. The quieter highways and restaurants suggested that many residents took the opportunity to travel, enjoy a well-deserved vacation, or visit family. As these summer joys fade, we once again face the familiar, and frustrating, announcement from our perennial “employer,” the Centers for Medicare & Medicaid Services: another reduction in physician compensation, offered as a dubious reward for a year of dedication and service. In mid-July, CMS issued its latest announcement under the Medicare Access and CHIP Reauthorization Act (MACRA): for CY2027, conversion factors will see statutory updates of +0.75% for qualifying Alternative Payment Model (APM) participants and +0.25% for non-qualifying participants, along with an estimated 0.53% adjustment for changes in work relative value units (RVUs). Beneath this formal and opaque language lies a sobering reality: the proposed CY2027 qualifying APM conversion factor of $33.17 reflects a projected decrease of $0.40 (–1.19%) from the current $33.57, while the non-qualifying APM factor drops by $0.56 (–1.68%) to $32.84. In announcing these changes, CMS Administrator Mehmet Oz, M.D., proclaimed, “We’re proposing some of the most significant Medicare reforms in recent years to strengthen primary care, expand accountable care, and modernize physician payment. These changes would make it easier for clinicians to focus on prevention, improve coordination for patients, and ensure Medicare rewards better outcomes rather than more services.” Almost immediately, leaders in organized medicine recognized the urgent need to increase our ongoing advocacy efforts on behalf of ourselves and our patients. Reduced physician reimbursement ripples through the entire healthcare system: diminished revenue jeopardizes the ability to cover overhead, support staff salaries, manJuly 2026

age insurance costs, and invest in essential technology. These are all essential elements needed to serve our patients. The resulting strain compresses the care physicians can provide, leading to longer wait times and diminished access for patients. As a member of DCMS, and by extension, the Texas Medical Association, you possess a vital voice in resisting these cuts, which target physician payments while leaving hospitals and other providers untouched. Our most pragmatic and reasonable request to Congress remains clear: implement permanent Medicare payment reform, with predictable updates linked to the Medicare Economic Index (MEI). Only such reform can halt the cycle of annual, destabilizing cuts and provide the stability our practices and our patients deserve. Throughout the latter half of 2026, DCMS physicians will engage with local, state, and national elected officials to advocate on your behalf. Our mission is twofold: to educate policymakers about the realities physicians face and to illuminate how these challenges directly affect patient care. Every individual deserves access to skilled medical professionals and a robust healthcare system, one that is not held hostage by political maneuvering. If you’re inspired to join these efforts, consider participating in the DCMS Legislative Committee or supporting the DCMS-PAC. We need compelling voices to share the realities of practicing medicine and navigating the complexities of insurance. While our physician membership is sizable, our collective influence grows exponentially when we speak with one unified message. As external interests continue to vie for their share of the healthcare landscape, our resolve and experience are essential to advancing the interests of both physicians and patients. Regardless of political affiliation, these healthcare policies touch all of us. The strength of our profession lies in a bipartisan, unified physician voice, one that lifts the entire system. I look forward to welcoming you to our advocacy efforts beginning in 2026 and continuing through our state legislative session in 2027. And if these developments have you contemplating retirement, there’s good news: this edition of the DMJ explores the path to a rewarding and well-earned next chapter. DMJ DALLAS MEDICAL JOURNAL | 3

EVP / CEO LETTER

The Last Patient, and the First Tuesday Morning Jon R. Roth, MS, CAE, Managing Editor

OVER THE YEARS, I HAVE LISTENED TO MANY conversations among members of the Dallas County Medical Society (DCMS) about the end of their practices. They almost always start with numbers. Valuation multiples. Deferred compensation. When to claim Social Security. How much runway the retirement account actually buys. The numbers matter. But the conversation rarely stays there. Sooner or later, somebody sets down the coffee and asks a quieter question: what am I going to do on Tuesday morning? That question is the real subject of this month’s issue. Financial planning is the dimension of retirement that the profession handles best, because it resembles other technical problems physicians are trained to solve. There are plenty of resources, such as financial planning professionals, to help. What follows the last day of practice, though, is not primarily a technical problem, and treating it as one is where preparation most often fails. The evidence bears this out. A systematic review by Silver and colleagues in Human Resources for Health found that physicians retire later than workers in nearly every other field, that many delay out of attachment to professional 4 | DALLAS MEDICAL JOURNAL

identity rather than financial necessity, and that unplanned exits carry real consequences for patients and health systems. The authors’ recommendations to institutions were notably not about money. They urged mentorship, education offered across a career rather than at its end, and post-retirement roles that preserve institutional ties through teaching and peer support. Dallas has strong models for exactly that. Craig D. Rubin, MD, joined the UT Southwestern faculty in 1985 and retired at the end of 2025 after a distinguished 40-year career. He served as the inaugural chief of the Division of Geriatric Medicine, leading its growth from three full-time faculty members to a nationally recognized program. Under his leadership, UT Southwestern developed the Care of the Vulnerable Elderly (COVE) house-call program, the Acute Care for Elders (ACE) unit, and the Perioperative Optimization of Senior Health (POSH) program in partnership with Surgery and Anesthesiology. He established the Geriatric Medicine Fellowship in 2000 and launched the Medicine-Geriatrics Residency pathway in 2022, the only program of its kind in Texas. Read that list again and notice what it actually is: a career spent building things designed to keep running without him. A physician who spent four decades studying how people age arranged his own departure as a July 2026

EVP / CEO LETTER

RESOURCES FOR THE ROAD AHEAD Texas Medical Board: Licensure Cancellation or Retirement Options for Physicians. Compares Retired, Emeritus Retired, and Voluntary Charity Care status. https://www.tmb. texas.gov Texas Medical Association: Resources for retired physicians, the 50-Year Club, practice closure, record retention, and charitable immunity guidance. texmed.org American Medical Association: Senior Physicians Section and Retire and Stay Active Within the Medical Community. https://www.ama-assn.org Silver MP, Hamilton AD, Biswas A, Warrick NI. A Systematic Review of Physician Retirement Planning. Human Resources for Health. 2016;14:67. Silver MP, Hamilton AD, Biswas A, Williams SA. Life After Medicine: A Systematic Review of Studies of Physicians’ Adjustment to Retirement. Archives of Community Medicine & Public Health. 2016;2(1):1-7. Stone MJ. When to Act and When to Refrain: A Lifetime of Learning the Science and Art of Medicine. A Dallas physician’s account of a career in medicine and life after active practice. The White Coat Investor (https://www. whitecoatinvestor.com). Physician-focused financial education and retirement planning resources; not a substitute for individualized fiduciary financial advice.

July 2026

handoff rather than a subtraction. That is not sentiment. It is succession planning, and it may be the most underrated form of retirement preparation in medicine. Marvin J. Stone, MD, offers the other half of the picture. He founded the Charles A. Sammons Cancer Center at Baylor University Medical Center in 1976 and directed it for thirty-two years, teaching students, residents, and fellows for more than forty. When he stepped back from clinical work, he did not stop. He served as president of the American Osler Society, taught medical humanities as a clinical professor at the University of Texas at Dallas, and wrote a memoir, When to Act and When to Refrain: A Lifetime of Learning the Science and Art of Medicine. Although he left active practice, he remained deeply engaged in teaching, medical history, and the enduring humanistic ideals that had shaped his career. That is the useful lesson. Retirement seldom goes well when it is framed as subtraction. It goes well when something specific is waiting on the other side. The physical dimension gets less attention than it deserves. Decades of call, irregular sleep, and deferred appointments leave a mark, and many physicians arrive at the end of practice having managed everyone’s health but their own. The first years afterward are when that debt comes due, and also when habits are most easily rebuilt. Establishing care with a primary care physician one does not know professionally, catching up on lapsed screenings, and building movement into a suddenly unstructured week are not soft suggestions. They are the difference between a long retirement and a brief one. Emotionally, the hardest losses tend to be the ones nobody warns about. The loss of a team. The loss of being needed at three in the morning. The loss of a title that answered the question of who one is before the question had to be asked. Spouses and partners face an adjustment of their own, often on a different timeline. Physicians who talk this through in advance with family, with peers, sometimes with a counselor, generally fare better than those who plan finances carefully and improvise the rest. On the practical side, the Texas Medical Board maintains three retirement pathways, and the differences matter. Retired and Emeritus Retired status end clinical practice entirely. Voluntary Charity Care status keeps a license active for uncompensated care for indigent or underserved populations, with a reduced continuing education requirement. Anyone hop-

ing to keep a hand in should understand those options before a biennial registration deadline forces the choice. The Texas Medical Association offers guidance on closing a practice, record retention, and charitable immunity, along with its 50-Year Club. Nationally, the American Medical Association’s Senior Physicians Section convenes physicians sixty-five and older, active and retired alike, and advocates on their behalf. For reading, the Silver Review is worth an hour, as is the AMA’s guidance on staying active in the medical community after practice. For financial groundwork, peer-oriented resources such as The White Coat Investor are a reasonable starting point. However, no website replaces a fiduciary advisor who understands practice structures and Texas law. DCMS has a part to play here, and it is not a passive one. This society represents more than 9,000 physicians, residents, and medical students, spanning the full arc of a career under one roof. Retired members are among the best positioned to teach at DCMS Foundation programs, to serve through the Dallas County Medical Reserve Corps when this community needs surge capacity, and to mentor the young physicians who will inherit Dallas medicine. The house of medicine has never had a surplus of people who know how the work is actually done. There is an old habit among Texas ranchers of planting live oaks they will never sit under. The trees take decades to mature. The person holding the shovel knows exactly who the shade is for, and plants anyway. That is not a melancholy arrangement. It is about the most confident thing a person can do with a season of life. The end of practice is not the end of a physician’s usefulness to this community. It is a change in the kind of shade being offered. To every DCMS member weighing that transition: the profession is not finished with you, and there is good work to be done from the porch. DMJ

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

DALLAS MEDICAL JOURNAL | 5

HEALTH AND WELLNESS

The Physician Beyond the White Coat: Reclaiming Identity at the Threshold of Retirement by Stephanie Byerly, MD

EDICAL TRAINING DOES SOMETHING extraordinary and something costly at the same time. From the moment we received our first acceptance letter, we were asked to fuse our identity with our function. We didn’t just learn medicine; we became medicine. Every long call night, every board exam, every year we deferred family, hobbies, friendships, and rest in service of mastery, cemented an unspoken equation: Worth equals Competence equals Identity. For decades, that equation serves us well. It gets us through residency. It keeps us sharp during codes. It makes us the person a frightened family trusts in their worst hour. But an equation built for survival in training was never designed to be a permanent architecture for a whole human life, especially not for the chapter that comes after active practice winds down. This is the barrier few of us are prepared for: when retirement removes the “competence” variable from daily use, many physicians experience something that looks and feels remarkably like grief. Not because they miss the paperwork or the pager. Because an entire self, built brick by brick over thirty or forty years, suddenly has no walls holding it up. This is not a personal failing. It is the predictable result of a training culture that rewards total identity fusion and offers al-

6 | DALLAS MEDICAL JOURNAL

most no scaffolding for identity separation later. This article is written not as one physician’s personal story, but as an invitation to every colleague standing at this threshold, whether that threshold is retirement itself, a slowing of practice, or simply a quiet moment where you’ve caught yourself wondering: who am I, if not “doctor”? This article is for you. THE CALLING BENEATH THE CALLING Before we can understand why letting go of the physician identity feels so destabilizing, it helps to look honestly at what drew so many of us to this profession in the first place. For a striking number of physicians, the pull toward medicine did not begin with a science fair project or a family legacy. It began earlier and quieter than that, often in childhood experiences marked by instability, neglect, illness, or trauma. Many of us, as children, watched physicians move through our lives, or the lives of someone we loved, as figures of extraordinary steadiness and care. They arrived in crisis and brought calm. They noticed pain and responded to it. They embodied a kind of attentive, competent nurturing that we may not have reliably received at home. Somewhere in that observation, we often made a quiet vow: I will become the person who shows up. I will become the noble caregiver I needed and did not have. July 2026

HEALTH AND WELLNESS

This is not a flaw in our origin story. It is, in many ways, the deepest source of the compassion so many of us bring to the bedside. But it also means that for a significant number of physicians, medicine was never simply a career choice. It was an unconscious attempt to give to others the care we ourselves once lacked, and, in doing so, to finally feel safe, needed, and worthy of belonging. This matters enormously at the threshold of retirement, because it reveals what is truly at stake when the title falls away. If the identity of “physician” was quietly built, in part, to answer a childhood wound, to prove we were capable of the care and attention we once went without, then retirement does not just end a career. It can feel, at an unconscious level, like the loss of the very evidence we had gathered that we were worthy of love and belonging in the first place. Naming this openly is not an indictment of anyone’s motivations for entering medicine. It is, instead, an invitation to healing. The care you gave so many patients over the decades was real, and it mattered. But your worth was never actually created by giving that care. It was there all along, long before medicine, long before the wound that first sent you looking for it in a white coat. Recognizing this distinction is often the single most liberating realization available to a physician approaching this chapter. WHEN THE ORIGIN STORY WAS NEVER EXAMINED Not every physician has had the opportunity, or the invitation, to look back and connect these dots. Many of us moved directly from a difficult childhood into the all-consuming demands of pre-med, medical school, residency, and practice, with barely a pause long enough to ask why we chose this path in the first place. The work was constant, the need was real, and the question of origin simply never rose to the surface. For those colleagues, retirement can carry an additional, often invisible, layer of difficulty. When the childhood wound beneath the calling has never been named or processed, the physician identity is not simply a role to be retired. It is, unconsciously, the very structure that has been holding a much older story together. In that case, the approach of retirement does not only raise the ordinary question of “what will I do now?” It can quietly July 2026

reawaken a far earlier and more painful question: “If I am no longer the one who cares for everyone else, will I still be worthy of care myself ?” This is often felt as a vague, hardto-name dread rather than a clear thought. This heaviness shows up as irritability, sleeplessness, or a strange reluctance to set a retirement date at all, even when every practical circumstance says the time is right. Physicians in this position may also find themselves gripping the identity more tightly rather than releasing it gracefully. They may take on extra call, delay retirement year after year, or immediately fill any newly available time with more clinical or administrative work, almost as if slowing down were dangerous. It is often not laziness or a lack of planning that is being avoided in these cases. It is the unprocessed fear that, without the role, the old childhood belief that one must earn love and safety through relentless caregiving will finally have nowhere left to hide. For physicians in this situation, the invitation is not to judge the pattern but to finally get curious about it. Understanding that an early wound may have seeded the drive toward medicine does not diminish a single moment of excellent, compassionate care given over a career. It simply means that healing that earlier wound, rather than only planning the practical logistics of retirement, may be the real work available now. This is precisely the kind of identity-level work that finance planners, retirement seminars, and even wellmeaning colleagues rarely address. It is also the kind of work that can transform retirement from something merely survived into something that finally feels like freedom. THE IDENTITY WE WERE NEVER WARNED ABOUT Physicians are trained extensively in diagnosis, procedures, and patient management. We are rarely trained in the psychology of our own professional identity, how it forms, what it costs, and what happens when it is no longer reinforced daily by scrubs, rounds, and referrals. Consider how thoroughly medicine occupies the architecture of a life. Residency alone often consumes the years many peers spend building outside identities, hobbies, and relationships. By the time training ends, the habit of defining oneself almost entirely through clinical competence is deeply grooved. It is reinforced further by every year

of practice: the trust patients place in us, the deference colleagues extend, the quiet certainty of walking into a room and knowing exactly what our role is and why we matter there. That certainty is a gift during active practice. It becomes a liability at the threshold of retirement, when the very thing that gave us our clearest sense of self is the thing being asked to recede. Compounding this, medicine as a culture rarely models healthy transition. We train new physicians meticulously. We rarely, if ever, train retiring ones. There is no residency for release, no fellowship in letting go. Colleagues who spent decades mastering complexity are often left to navigate one of the most complex psychological transitions of their lives with no framework at all. They are expected to know how to do it, just as they were once expected to simply know how to carry the weight of the profession itself. THE SACRIFICES WE RARELY NAME OUT LOUD If we are honest about the sacrifices we have made, and medical journals rarely ask us to be, most physicians made a long, quiet list of trades to become who they are. Few ever stopped to itemize them. It is worth naming some of what is so often sacrificed, sometimes invisibly, along the way: Time with our own children, exchanged for time in call rooms and clinics. Many physicians can recite exactly how many recitals, games, or bedtimes they missed, and carry a specific ache for each one. Friendships outside medicine, which quietly atrophy when the only common language left is differential diagnoses and RVUs. Physical and emotional health, deferred indefinitely under the assumption that “I’ll deal with that after residency… after fellowship… after partnership… after retirement.” Curiosity and hobbies that had nothing to do with medicine, such as the instrument, the language, or the novel half-written in one’s twenties, were set aside “for later,” where later kept movDALLAS MEDICAL JOURNAL | 7

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ing further away. Marriages and partnerships strained by unpredictable hours and chronic exhaustion, where a spouse slowly stopped expecting emotional presence because there was rarely capacity to offer it. The right to be uncertain. Physicians are trained to project authority and certainty into every room they enter, even when they are internally afraid, unsure, or simply tired. Decades of performing certainty can make it profoundly disorienting to sit with the very real uncertainty of what comes next. A private life separate from a public role. Many physicians describe never fully being “off duty,” as they are approached at church, at their children’s school, at the grocery store, always as doctor first and person second. Over decades, this can quietly erode the boundary between the role and the self until the two feel indistinguishable. For women physicians particularly, these sacrifices often carried an additional layer. Many built careers inside systems that were not originally designed with them in mind, where authority was still, more often than not, assumed to look male; where compassion was expected but rarely counted as clinical excellence; where maternity leave was something to apologize for rather than a right; and where being competent, warm, and ambitious simultaneously could read to colleagues as somehow “too much.” Many women in medicine learned to make themselves smaller in rooms where their male counterparts were never asked to shrink, and absorbed additional emotional labor for patients, for staff, and 8 | DALLAS MEDICAL JOURNAL

for families. This type of work was rarely reflected in compensation, titles, or recognition. This additional layer often means that when retirement finally arrives, women physicians are not only releasing a professional identity. They are releasing a role they may have had to fight harder to earn and defend in the first place, which can make the letting go feel even more fraught, and even more deserving of deliberate, compassionate attention. None of this is offered as a complaint. It is offered as acknowledgment, because a sacrifice that is never named cannot be honored, and a sacrifice that is never honored cannot be released. WHY RETIREMENT CAN FEEL LIKE AN IDENTITY CRISIS, NOT A REWARD We often speak of retirement in medicine as an achievement: the culmination of decades of discipline, the reward finally claimed. And it is that. But for many physicians, it also arrives as something unexpected: a kind of quiet unraveling. This is because retirement does not just remove a job. It removes the daily structure that organized a sense of purpose. It removes the instant respect and deference that came with the title “doctor.” It removes the clear metric of success, such as a save, a diagnosis, or a patient’s gratitude, that offered real-time proof of mattering. It removes the community of colleagues who understood that world without explanation. And it removes the identity that has answered the question “who are you?” for an entire adult life. Without a plan to replace these internal structures, not external ones like travel or hobbies, but internal ones like meaning, contribution, and self-worth, many retiring physicians unconsciously brace for a kind

of invisibility. And invisibility, for those who spent a career being needed in acute, highstakes moments, can feel almost unbearable. This is not a weakness. This is the predictable psychological cost of decades spent building an entire sense of self on a single foundation: being the physician in the room. Research on identity and retirement in high-responsibility professions consistently shows the same pattern: the more tightly a career and a sense of self are fused, the more disorienting the transition out of that career becomes, regardless of how financially secure or well planned the retirement itself is. Financial readiness has almost nothing to do with identity readiness, and the two are too often conflated in the advice physicians receive as they approach this stage. THE REFRAME: YOU WERE NEVER ONLY A PHYSICIAN Here is a truth every physician nearing retirement, or simply feeling stuck, deserves to hear clearly: being a physician was never the whole of who you are. It was the vehicle through which a much larger set of qualities expressed themselves. The discernment that catches a subtle diagnosis others miss is discernment, a trait that will serve in any future chapter, from mentoring to writing to advising to simply guiding the next generation with clarity. The steadiness that holds calm during a code is nervous system regulation under pressure, a rare and valuable human capacity that has nothing to do with a medical license. The compassion that lets a frightened patient feel safe in your care is a form of presence, and presence is desperately needed everywhere, not only in exam rooms. The discipline that carried you through decades of training is a demonstrated capacity to commit to mastery, which can be redirected toward any pursuit chosen next. The judgment forged by thousands of complex decisions, often made with incomplete information under time pressure, is a form of wisdom that boardrooms, classrooms, and community organizations are, in fact, hungry for, even if that wisdom no longer wears a white coat. Medicine borrowed these qualities for a season. It did not create them, and it does not own them. When the white coat comes July 2026

HEALTH AND WELLNESS

off, these capacities do not disappear; they simply become available for a new form. IDENTITY-LEVEL TRANSFORMATION, NOT BEHAVIOR-LEVEL ADJUSTMENT Most advice given to retiring physicians misses the actual problem. Colleagues are told to “find a hobby,” “travel more,” “spend time with grandchildren,” or “consider consulting work.” These are solutions at the level of behavior rather than identity, but the crisis is at the level of identity. A behavior cannot fill an identity vacuum. The identity itself has to be rebuilt. This means asking harder, more honest questions than “what will I do with my time?” It means asking: Who was I before medicine gave me a role to organize my life around? What did I love, wonder about, or feel drawn to before “doctor” became the answer to every question about who I am? What parts of myself did I quiet down in order to survive training, and are they still there, waiting? If competence is no longer the currency of my worth, what is? What do I actually want the next chapter to mean, not do, but mean? These are not comfortable questions. They were never meant to be comfortable. They were meant to lead toward wholeness. This kind of identity work is rarely instant and rarely linear. It often involves a genuine period of grief, grieving the version of oneself that was, for so long, singularly defined by a title, before a new, more integrated sense of self has room to take shape. Physicians, of all people, understand grief as a process rather than an event. The same patience extended to patients navigating loss deserves to be extended to oneself in this transition.

A PATH FORWARD: PRACTICAL FIRST STEPS For colleagues standing at this threshold now, a few starting points can make the identity work concrete rather than abstract: Begin naming the sacrifices, out loud or in writing, before naming the plans. Skipping this step and jumping straight to “what’s next” tends to leave the underlying grief unprocessed, where it quietly resurfaces later as restlessness or dissatisfaction with an otherwise good plan. If you suspect that a childhood experience first pointed you toward medicine, consider exploring that connection deliberately with a therapist, a coach, or simply honest reflection, rather than letting it remain an unexamined undercurrent. Understanding the “why” beneath the calling often dissolves much of the fear that surfaces when the calling itself begins to change form. Seek out at least one relationship, community, or mentorship role in which you are valued for a quality other than your clinical competence, such as your curiosity, your humor, your storytelling, or your steadiness. Let that relationship reinforce a broader sense of who you are. Resist the pressure to have the whole next chapter figured out immediately. Identity rebuilding is iterative. Small, honest experiments such as writing, teaching, board service, or creative pursuits long set aside often reveal more than any single grand plan conceived in advance. Consider working with a coach, therapist, or trusted peer group specifically around this transition, rather than navigating it alone. The same profession that taught us to seek consultation for a complex diagnosis can extend that same wisdom to a complex personal transition.

THE WISDOM YOU ARE SITTING ON Here is what matters most to say to physicians at this threshold, whether five years from retirement or five months into it: the wisdom accumulated across a career in medicine is not diminishing; it is the raw material for something magical. You have sat with human beings in their most vulnerable moments. You have made decisions under conditions of extraordinary pressure and uncertainty. You have absorbed grief, held hope, and learned the precise weight of both truth and compassion delivered at the bedside. This knowledge does not expire when a license does. It is wisdom, the rarest currency there is, and it is exactly what the next chapter is asking to be brought forward, unhidden by a title, unarmored by a coat. The physicians who navigate this transition most gracefully are not the ones who cling hardest to the identity of “doctor.” They are the ones willing to grieve what medicine cost them, honor what it gave them, and then have the courage to ask who they might become when they are no longer defined by what they do, but by who they have always, underneath it all, been. You do not stop being wise, discerning, steady, or deeply human when you retire. You simply, finally, get the chance to be all of that, unapologetically, and on your own terms. That is not an ending. That is the beginning of the wildest, most integrated chapter yet. DMJ

DR. STEPHANIE BYERLY is a physician and life, leadership, women-centered, and trauma-informed coach who helps high-achieving professionals reclaim their authentic power and presence. She is the founder of Stephanie I. Byerly, LLC and creator of The UNNUMB Method, a framework for identity-level transformation. Formerly a Professor of Anesthesiology and Pain Management, Dr. Byerly is a Neuro-Obstetrical Anesthesiologist who transitioned from academic medicine to private practice. Dr. Byerly brings a rare depth of clinical, academic, and executive leadership experience to her coaching work. Through her writing, speaking, and coaching, she guides professionals navigating major life and career transitions toward aligning with their purpose and leading with impact. For more information, visit www.stephaniebyerly.com or contact Dr. Byerly at stephanie@stephaniebyerly.com

July 2026

DALLAS MEDICAL JOURNAL | 9

HOUSE CALL

CARRYING PURPOSE FORWARD An Interview with Winfed Parnell, MD about Building a Life Well Lived Before and After Retirement by Stephanie Jennings

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HEN PLANNING THE DALLAS MEDICAL

Journal's special issue on retirement, I asked Dr. Winfred Parnell to reflect on a question many physicians eventually face: What does a successful retirement look like? I also asked him to share not only how he prepared to leave medical practice, but also how he has approached the larger question of living a meaningful life. Over the course of our conversation, he shared the lessons he has learned from a life shaped by purpose, service, family, and medicine, and how those same values have guided his transition beyond clinical practice. Rather than viewing retirement as an ending, Dr. Parnell describes it as a thoughtfully planned next chapter, one that offers insight for any physician hoping to build not only a successful career, but a life well lived. Recently, Dr. Winfred Parnell found himself in a scene worlds apart from the life he had long known: tending the barbecue for his grandchildren on a sunlit afternoon. There was no pager anchored to his belt, no hospital’s call echoing in the background, no patient in labor or operating room schedule demanding his attention, no late-night summons pulling him away from the present. Instead, there was laughter drifting from the pool, the sizzle of food on the grill, and a moment he will not soon forget: his youngest grandson, who once hesitated at the water’s edge, finally leaping from the diving board for the very first time. July 2026

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“That was the biggest thing of my day,” Dr. Parnell reflected. “Those are the kinds of things that are meaningful.” He hopes that, in time, the memory will linger for his grandchildren, “some time that they will remember with their granddad.” For many physicians, conversations about retirement orbit around numbers: savings, investments, insurance, estate planning. And while those matter, Dr. Parnell’s story beckons us toward a more profound question and one less easily calculated, but no less essential: When the work that has shaped your daily rhythm, identity, and sense of purpose recedes, what will fill the space it leaves behind? What will give your days meaning? For Dr. Parnell, the answer did not arrive by accident. It emerged from years of reflection and intention, distilled into a simple phrase he returns to again and again: “Make a plan.” Those three words, he insists, are what he would offer any colleague approaching retirement with uncertainty. “Make a plan,” he says, “with an exclamation point behind it.” But for Dr. Parnell, planning was never simply about leaving medicine. Instead, he sought to carry forward the richest gifts his vocation had given him: purpose, service, relationships, learning, and care, bringing them with him into the unwritten chapter that lay ahead. A LIFE SHAPED BY LEGACY Dr. Parnell’s understanding of legacy began long before he entered an operating room. Raised in Lake City, Florida, a small town in northern Florida near the Georgia line. His father, now 103, was a farmer and sharecropper who held tightly to a dream: that all five of his children would one day have a place on the family land. His father stressed faith, family, and education. Today, that dream is coming true. The family is building a house on the land, returning to a place imbued with generations of meaning. Dr. Parnell often reflects on his great-grandfather, who was once enslaved and later received 40 acres in Florida. He still possesses the official document from the state, bearing his ancestor’s mark: a single X where a signature might have been. In time, Dr. Parnell’s family hopes to reclaim that original parcel and restore it as part of their living legacy. This profound sense of inheritance, knowing both where one comes from and what one July 2026

hopes to pass on, remains at the center of Dr. Parnell’s life. “We wanted to establish a legacy for the family,” he says. “That’s always been important to us.” His upbringing was rooted in an agrarian world that may be difficult for younger generations to imagine. The family kept animals, tended farmland, and relied on practical skills from an early age. When livestock were butchered, young Winfred was drawn to understand the inner workings of anatomy. Whenever a dog, cat, or other animal was injured, he found himself improvising care and doctoring them. Initially, those around him encouraged the young man raised on a farm to become a veterinarian. He even began college studying animal science. Yet, after just one semester, he realized his true calling lay elsewhere. “I don’t want to do this,” he recalls thinking. “I want to be a doctor.” From that moment, he never looked back. His journey led him from Florida A&M University to medical school at the University of Florida, then on to Dallas for an internship and residency at Parkland Hospital. He would later practice at Methodist Hospital and Medical City, ultimately building a 41-year career in obstetrics and gynecology. Yet, one of the most formative experiences of his life occurred much earlier, in a doctor’s waiting room. As a child with asthma, Dr. Parnell visited

the doctor often with his mother. These visits occurred during segregation, a time when the office had two waiting rooms. White patients were seen first, ushered into the front room with its big leather chairs. Black patients, including Dr. Parnell and his mother, waited in the back room, where the chairs were simple wooden rocking chairs. He speaks of that history without bitterness, but with unmistakable clarity. “It was the reality,” he said, “and it kind of shapes you.” The memory shaped him so deeply that, once he entered practice and could afford it, he made sure his own office offered big leather seats for everyone. “You wanted to be the change,” he said. “You want to be the change that you want to see in the world.” That early memory became a calling, forming a physician whose decades in medicine were defined not only by technical skill, but by a commitment to honoring the dignity of every person who sat before him. FORTY-ONE YEARS OF MEDICINE AND MEANING Dr. Parnell chose obstetrics and gynecology, a specialty that allowed him to blend technical skill with enduring rela-

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Dr. Parnell and three generations of his family.

tionships. He found deep fulfillment in the operating room, describing himself as being “at home” there. Even during the final stretch of his career, he continued both obstetrics and gynecology until about six months before retirement, while many physicians in the specialty stop obstetrics years earlier. During those last months, he no longer took call, but he remained in the operating room, assisting his partners with surgeries. This transitional period allowed him to stay connected to the work he loved while gently beginning the process of stepping away. Dr. Parnell advises most physicians to consider a step-down period, which can include options like reducing hours, dropping call, shifting to administrative or advisory roles, teaching, or working as a locum tenens. 12 | DALLAS MEDICAL JOURNAL

His affection for medicine is unmistakable. “I enjoyed my practice,” he said. “I was living my dream because as a little kid, I wanted to do that all my life.” What he remembers most, though, are not the procedures or the years of dedicated labor, but the patients themselves. In obstetrics, he said, physicians are present at extraordinary moments in people’s lives. They see “the smiles on the parents' faces” when a baby is delivered. Over the course of a long career, those relationships deepen. By the time he retired, he found himself caring for second (and sometimes third) generations of the same families. Retirement, for Dr. Parnell, was never an escape from a profession he resented. Instead, it was preparing for an intentional closing of a chapter he had dearly loved. For those who find deep meaning in their work, retirement

can be both richer and more complex. He had seen colleagues work longer than they should have, only to retire and become ill or unable to enjoy the years that followed. Others left practice without a plan and struggled with the loss of structure and identity. Those observations shaped his own decision. PLANNING FOR THE NEXT SEASON If Dr. Parnell could offer physicians nearing retirement a single piece of advice, it would be this: plan for more than just your finances. Physicians are trained to plan. They prepare for college, medical school, residency, board certification, practice, partnership, leadership, volunteerism, and patient care. But Dr. Parnell notes that many do not approach retirement with the same intention, even though it marks one of life’s major transitions. In his view, retirement is comparable in magnitude to other significant life shifts, such as graduating from medical school or getting married. Each requires adaptation. Each brings new responsibilities, rhythms, and identity. He began planning for his current activities and commitments nearly a decade before leaving practice. “The things I’m doing now, I started planning those about ten years before,” he said. A meaningful, proactive succession plan also eased his transition. He recruited another physician, who also happened to be his daughter, to join the practice about eight to ten years before he retired. As he described it, he was stepping down while she was stepping up. That transition made retirement less emotionally difficult, as he was able to leave his portion of the practice in the hands of a trusted colleague. For physicians without that particular circumstance, he returns to the same principle: start planning early. Ask what you want your retirement to look like. Identify what will provide purpose. Consider how to maintain relationships. Think about the kind of legacy you want your life to reflect. “You have your profession,” he said, “but you don’t want your profession to be your entire life. You want to have another life outside of that.” That can be difficult for physicians, whose professional lives often demand so much that the boundaries between work and identity blur. Dr. Parnell has seen physicians whose self-worth July 2026

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was tied almost entirely to being a doctor. When that role changed, they struggled. His own identity, he said, has always been tied less to the title of doctor than to the act of making a difference. “My whole value, I think, is related to making differences,” he said. “And you can still make differences without being at the bedside.” That distinction became the bridge from practice to retirement. He reflected further on the broader trends and personal considerations at play. Most physicians retire between the ages of 65 and 68 [1], with male physicians statistically more likely to delay retirement than their female colleagues [2]. Those who remain in practice often do so because of high job satisfaction or a sense that their identity is closely tied to their profession. However, Dr. Parnell emphasized that clinical competency and patient safety should always be central to any retirement plan. He noted the importance of selfassessment and honest feedback from peers when making such a significant decision, as individuals age at different rates and the cognitive and physical demands of medicine are considerable. “No physician”, he said, “wants their legacy to be defined by involuntary retirement resulting from concerns about competency or patient safety.” Dr. Parnell also pointed out that age is not the only factor to consider. Personal health and family medical history can directly affect the timing of retirement, especially when certain illnesses are involved. In his experience, physicians who transition gradually into retirement tend to be more satisfied and experience fewer emotional and identity-related challenges. He has found that maintaining a medical license during early retirement can provide valuable flexibility, a sense of identity, and options. He observed that colleagues who relinquished their licenses immediately sometimes regretted the decision. For Dr. Parnell himself, keeping his license has been a positive choice, allowing him to remain connected to his profession on his own terms. FROM BEDSIDE TO BOARDROOM Today, Dr. Parnell remains engaged in health care, but in a different way. He serves on several boards, including the Parkland Center for Clinical Innovation, where he is involved in work related to artificial intelligence, machine learning, and the future of medicine. July 2026

He also works with the Texas Hospital Trustees Board, helping board members understand their responsibilities and become better advocates for patients from the boardroom. He was also previously the board chair. As a former Dallas County Medical Society board member, he is still involved on the investment and retired physicians committee. For Dr. Parnell, this is not a detour from medicine. It is a continuation of the same mission, now channeled through new avenues. “I’m not at the bedside,” he said, “but I’m still doing things to care and make a difference for people.” He sees board service as a way to influence decisions that ultimately affect patients. “The decisions that are made in the boardroom affect the bedside,” he said. This work keeps him learning. On forprofit healthcare boards, he has learned about SEC filings, 10-Ks, 8-Ks, and other aspects of business and governance that were not part of his original medical training. In addition, he's a member of the Institute of Excellence in Corporate Governance at the University of Texas at Dallas. Retirement, in other words, has not narrowed his world. It has widened it. He remains connected to medicine, but is no longer tethered to the pager. He is still learning, still contributing, and still asking how systems can better serve patients. PROTECTING TIME WITHOUT OVERFILLING IT Dr. Parnell is careful to say that retirement should not simply become another version of overwork. Physicians are accustomed to being needed. When others learn that a physician is retired, requests can quickly multiply. “You can over-volunteer,” he said. “My time has been my most valuable asset in retirement.” That is why he emphasizes control. In retirement, physicians finally have more control over their schedules, but that freedom must be protected. “I think one of the things that has helped is I try to protect my time and do the things I really want to do and I like doing,” he said. That does not mean every day must be full. In fact, one of the most important adjustments for him was learning that it is acceptable not to accomplish something every day. Physicians are driven, he said. They are wired to produce, respond, solve, and achieve. “It took some time,” he said, “because we’re so wired to accomplish something every day.”

PRACTICAL TAKEAWAYS FOR PHYSICIANS APPROACHING RETIREMENT Make a plan and make it early. Dr. Parnell began shaping the activities and commitments that now define his retirement years before he left practice. It is better to have a plan in waiting than to abruptly find yourself in transition without any plan in place. Plan beyond finances. Consider purpose, relationships, health, daily rhythm, community and legacy, not just savings and budgets. Redefine identity before retirement arrives. Dr. Parnell encourages physicians not to let the profession become their entire lives; his own identity centers on making a difference, whether at the bedside or beyond. Protect your time. Retirement can become overfilled quickly; he cautions physicians not to over-volunteer and to preserve control over their schedules. Find your “happy place.” For Dr. Parnell, exercise clears his mind. For others, it may be golf, reading, travel, creative work, volunteering, or family time. Stay connected. Conversations with retired colleagues can help physicians anticipate emotional and identity shifts. Invest in health. Retirement is a time to focus on the preventive care, exercise, and self-care physicians have long recommended to patients. He recommends visiting https://www. ama-assn.org/topics/physicianretirement for a variety of retirementrelated resources.

Now, he can say: If there is nothing scheduled, that can be a gift, not a failure. “It’s okay not to have anything to do one day,” he said. “It’s okay.” That mindset shift may be one of retirement’s most underrated challenges. After years of urgency, it can take time to settle into stillness. “You relieve a lot of emotional stress,” he said. “It takes a while to get to that point.” DALLAS MEDICAL JOURNAL | 13

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FINDING THE HAPPY PLACE For Dr. Parnell, exercise serves as a daily anchor, grounding him in both mind and body. When he was practicing, he worked out early in the morning because, as he said, after that he did not truly “own” the day. Patients, calls, meetings, and responsibilities could quickly take over. That early workout, though, was time reserved for himself. Even now, most of his days begin with a workout, lasting about an hour to an hour and a half, followed by a late breakfast and, often, lunch with colleagues, friends, or people he knows through board service. Exercise is not just a physical routine for him. It clears his mind. “When I’m working out, nothing troubles me anymore,” he said. “My mind’s totally clear.” His advice to physicians is not to choose exercise specifically, but to identify whatever place, activity, or rhythm brings calm and restoration. “Where is your happy place?” he asks. “Where am I at my calmest and most relaxed?” For some, that may be golf, tennis, pickleball, reading, travel, service, art, teaching, or time outdoors. The point is to know what restores you and to intentionally make room for it. “Plan to go to your happy place every day, as many times as you can,” he said. RELATIONSHIPS AS RETIREMENT’S RICHEST WORK If planning is the framework of Dr. Parnell’s retirement, relationships form its heart. He speaks warmly of his wife, Debra, who retired before he did. One surprise of retirement, he said with humor, was realizing she was “the CEO of our home.” The adjustment took time, but together they found new harmony. Retirement has allowed him to support her in ways he could not during his years in practice. When she served as president of the Dallas County Medical Society Alliance, he took great pleasure in standing by her, rec14 | DALLAS MEDICAL JOURNAL

ognizing how much she had supported him over many years. He also spends more time with his children and grandchildren. He is not just present, but patient. During his years in practice, even family moments could be interrupted by the beeper. Now, he can linger. He can barbecue. He can watch a child jump into the pool again and again. He can send food home. He can be fully there. That, too, is legacy. “When you’re in retirement, you have a little more time to do some reflection,” he said. He encourages physicians to ask whether they want their legacy to be associated only with medicine, or also with being a good father, mother, grandfather, grandmother, spouse, friend, and community member. “You want your legacy to be more than just the practice of medicine,” he said. He also treasures time with his 103-yearold father, taking him for rides, walking with him, and listening to stories about his life. “That’s invaluable for me at this point,” Dr. Parnell said. For physicians who have spent decades caring for others, retirement may offer something profound. It is time to listen to stories, nurture relationships, and pour into the people closest to them. HEALTH, SELF-CARE, AND PRACTICING WHAT PHYSICIANS PREACH Dr. Parnell believes physicians should approach retirement with a health plan in mind. Physicians spend their careers advising patients to exercise, eat well, keep appointments, drink less, and attend to preventive care. Yet many, he notes, neglect those same practices in their own lives because they are so busy caring for others. “I like to think of my health as my most valuable asset,” he said. As retirement approaches, he encourages physicians to focus on routine care, exercise, nutrition, and habits they may have postponed during their practice. Retirement can be a time to finally do what they have long counseled patients to do. “If you haven’t been doing them,” he said, “try to spend some time and focus on those things you’ve been telling your patients to do.” This advice is practical, but it is also philosophical. Retirement is not just about how

long one has after practice. It is about the quality of those years: the ability to travel, serve, think, laugh, exercise, learn, and be present with loved ones. THE ROLE OF COMMUNITY Dr. Parnell believes peer connection is vital. Physicians who are newly retired can benefit from talking with those who have already navigated the transition, people who understand the shifts in identity, pace, and the sense of loss that sometimes comes with stepping away from practice. I am involved with the retired physicians group at the Dallas County Medical Society “Have conversations with people who have retired,” he said. “There’s always some wisdom, and you can learn something.” A DIFFERENT KIND OF CALLING Dr. Parnell is clear that he loved practicing medicine. He loved his patients, the operating room, the relationships, and the feeling of making a difference every day. Retirement has not meant the end of that calling. Instead, it has meant discovering new forms for it. Now, he makes a difference in boardrooms, with grandchildren, with his wife, with his father, with colleagues over lunch, and through the example of a life still engaged. He has not stopped being a physician in the deepest sense of the word. He has simply allowed his identity to grow larger than the title. His story offers physicians approaching retirement a powerful reframing. The question is not only when to retire, or whether the finances are ready. It is what kind of life you are preparing to enter. What relationships need more of you? What purpose still calls? What part of your identity deserves room to grow? What have you always told patients to do that you now need to do for yourself ? Where is your happy place? And what legacy do you want to leave beyond the work itself ? Dr. Parnell’s answer begins, as always, with a plan. But it ends somewhere warmer: with barbecue smoke in the air, children laughing in the pool, a grandson gathering courage at the edge of the diving board, and a retired physician fully present to see him jump. DMJ

July 2026

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WOMEN IN MEDICINE

DCMS Inaugural Women in Medicine Leadership Conference by Sarah Donahue, Vice President, Events and Fundraising THE DALLAS COUNTY MEDICAL SOCIETY’S 2026 INAUGURAL WOMEN IN Medicine Leadership Conference concluded June 13 at Scottish Rite for Children, uniting 108 participants for two days of candid conversation, mentorship, and professional development. The conference purposefully attracted a diverse cross-section of the North Texas medical community, including high school students considering a future in healthcare, undergraduates and medical students, residents and fellows, and established physicians and healthcare leaders, cultivating a unique environment for cross-generational connection that lies at the heart of the event’s mission. Dr. Shaina Drummond, Chairwoman of the DCMS Board of Directors, opened the conference Friday afternoon with remarks that set a tone of authenticity. Dr. Stephanie Byerly followed with an unflinching examination of the “achiever identity” many high-performing women in medicine carry, encouraging attendees to redefine success on their own terms. The afternoon featured Dr. Bonnie Prokesch and Laura Kirk, PA-C, who introduced a coaching-based framework for intentional leadership, both professionally and personally. Dr. Deborah Fuller then led a guided discussion on women’s health and menopause, a topic participants noted is rarely addressed in professional settings. The day concluded with a cocktail reception at DCMS headquarters, offering a relaxed atmosphere for continued conversation. Saturday opened with an inspiring keynote from Dr. Sasha Shillcutt on leadership, courage, and crafting a medical career that integrates with one’s whole life. Attendees then divided into three breakout tracks tailored to their professional stages. The Professional Development Track, featuring Dr. Sejal Mehta and Dr. Aashoo Mentreddi, explored how to step into leadership roles and pursue nontraditional career paths. The Personal Empowerment Track, led by Dr. Susan Matulevicius, Dr. Evelyn Ilori, and Dr. Sunati Sahoo, focused on finding one’s voice and overcoming burnout for lasting success. The High School Student Track offered younger participants direct engagement with physicians, including Dr. Archana Rao, Dr. Sandra Lozano, Dr. Jodi Jones, Dr. Sue Bornstein, and Dr. Sarah Baker, who candidly shared their journeys into medicine. Students also heard from UT Southwestern medical students Lauren Blaydon and Audrey DeJong, who discussed their recent experiences and motivations for entering the field. Saturday also featured a networking lunch with Sarah Way, MD, JD, moderated by NBC5’s Bianca Castro, and facilitated mentoring sessions connecting students and trainees with established physicians. The final session, a vibrant conversation moderated by Dr. Sara Austin with Marjorie Petty, JD, and Dr. Debra Patt, left participants energized and inspired. Dr. Deborah Fuller closed the conference, sending attendees off with over five hours of CME credit and, by many accounts, a revitalized sense of community. This event was made possible by the generous support of sponsors and exhibitors, including MedTech Solutions, Southwest Diagnostic Imaging Center, Southwestern Medical Foundation, Dr. Healthy Homes, Frost Bank, TMA, TMAIT, The HRT Club, and Medical Innovations, LLC. Special appreciation goes to the DCMS Board of Directors and the former and current Women in Medicine Forum Chairs, Dr. Joy Chen and Dr. Alexandra Dresel. DCMS extends its sincere thanks to every speaker, sponsor, and attendee who made this year’s conference a success, and looks forward to building on this momentum in 2027. DMJ

July 2026

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The Magic Elevator Ride: A Dallas Cardiologist Takes Independent Medicine’s Case to Congress DCMS Past President Rick Snyder II, MD, testifies before the House Energy and Commerce Subcommittee on Health on Medicare physician payment reform

N MAY 20, 2026, THE SUBCOMMITTEE on Health of the U.S. House Committee on Energy and Commerce convened a hearing on the Medicare Physician Fee Schedule and its consequences for independent medical practice. Among the witnesses called to Washington was one of our own: Rick Snyder II, MD, an interventional cardiologist, Past President of the Dallas County Medical Society, and President of HeartPlace, one of the largest independent cardiology practices in Texas. Dr. Snyder also serves as Vice President of the American Independent Medical Practice Association (AIMPA) and was recently appointed Chief Physician Executive of US Heart & Vascular. The committee he addressed carries weight. Established in 1795, Energy and Commerce is the oldest standing legislative committee in the U.S. House of Representatives, and its jurisdiction, which spans energy, technology, and health care, is the broadest of any congressional authorizing committee. Rep. Brett Guthrie (KY-02) chairs the full committee, with Rep. Frank Pallone (NJ-06) as Ranking Member. The Subcommittee on Health is led by Chairman Morgan Griffith (VA-09) and Ranking Member Diana DeGette (CO-01). Dr. Snyder's message was blunt: Medicare physician payments have fallen 33% behind inflation since 2001; hospitals are acquiring independent practices with, as he put it, “the government's money”; and patients pay the difference every time care shifts to a higher-cost setting. His illustration of that last point, the “magic elevator ride” in which the price of an echocardiogram more than quadruples when a patient rides one floor down from his office to a hospital outpatient department in the same building, surfaced again and again in members' questions. His full written testimony appears below, followed by selected exchanges from the question-and-answer session. The Dallas Medical Journal thanks Dr. Snyder for permission to publish both. WRITTEN TESTIMONY OF RICHARD W. “RICK” SNYDER II, MD Before the Subcommittee on Health, House Committee on Energy and Commerce — May 20, 2026 Chairman Griffith, Ranking Member DeGette, and members of

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the Subcommittee, thank you for the opportunity to testify today. My name is Dr. Rick Snyder. I am an interventional cardiologist, and I serve as President of HeartPlace, one of the largest independent cardiology practices in Texas. Every day, my colleagues and I care for Medicare patients in ten counties across the Dallas-Fort Worth metroplex — patients with heart attacks, heart failure, blocked arteries, and other serious cardiovascular conditions. The Medicare Physician Fee Schedule is not just an accounting formula. It is one of the most important forces shaping where patients receive care, what that care costs, and whether independent physicians can continue serving the people who rely on them. Right now, the system is completely broken. Hospitals receive automatic annual inflationary updates from Medicare. Physicians do not, even though the costs of operating a medical practice — staffing, rent, insurance, technology, and supplies — continue to rise dramatically. After adjusting for inflation, Medicare physician reimbursement has declined 33% since 2001. This divergence in how hospitals and medical practices are paid by Medicare is reshaping our healthcare system in ways that directly affect patients. Independent practices are disappearing. Many physicians, especially in primary care, cannot keep absorbing rising costs while reimbursement falls further behind. Some are retiring early. Some are shifting to concierge models. Many are selling to hospitals and large health systems because owning and operating an independent practice is no longer financially viable. Medicare's reimbursement structure offers hospitals an additional advantage. It pays them more than independent physician practices for identical care. That disparity harms patients, who end up paying more out of pocket for healthcare services in the hospital outpatient setting than they do for the same services in the independent practice setting. Consider an example from my own practice. My clinic is on the campus of a major hospital in Dallas. When I perform an echocardiogram — an ultrasound of the heart that helps diagnose and manage heart disease — in my office, Medicare pays my practice a technical fee of about $123. My patient's co-pay for that fee through Medicare is roughly $24. If a patient walks out my door and takes the elevator down one floor to a hospital outpatient lab in the exact same building, the cost of that July 2026

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echocardiogram to Medicare and to the patient more than quadruples. That's what I call a magic, and very disturbing, elevator ride. Physicians across the country have shared similar stories with me at gatherings convened by the American Independent Medical Practice Association, where I serve as vice president. AIMPA represents more than 14,000 physicians caring for more than 40 million patients across 48 states. My independent physician colleagues and I have watched these payment disparities accelerate hospital acquisition of physician practices and the consolidation of local healthcare markets. Hospitals acquired nearly 33,000 physician practices and added more than 181,000 physicians to their employment rolls between 2018 and 2026. In 2012, about 60% of physicians practiced independently. Today, almost 60% are employed by hospitals. Patients and taxpayers are paying the price for this wave of hospital consolidation. When an independent practice closes, patients don't just lose a doctor. They lose a trusted, convenient entry point to the healthcare system which forces them to wait longer for an appointment or, especially in rural areas, travel hours to see a provider. Many seniors would much rather receive care in a familiar community practice than navigate a large hospital system for routine outpatient care. And given how much more expensive care is in the hospital setting, taxpayers lose out, too. If my own practice were to become part of a hospital system, the increased annual cost to Medicare for just two common, outpatient, office-based cardiovascular tests would be more than $25 million. Nothing about the care would change, just the amount taxpayers and patients pay. Our practices are being bought with the government's money! If we want to preserve the viability of independent physician practice, and if we want to make sure that patients can seek timely access to high-quality, lower-cost care in their communities, then we must reform the Medicare physician payment system. At a minimum, Medicare physician reimburseJuly 2026

ment should include a permanent inflation-based update tied to the Medicare Economic Index, just as many other parts of the healthcare system already receive. Physicians cannot continue absorbing rising practice costs while reimbursement keeps declining in real terms. H.R. 6160, which has been led, on a bipartisan basis, by two members of this subcommittee, Dr. Ruiz and Mr. Bilirakis, addresses this disparity. I commend and appreciate their leadership. More broadly, Congress should pursue site-neutral payment reforms. Medicare should pay identical rates for identical services, regardless of where those services are delivered. Medicare policy should encourage site-of-care optimization, wherein care is delivered in the lowest-cost setting where it can be provided safely and effectively — whether that is a physician office, an ambulatory surgery center, or a hospital outpatient department. Congress and Medicare officials have already taken some important incremental steps in this direction for certain services. But more work remains. Today's payment disparities encourage hospitals to acquire independent physician practices and shift care into higher-cost settings, which increases costs for both patients and taxpayers. Peer-reviewed research published last year by several of my AIMPA colleagues found that hospital-affiliated physicians were much more likely than their independent physician counterparts to deliver care in the higher-cost hospital outpatient department. Across 32 common procedures and services, Medicare beneficiaries treated by hospital-affiliated physicians had just a 37% chance of receiving care in the lower-cost office or ambulatory surgery center setting. Independent physicians were much more likely than their hospital-affiliated counterparts to deliver care in the lower-cost office or ambulatory surgery center setting. Across those same 32 procedures and services, patients cared for by independent physicians had a roughly 60% chance of receiving care in the lower-cost setting.

DALLAS MEDICAL JOURNAL | 19

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Those decisions about where to deliver care have serious implications for patients and taxpayers. The difference in out-of-pocket costs can be thousands of dollars for patients and billions of dollars for taxpayers. The question is not whether a physician should be incentivized or penalized for their decision to refer a patient to a higher-cost site of care. It's whether the patient should be forced to bear the cost burden of that choice. There is something fundamentally broken about a payment system in which the cost of a service more than quadruples when a beneficiary takes a “magic elevator ride” from my office down one floor to a hospital outpatient department in the same building for the very same service. If we fail to act, we will continue moving toward a healthcare system dominated by larger and more expensive institutional providers. That will mean higher costs for taxpayers and beneficiaries, fewer options for patients, and less access to community-based care. Thank you again for the opportunity to testify today. I look forward to your questions. FROM THE HEARING ROOM: SELECTED QUESTIONS AND ANSWERS The following exchanges are drawn from the hearing transcript and have been lightly edited for clarity and length. Full Committee Chairman Brett Guthrie (R-KY): Dr. Snyder, why is reforming the Medicare Physician Fee Schedule important? And what does it mean for the viability of independent practices and the affordability for seniors, depending on where they get their care? Dr. Snyder: It's critical. We are in a crisis in the health care economics of this country right now, and part of it is the Medicare Physician Fee Schedule. Unfortunately, there is not meaningful practice viability for a lot of specialties, especially primary care, under the current reimbursement methodologies and with the administrative burden being placed on physicians. When physicians have to make the very painful decision either to retire or to sell to a higher-cost provider network, like a hospital system, we are not optimizing quality and low-cost access for patients. Our goal should always be timely access to high-quality, affordable care, and independent physicians are the optimal model for delivering it. Subcommittee Vice Chair Diana Harshbarger (R-TN): Dr. Snyder, the “magic elevator ride” is really striking because it is absolutely true. I'd like you to speak more about it — how the current structure of the Medicare Physician Fee Schedule encourages consolidation, and what that means for patient costs and quality of care. Dr. Snyder: It's a significant issue. The payment structure gives higher-cost systems an incentive to pursue the proceduralists — cardiologists and others who perform high-intensity procedures — and to consolidate them in order to capture those referrals and those procedures. 20 | DALLAS MEDICAL JOURNAL

Rep. Gus Bilirakis (R-FL): Dr. Snyder, in your testimony you discussed the financial pressures facing independent practices and the downstream effects those challenges have on patients. How does the current Medicare reimbursement structure affect the ability of independent practices to staff appropriately, invest in technology, and continue offering quality services to patients? Dr. Snyder: It is making it very challenging to maintain an office. Our staff are frequently looking elsewhere where they think the grass is always greener on the other side, and they are moving to hospitalemployed models because those systems can offer more since their reimbursement is higher. It is having a significant impact on our ability to see as many patients in the office as we would like to. Rep. Bilirakis: If these reimbursement challenges remain unresolved, what would that mean for patient choice, access to communitybased care, and overall health care costs? The bottom line. Dr. Snyder: If these trends go unabated, we will keep seeing what I affectionately call physicians entering the “physician transfer portal” and moving to hospital employment. Frequently their patients will follow them, but we see those patients come back. They tell us, “Yes, I wanted to follow Dr. Jones. I've known him a long time, and we have a very good relationship. But when I went for my annual echocardiogram or my guideline-indicated stress test, it cost two to three times as much, and I was on the hook for that.” And they frequently come back to my independent practice. Rep. Earl L. “Buddy” Carter (R-GA): Dr. Snyder, when a hospital system acquires an independent practice and converts it to a hospital outpatient department, Medicare pays a facility fee on top of the physician fee. Can you walk us through what that cost shift looks like in dollar terms for a Medicare beneficiary? Dr. Snyder: In my testimony I gave an example. When we do an echocardiogram in my office — probably the most common test we perform in cardiology to evaluate the heart — the professional fee and the technical fee together come to about $200, with the technical component around $123. Go one floor below to the hospital outpatient department, and it is about three to four times that amount. Rep. Kim Schrier, MD (D-WA): How would you like Congress to fix this issue? July 2026

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Dr. Snyder: Number one, make sure we are putting the patient first; that we have a financial system that rewards high-quality, low-cost care that patients can access in a timely way. To do that, we need to empower and embolden independent practice financially, so that independent physicians receive meaningful reimbursement and meaningful value for the care they deliver in the lowest-cost sites. EDITOR'S CLOSING COMMENTARY Two things stand out from Dr. Snyder's afternoon before the subcommittee. The first is how little translation his argument required. Health policy testimony often disappears into acronyms and actuarial tables. The magic elevator ride needs neither: same patient, same test, same building, four times the price. Vice Chair Harshbarger opened her questioning by calling the image striking “because it is absolutely true.” When a witness's framing becomes the committee's vocabulary, the witness has done his job. The second is that no member disputed the premise. Republicans and Democrats alike asked how to fix the problem, not whether it exists. Rep. Carter probed the dollar mechanics of facility fees. Rep. Schrier, herself a physician, asked directly what Congress should do about vertical integration. That agreement on the diagnosis matters, because the

remedies Dr. Snyder endorsed, a permanent inflation update tied to the Medicare Economic Index and site-neutral payment across settings, will require bipartisan votes to become law. H.R. 6160, the bipartisan bill he credited to Dr. Ruiz and Mr. Bilirakis, is one vehicle already moving. None of this guarantees action. Organized medicine has argued for MEI-based updates for years while the fee schedule continued its slide in real dollars. But testimony like this changes the record. The numbers Dr. Snyder placed before the committee, including a 33% decline in inflation-adjusted physician payment since 2001, nearly 33,000 practices acquired by hospitals since 2018, and physician employment inverting from 60% independent to nearly 60% hospital-employed, are now part of the official case for reform delivered in the voice of a practicing Dallas cardiologist. That is physician advocacy at its most effective, and it is why DCMS invests in developing leaders who can carry the profession's case from the exam room to the committee room. A single practice cannot change the Medicare fee schedule. A colleague who can put the problem before the committee that writes the law can ensure Congress cannot say it wasn't told. DMJ

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The Physician’s Retirement Roadmap: Building Financial Confidence for the Decades Ahead by Alex Ugge, CPWA®, AEP®, ChFC®, CLU®, RMA®, BOK Financial Private Wealth, Inc.

O R M A N Y P H YS I C I A N S , R E T I R E M E N T planning often takes a back seat to patient care, practice management, and family responsibilities. Years of intensive education, residency training, and demanding schedules can delay meaningful retirement planning, even among high earners. Yet physicians face a unique retirement challenge: while they often earn substantial incomes, they may begin accumulating wealth later in life and frequently have lifestyle expectations that require careful long-term planning. The good news is that retirement success is not determined by predicting markets or finding the next great investment. Instead, it is often the result of making thoughtful decisions around saving, spending, asset allocation, taxes, and timing. Whether retirement is ten years away or just around the corner, understanding a few key principles can dramatically improve the likelihood of achieving financial independence and maintaining your desired lifestyle throughout retirement. PLAN FOR A LONGER RETIREMENT THAN YOU EXPECT One of the most common retirement planning mistakes is underestimating longevity. Advances in healthcare, nutrition, and medical technology continue to improve life expectancy. Not surprisingly, physicians and other high-income professionals often enjoy even longer

22 | DALLAS MEDICAL JOURNAL

lifespans than the general population. Research suggests that wealthier Americans may live three to five years longer than average. For many physician households, retirement may last 30 years or more. At age 65, a healthy couple has a high probability that at least one spouse will live well into their 90s. While longevity is certainly a blessing, it creates a significant financial challenge: your assets may need to support decades of spending after employment income ends. Retirement is no longer a short chapter at the end of life. For many physicians, it can be as long as an entire career. That reality requires planning for more than just the first few years after leaving practice. A successful retirement strategy should account for changing spending patterns, healthcare costs, inflation, and evolving family priorities over several decades. Too often, investors spend significant energy worrying about the next market correction while overlooking areas that may have a larger impact on long-term success. The most effective retirement plans focus on optimizing the decisions you can control while building flexibility around those you cannot. THE POWER OF DELAYING SOCIAL SECURITY Many physicians assume Social Security will represent only a small portion of their retirement income. While that may be true relative to their overall wealth, the timing of Social Security benefits can still have a substantial impact on retirement outcomes. July 2026

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The increase in guaranteed lifetime income associated with delaying benefits can be significant. For healthy physicians with sufficient assets to cover expenses during their 60s, delaying Social Security may serve as a valuable longevity hedge. Higher benefits create a larger stream of inflation-adjusted income that lasts for life, helping reduce pressure on investment portfolios later in retirement. Of course, every situation is different. Health considerations, family longevity, marital status, and overall financial resources should all be evaluated before determining the optimal claiming strategy. The key takeaway is simple: Social Security is one of the few inflation-adjusted income streams available for life, and thoughtful timing decisions can meaningfully improve retirement security. SPENDING MATTERS MORE THAN MOST INVESTORS REALIZE Retirement planning discussions often focus heavily on investment returns. While returns are important, spending habits may have an even greater influence on retirement success. The two variables that most directly affect the longevity of a retirement portfolio are: 1. The amount withdrawn each year 2. The asset allocation supporting those withdrawals A common guideline is the "4% withdrawal rule," which suggests that a retiree may be able to withdraw approximately 4% of their portfolio annually while maintaining a reasonable probability of long-term success. While no rule applies universally, the broader lesson remains relevant: spending and portfolio design must work together. For physicians accustomed to high incomes, retirement often requires a deliberate transition from earning wealth to spending wealth. Understanding future spending needs before retirement begins is critical. Questions worth considering include: • How much income will be required to maintain your desired lifestyle? • Will travel expenses increase during the early retirement years? • How might healthcare costs evolve over time? • What charitable or family gifting goals exist? • What legacy objectives should be incorporated into the plan? Retirement confidence often comes less from maximizing returns and more from understanding how spending decisions affect long-term sustainability. ASSET ALLOCATION REMAINS THE PRIMARY DRIVER OF LONG-TERM RESULTS One of the most persistent myths in investing is that success comes primarily from selecting the perfect stock or correctly timing market movements. In reality, numerous studies have shown that asset allocation, the mix of stocks, bonds, cash, and other investments, has historically been the dominant driver of portfolio outcomes. While security selection and tactical adjustments can contribute value, they typically play a much smaller role than the broader allocation framework. For physicians, the challenge is not determining whether markets will rise or fall next year. The challenge is building a portfolio that appropriately balances: • Growth needs • Income needs • Risk tolerance July 2026

• Liquidity requirements • Tax considerations • Time horizon A physician entering retirement may still have a 25- to 30-year investment horizon. Maintaining adequate exposure to growthoriented assets can help preserve purchasing power and combat inflation, while fixed-income allocations provide stability and income. The optimal mix varies from one family to another, but thoughtful asset allocation remains one of the most important decisions a retiree can make. THINK OF SOCIAL SECURITY AS A BOND One concept many investors overlook is the role Social Security already plays within their overall balance sheet. Because Social Security provides a predictable stream of income that is largely insulated from market volatility, it behaves similarly to a government bond. When viewed through that lens, physicians may discover they already possess a substantial fixed-income asset in the form of future Social Security benefits. This perspective can influence broader portfolio decisions. For example, a retiree receiving reliable Social Security income may have greater flexibility to maintain equity exposure within investment accounts because a portion of basic spending needs is already supported by a relatively stable income source. Rather than viewing Social Security and investments separately, consider how all retirement income sources work together within a unified financial plan. PREPARE FOR HEALTHCARE COSTS Physicians understand better than most that healthcare expenses tend to increase with age. Although many retirement budgets assume spending will gradually decline, healthcare often moves in the opposite direction. Medicare provides valuable coverage, but retirees still face

A comprehensive plan is helpful in evaluating factors you can control while understanding those you can’t. WHAT YOU CAN CONTROL: Saving Spending Asset Allocation & location

WHAT YOU CAN’T CONTROL: Market returns Government policies Healthcare costs

DALLAS MEDICAL JOURNAL | 23

HEALTH ALLIES

ALIGN SPENDING AND ASSET ALLOCATION The amount you withdraw from your portfolio and the asset allocation you choose drive your probability of success. A 60/40 portfolio can withdraw 4% annually and have an 85%–90% chance of having funds remaining after 35 years. Initial Withdrawal Rate

0/100 (Equities/Bonds)

20/80 (Equities/Bonds)

40/60 (Equities/Bonds)

50/50 (Equities/Bonds)

60/40 (Equities/Bonds)

80/20 (Equities/Bonds)

100/0 (Equities/Bonds)

95-100

75-80

90-95

85-90

80-85

15-20

45-50

60-65

65-70

0-5

5-10

25-30

35-40

40-45

45-50

50-55

0-5

5-10

15-20

20-25

30-35

35-40

0-5

5-10

10-15

20-25

25-30

0-5

10-15

15-20

10%

0-5

5-10

10-15

Table shows probability of portfolio success (%) over a 35-year retirement horizon, by initial withdrawal rate (rows) and equities/bonds asset allocation (columns).

expenses related to premiums, deductibles, long-term care, prescription drugs, and out-of-pocket medical costs. Planning for these expenses before retirement is essential. Strategies may include: • Maximizing Health Savings Account (HSA) contributions during working years • Maintaining dedicated healthcare reserves • Evaluating long-term care funding options • Incorporating healthcare inflation assumptions into retirement projections Failure to address healthcare costs can place significant strain on retirement assets later in life. TAXES DON'T END AT RETIREMENT A common misconception is that taxes become less important after leaving the workforce. In reality, retirement often presents new tax-planning opportunities and challenges. Physicians frequently accumulate assets across multiple account types, including: • Traditional 401(k)s • IRAs • Roth accounts • Taxable investment accounts • Deferred compensation plans • Practice-sale proceeds The order in which assets are utilized can materially affect after-tax retirement income. Thoughtful planning around Roth conversions, required minimum distributions, charitable giving strategies, and tax-efficient withdrawals may help preserve more of a family's wealth over time. As with investment management, retirement tax planning should be proactive rather than reactive. RETIREMENT IS MORE THAN A FINANCIAL EVENT Physicians spend decades developing professional identities centered on patient care, leadership, and service. Retirement plan24 | DALLAS MEDICAL JOURNAL

ning therefore extends beyond financial preparation. It should also address lifestyle, purpose, and fulfillment. Many retired physicians find satisfaction through: • Teaching and mentoring • Volunteer medical work • Board service • Philanthropy • Consulting • Spending increased time with family A successful retirement plan prepares not only for financial independence, but also for a meaningful and rewarding next chapter. THE BOTTOM LINE Retirement planning for physicians is ultimately about balancing opportunity with preparation. While no one can predict market returns or future policy changes, investors can improve their odds of success by focusing on the areas they control: • Plan for longevity. • Create a sustainable spending strategy. • Optimize Social Security decisions. • Build a thoughtful asset allocation. • Manage taxes proactively. • Prepare for healthcare expenses. • Align financial resources with personal goals and values. Retirement should be one of life's most rewarding seasons. With disciplined planning and a clear strategy, physicians can enter retirement with confidence, knowing their financial resources are aligned with the future they have worked so hard to create. DMJ ALEX UGGE, CPWA®, AEP®, CHFC®, CLU®, AND RMA® is a Senior Vice President and Private Wealth Advisor with BOK Financial Private Wealth, Inc. He works with physicians, business owners, executives, and highnet-worth families to develop comprehensive wealth management strategies focused on retirement planning, tax efficiency, investment management, and legacy planning.

July 2026

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DALLAS MEDICAL JOURNAL | 27

B B SPOTLIGHTS

B B D D

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AT FORTUNA HEALTHCARE CONSULTING SERVICES, our mission is to empower physician-led practices to scale into high-performance, independent healthcare platforms by integrating operational excellence, revenue expansion strategies, and AI-enabled systems. We design, build, and optimize the infrastructure that allows physicians to grow sustainably, increase profitability, and deliver exceptional patient outcomes—without sacrificing control of their practice. Fortuna Healthcare Consulting Services is a healthcare consulting and operations partner focused on transforming physician-led practices into scalable, high-performance platforms. We combine operational excellence, revenue expansion strategies, and AI-enabled systems to improve efficiency, increase profitability, and unlock growth. Our approach enables physicians to scale their practices with confidence—while maintaining control, independence, and a relentless focus on patient outcomes. Key Offerings & Upcoming Initiatives Fortuna Healthcare Consulting Services is expanding beyond traditional consulting to deliver a fully integrated growth platform for physician-led practices. Our key offerings include building MSO-aligned infrastructure, deploying revenue-expansion engines across ancillary and chronic care services, and implementing automation and AI-driven workflows to improve efficiency and scalability. As part of our upcoming initiatives, FHCS is actively advancing intelligent automation across front-end and revenue cycle operations, developing standardized multi-location operating models, and launching enhanced data and performance intelligence platforms to provide real-time visibility into practice performance. We are also expanding our capabilities in remote workforce delivery and structured referral growth systems to support sustained, scalable growth for our partner practices.

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