SMART MEDICINE FOR SMALL PATIENTS
AI innovations, mental health breakthroughs, and the new rules of vaccinations
AI FOR PEDIATRICIANS NAVIGATING THE COMPLEXITIES OF PEDIATRIC MENTAL HEALTH INCLUDES
Jon R. Roth, MS,
EDITORIAL
EDITOR,
Lauren S. Williams
DESIGNED BY Morganne Stewart
COMMUNICATIONS COMMITTEE
Michelle Caraballo, MD, Chair
Ravindra Mohan Bharadwaj, MD
Jawahar Jagarapu, MD
Ravina R. Linenfelser, DO
Sina Najafi, DO
Celine Nguyen, Student
Shyam Ramachandran, Student
Erin Roe, MD, MBA
BOARD OF DIRECTORS
Shaina Drummond, MD, President
Gates Colbert, MD, President-elect
Vijay Giridhar, MD, Secretary/Treasurer
Deborah Fuller, MD, Immediate Past President
Emma Dishner, MD, Board of Censors Chair
Neerja Bhardwaj, MD
Justin Bishop, MD
Sheila Chhutani, MD
Philip Huang, MD, MPH
Nazish Islahi, MD
Allison Liddell, MD
Riva Rahl, MD
Anil Tibrewal, MD
Standing With Our Pediatricians Building a Healthier Future for Every Child
Shaina Drummond, MD
PEDIATRICS REMAINS ONE OF THE MOST
challenging and deeply rewarding fields in medicine. As this month’s DCMS Journal highlights the specialty of pediatrics, I want to extend my heartfelt gratitude to those of you who care for some of our most vulnerable patients—our children. From general pediatricians to pediatric subspecialists, thank you not only for the medical care you provide, but also for the emotional labor of supporting anxious families and navigating the unique stress that comes with treating children.
I was reminded of just how emotionally charged pediatric care can be when my daughter, then two years old, broke a bone in her foot after jumping on a small trampoline during a Gymboree class. Like any well-meaning parent, I encouraged her to be brave, clearly overestimating her readiness for gymnastics. The moment I put her shoes on, she burst into tears, and I knew something was wrong. Sure enough, she had a minor fracture in one of the bones in her foot. Watching her hobble around in a tiny walking cast for weeks, I carried the guilt of knowing I had cheered her into that injury. Even as a physician, I was not immune to panic. My clinical instincts were quickly replaced by pure mom worry. Thankfully, she did not need surgery, and we were fortunate to be cared for by a kind and skilled pediatric orthopedic surgeon at a Dallas children’s hospital. That experience left me with a renewed respect for the patience, expertise, and empathy pe-
diatric providers bring to every encounter, not just for the child, but for the entire family.
Challenges Facing Pediatric Care
More recently, I had a heartfelt conversation with a friend who practices general outpatient pediatrics in North Texas. They were visibly tired and admitted they were unsure how much longer they could keep their practice afloat. The financial pressure had become overwhelming. With reimbursement from public programs continuing to shrink and private insurers offering lower payments for complex pediatric care, they questioned whether the private practice model was even sustainable. This wasn’t a moment of frustration—it was a moment of truth that reflected the growing challenges so many pediatricians are quietly navigating.
As I began researching the data, I discovered something deeply troubling. Texas currently ranks 50th in the nation for children’s health and access to care. Approximately 36% of children in Texas receive their care through Medicaid or CHIP. In 2023, nearly 12% of Texas children were uninsured—more than double the national average. For children under 6, the uninsured rate was 9%; for those aged 6 to 18, it climbed to 13%. These numbers are not just statistics; they represent missed well visits, delayed diagnoses, untreated pain, and preventable illness.
While Texas is home to more than 2,500 general pediatricians, systemic challenges continue to strain the pediatric workforce. Low reimbursement rates, limited access to subspecialists, and barriers to preventive services place an outsized burden on those caring for our youngest patients. At the same time, the pipeline into pediatrics is showing signs of fragility. In the 2024 residency Match, pediatrics experienced a 6% decline in applicants—the steepest drop in a decade—with only 48% of positions filled by U.S. MD seniors. Compensation remains another disincentive: pediatricians in Texas earn between $192,000 and $225,000 annually, which is nearly 25% less than their adult care counterparts. These converging pressures—declining reimbursement, waning interest from trainees, and stagnant pay—create a concerning outlook for access to pediatric care in our region.
As we recognize the vital contributions of pediatricians, we must also acknowledge the increasing challenges they face in delivering consistent, high-quality care to all children. Supporting the health of future generations begins with supporting the professionals who care for them each day. As members of the Dallas County Medical Society, we have both a responsibility and an opportunity to stand with our pediatric colleagues. Through
advocacy for improved reimbursement, greater access to care, and stronger investment in pediatric training and resources, we can help create a healthcare system that truly serves every child. The strength of pediatric medicine tomorrow depends on the actions we take today. Let us work together to build a future where all children receive the care they need and every pediatrician is empowered to continue their essential work.
Bringing Pediatric Pain into Focus
While issues such as access, reimbursement, and workforce strain are often at the forefront of conversations about pediatric care, another critical area that receives insufficient attention is how we recognize and manage pain in children. As an anesthesiologist with fellowship training in pain management, and as a parent who has personally experienced the fear of seeing my own child in pain, I have come to understand just how overlooked this issue truly is. Pain is one of the most common reasons children seek medical attention, yet it is still frequently under-recognized and inadequately treated. The way we approach pediatric pain not only affects a child’s immediate comfort but also shapes their recovery, emotional development, and long-term trust in the healthcare system.
Compounding this problem is the lingering backlash from our nation’s opioid epidemic. While the effort to curb misuse and addiction has been necessary, it has also created a climate of fear around prescribing opioids, even when they are appropriate. This stigma has affected providers’ willingness to treat pain adequately across all age groups. While multimodal pain treatment is a best practice and should be utilized to minimize opioid use when possible, the reality is that for acute pain, postoperative pain, and pain associated with malignancy, opioids remain a critical and evidence-based part of treatment. This applies to children just as it does to adults. Responsible prescribing, supported by careful monitoring and patient education, can relieve suffering without compromising safety.
The Science of Pediatric Pain: Not Just Small Adults
Emerging research in pain neurobiology suggests that the
and Healing: Advancing Pediatric Oncology Rehabilitation
In Person:
Children's Health Specialty Center 1
V ir tual: Zoom
Registration fees:
Who Should Attend:
This conference is designed for a multidisciplinar y audience involved in pediatric oncology rehabilitation and patient care
Physicians & Advanced Prac tice Providers
Therapis t s & Allied Health Profes sionals
Nurses & O ther Healthcare Profes sionals
Medical Students , Residents , & Fellows
neonatal and pediatric nervous system is not only capable of perceiving pain but may also be more sensitive to it than the adult nervous system. Nociceptive pathways begin to develop in utero and become functional by the third trimester. By the time a baby is born, their peripheral pain receptors are fully active, but their descending inhibitory pathways—the brain’s way of dampening pain signals—are immature. This imbalance means infants and young children may feel pain more intensely, not less.
Brain imaging studies reinforce this reality. Functional MRI scans have demonstrated that painful stimuli activate similar brain regions in infants and adults, including the somatosensory cortex, thalamus, and limbic system. Yet many children still receive little or no analgesia for painful procedures, from circumcisions and lumbar punctures to postoperative surgical recovery and chronic conditions like juvenile arthritis or sickle cell disease. Even something small like moving an extremity with a fracture for X-rays warrants pain treatment.
Why Is Pediatric Pain Undertreated?
Several factors contribute to the under-recognition and undertreatment of pain in children:
• Communication barriers: Infants and young children may not have the verbal skills to express their pain, leading clinicians to underestimate its severity.
• Misconceptions: Long-standing myths that children do not feel or remember pain persist in some medical environments.
• Fear of opioids: Clinicians may hesitate to prescribe adequate analgesia due to concerns about respiratory depression, addiction, or regulatory scrutiny—even when opioids are indicated and can be safely used.
• Lack of training: Many healthcare workers and physicians receive limited education on pediatric pain assessment and management, resulting in the underutilization of validated pain scales and multimodal strategies.
• Systemic issues, including time pressures, inadequate staffing, and a lack of pediatric-specific protocols, contribute to inconsistent pain management in emergency departments and primary care settings.
Short- and Long-Term Consequences
When pain goes untreated in children, the outcomes can be profound. In the short term, unmanaged pain can lead to increased anxiety, sleep disturbances, delayed healing, and behavioral regression. Over time, it can result in altered pain sensitivity, posttraumatic stress, and needle phobia that may persist into adulthood.
Children who repeatedly experience pain without relief—such as those with chronic illnesses—are also more likely to develop mood disorders, poor school performance, and reduced quality of life.
Evidence-Based Approaches to Managing Pain in Children
Addressing pediatric pain requires intentionality, education, and a multidisciplinary, evidence-based approach that includes the
following key strategies:
1. Incorporate Age-Appropriate Pain Assessment Tools
2. For infants and nonverbal children, validated tools such as the NIPS, FLACC scale, or N-PASS are critical for accurately identifying pain. For older children, options such as the FACES scale or a numerical rating scale, like the Visual Analog Scale (VAS), are effective. Pain assessment should be a routine part of clinical care and documented consistently.
3. Embrace Multimodal Strategies
4. Non-opioid medications such as acetaminophen and NSAIDs should be used when appropriate. However, opioids remain necessary for moderate to severe pain, especially postoperatively or in the case of fractures. Regional anesthesia and nerve blocks offer additional options. Whenever possible, pharmacological treatments should be combined with non-drug interventions, such as positioning, rest, and cold therapy.
5. Don’t Forget Non-Pharmacologic Tools
6. Distraction techniques, virtual reality, guided imagery, AI, and relaxation exercises are effective, especially for procedural pain. Child life specialists are often underutilized but can significantly reduce fear and distress in children.
7. Build a Multidisciplinary Approach
8. Persistent or complex pain often requires a team-based approach involving pediatricians, anesthesiologists, nurses, psychologists, physical therapists, and child life specialists. Collaborative care enhances both outcomes and the overall care experience.
9. Educate and Advocate
10. Pediatric pain training should be a standard part of medical education and residency programs. Clinicians must also feel empowered to advocate for their patients when systems, protocols, or policies fail to meet their needs. At the policy level, balanced approaches to opioid regulation are needed to ensure that concerns about misuse do not impede access to appropriate pain relief.
Striving Together for Better Pediatric Pain Care
Pediatric pain is real, measurable, and treatable. As physicians, we carry both a moral and scientific responsibility to relieve suffering in our youngest patients. Meeting that responsibility begins with a renewed commitment to addressing pediatric pain thoughtfully and thoroughly. It requires decisions rooted in both evidence and empathy, a willingness to challenge outdated assumptions, and a dedication to keeping each child’s comfort and dignity at the center of care.
When a child is in pain, they deserve to be recognized, supported, and treated with intention and compassion. This is not only the standard of care they need—it is the kind of care every child deserves and what we must continue striving to provide together. DMJ
10%
COURSE
DISCOUNT FOR DCMS MEMBERS
CERTIFICATE PROGRAM
“This program offers a challenging curriculum of leadership training and self reflection The speakers from the different sectors of healthcare were engaging and provided real examples of how our healthcare system weaves together, for better or worse. I feel more prepared as an effective leader of the teams I influence today and the teams of my future.”
Gates Colbert, MD, FASN
The Dallas County Medical Society and the UT Dallas Alliance for Physician Leadership Program (APL) are offering a physician leadership certificate that will cover timely and important topics in today’s ever-changing healthcare environment. The certificate program covers areas of focus such as physician wellness, leadership skills, value-based contracting, quality performance, emerging IT opportunities, revenue and financial management. The program is cohort style and will adapt to industry trends and the needs/topics of interest to the physician attendees.
The DCMS/APL program includes six in-person full-day sessions, a final project session, along with interim readings, case studies, and engagement with program faculty on an ongoing basis. The program design is intended to provide meaningful and focused learning with the in-person cohort, while respecting the time demands of a physician’s schedule.
Ruby Blum, VP Policy & Legislative Affairs ruby@dallas-cms org (214) 413-1424
dallas-cms.org/leadershipprogram
NEW DCMS HEADQUARTERS IN THE HEART OF UPTOWN
CAMPAIGN FOR THE FUTURE
Pediatric Vaccination at a Critical Juncture Addressing Declining Rates and Policy Challenges
Jon R. Roth, MS, CAE
AS WE EXAMINE THE CURRENT STATE OF PEDIATRIC
vaccination rates in the United States, physicians of the Dallas County Medical Society (DCMS) are witnessing concerning declines in vaccination rates and significant policy changes that threaten to undermine decades of progress in childhood disease prevention.
The American pediatric vaccination program has achieved remarkable milestones over the past several decades. Since the implementation of comprehensive childhood immunization schedules, we have seen dramatic reductions in diseases that once claimed thousands of young lives annually. The elimination of polio from the United States by 1979 and the nearcomplete eradication of measles, mumps, rubella, and other
childhood diseases represent some of modern medicine’s most outstanding achievements.
Historical data demonstrates strong vaccination coverage rates, with national coverage for the combined seven-vaccine series reaching approximately 94%-95% of children by age 24 months in the years leading up to 2020. Texas consistently performed near the upper end of states for MMR, DTaP, and Varicella Vaccines, reflecting the hard work and dedication of public health officials, pediatric physicians, and family practitioners across our state to convince and provide access to Texas families.
Troubling Trends Emerge
Recent developments present serious concerns for the pediatric medical community. Vaccination coverage for children born in 2020 and 2021 declined across most recommended vaccines. While the numbers may appear modest, they represent hundreds of thousands of unprotected children nationally and signal a dangerous erosion in population immunity.
More alarming is the trend in vaccination rates among schoolage children. Kindergarten MMR vaccination rates have fallen from 95.2% in the 2019-2020 school year to 92.7% in the 2023-2024 school year. This decline places communities below the 95% threshold required to maintain herd immunity against measles, creating vulnerabilities that are already manifesting as disease outbreaks.
The consequences of these declining rates are no longer theoretical; they are now a reality. Texas is experiencing the state’s largest measles outbreak in over 30 years, with more than 750 patients affected and cases spreading to neighboring states. Tragically, an unvaccinated Texas child has died from measles. Nationally, 2025 marks the first time the U.S. has surpassed 1,000 confirmed measles cases in five years, with approximately 96% occurring among people who are unvaccinated or whose vaccination status is unknown.
Concerning Policy Changes
Recent changes in federal health policy have introduced significant uncertainty into pediatric vaccination recommendations. Secretary Robert F. Kennedy Jr. announced that the Centers for Disease Control and Prevention would no longer recommend COVID vaccines for pregnant women or healthy children, bypassing the agency’s established process for evidence-based policy development.
More concerning was Kennedy’s decision to fire all 17 members of the Advisory Committee on Immunization Practices (ACIP) and replace them with eight new appointees. Many of these new members lack the specialized expertise in vaccinology and epidemiology that has traditionally guided this critical advisory body. This unprecedented action undermines the scientific rigor that has underpinned vaccine policy for decades.
The Department of Health and Human Services has also altered research priorities, reportedly canceling studies on vaccine safety and effectiveness while hiring individuals with histories of promoting discredited theories linking vaccines to autism. These changes pose a threat to the robust surveillance systems that monitor vaccine safety and inform clinical recommendations.
International Implications
Kennedy’s announcement that the U.S. would halt contributions to Gavi, the international vaccine alliance, represents a troubling retreat from global health leadership. This decision affects an organization that has vaccinated 1.1 billion children and claims credit for saving 20 million lives. Reducing American support for international vaccination efforts increases the likelihood that vaccine-preventable diseases will resurge globally and eventually return to American communities.
Texas Faces Immediate Challenges
Within our state, the current measles outbreak demonstrates how quickly vaccine-preventable diseases can spread when community immunity weakens. Public health data shows that vaccination rates in affected areas of West Texas fell below critical thresholds, creating the conditions for sustained transmission.
While some Texas parents have responded to the outbreak by seeking early measles vaccination for their children—with 8.7% of six-month-olds receiving measles vaccine in April 2025, a 31.7-fold increase—this reactive approach cannot substitute for maintaining consistently high vaccination rates across all communities.
The outbreak has strained local healthcare resources and required emergency public health responses that could have been prevented through sustained high vaccination coverage. Healthcare workers in affected areas report increasing numbers of families questioning routine childhood vaccines, emboldened by conflicting messages from federal authorities.
Clinical Practice Implications
These developments create immediate challenges for pediatric practitioners and their patients’ families. The changing federal guidance creates confusion about vaccination recommendations, requiring physicians to provide clear, evidence-based information while navigating contradictory official policies.
Our DCMS colleagues report an increasing number of families expressing hesitancy about routine childhood vaccines, necessitating enhanced patient education and communication strategies. The current environment requires physicians to be prepared to discuss the benefits, safety profiles, and substantial scientific evidence supporting current vaccine recommendations. In Texas, the legislature approved House Bill 1586 (HB 1586), authored by State Rep. Lacey Hull (RHouston). Gov. Greg Abbott signed the bill into law, which will take effect on Sept. 1. This bill allows parents to download a form that will exempt their children from vaccination requirements to attend public schools. Currently, parents must contact the Texas Department of State Health Services to request that the exemption form be mailed to them.
The medical community must recognize that vaccine hesitancy is not merely a matter of education but reflects broader concerns about institutional trustworthiness. When federal health authorities provide contradictory information or promote unsubstantiated theories, public confidence in the entire vaccination program suffers.
Research and Surveillance Concerns
The current environment poses a threat to the robust research and surveillance systems that have ensured vaccine safety and effective-
ness. Canceling studies on vaccine safety and efficacy reduces our ability to identify rare adverse events and maintain public confidence through transparent monitoring.
Continued surveillance of vaccination rates and disease incidence is essential for understanding the impact of current policy changes and identifying communities at risk. This data should inform future clinical recommendations and guide public health interventions aimed at preventing disease outbreaks.
Urgent Need for Action
The current trajectory of declining vaccination rates and weakened federal policy support requires immediate action. While working on macro policy changes, physicians can also strengthen relationships with patients’ families by providing clear, compassionate guidance about vaccination decisions based on scientific evidence rather than political considerations. We must collaborate with schools, community organizations, and state health agencies to maintain robust immunization programs despite uncertainties in federal policy.
Declining vaccination rates disproportionately affect our most vulnerable populations. Coverage is consistently lower among children living below the poverty level, racial and ethnic minorities, and uninsured children. Federal policies that undermine vaccination programs essentially abandon these children to preventable suffering and death.
Healthcare systems and professional organizations must prioritize ensuring equitable access to vaccines and vaccination education. This includes supporting community health programs, improving vaccine delivery in underserved areas, and addressing cultural and linguistic barriers to vaccination.
Looking Forward
The current period represents a critical juncture for pediatric vaccination in the United States. The choices made today will determine whether we maintain the remarkable progress achieved over the past decades or witness the return of diseases that previous generations worked tirelessly to eliminate.
The physicians of DCMS remain committed to evidencebased medicine and the welfare of children in our communities. We will continue to provide accurate information about the benefits and risks of vaccination, advocate for policies that protect child health, and work to maintain high vaccination rates despite current challenges.
However, we cannot accomplish this alone. Success requires coordinated action from healthcare professionals, public health agencies, educational institutions, and community organizations. We must rebuild public trust in vaccination through transparent communication, rigorous science, and unwavering commitment to child welfare. DMJ
Jon R. Roth, MS, CAE DCMS EVP/CEO
THE EVOLVING LANDSCAPE OF CHILDHOOD VACCINATIONS
Addressing Misinformation and Promoting Uptake
by Zachary M. Most, MD, MSc, Assistant Professor, Department of Pediatrics, UT Southwestern Medical Center
IN RECENT YEARS, SEVERAL COMMUNICABLE
diseases have been at the forefront of our society. The COVID-19 pandemic remains a recent memory, while the antimicrobial resistance pandemic is accelerating, and novel pathogens, such as avian influenza, appear poised to cross over into human populations in the near future. However, perhaps the most captivating story of the year has been the reemergence of measles in the United States. Declining vaccination rates have predisposed our community to a measles outbreak, which may be just the prelude to the return of previously eliminated diseases. In fact, in 2019, the World Health Organization (WHO) identified vaccine hesitancy as one of ten global health threats facing the world over the next decade. 1 What is happening to childhood vaccination rates? Why are they declining, and what can be done about it? This is a complex issue, but despite an explosion of available misinformation and a growing distrust of experts, physicians still play a crucial role in promoting vaccine uptake.
WHAT EXACTLY IS EVOLVING?
Routine childhood vaccinations have been around since the mid1800s. Even now, more than 90% of children in the United States receive their routine childhood vaccination schedule on time. So, what do we mean when we say the landscape of childhood vaccinations is evolving?
The uptake of childhood vaccinations in Texas and the United States has been declining for the past decade, and this problem was exacerbated by the COVID-19 pandemic. The Centers for Disease Control and Prevention (CDC) has two main sources of data on childhood vaccine uptake: school entry vaccine exemption data and results from the National Immunization Survey. MMR vaccination rates for children entering kindergarten in the USA declined from 95.2% for the 2019-20 school year to 92.7% for the 2023-24 school year. In Texas, there has been an even more stark decline: In the 2011-12 school year, 99.3% of kindergarteners were up to date with the MMR vaccine, which declined to 96.9% before the COVID-19 pandemic and to 94.3% for the 2023-24 school year. However, these
SELECTED VACCINE EFFICACY AND SAFETY DATA
Pathogen: Measles
Vaccine: MMR
Effectiveness/Efficacy*: 99%
Reduction in peak incidence: 99.9%
Rate of serious adverse events^: 0.03%
Common adverse events: Fever, rash, febrile seizure
Pathogen: Hemophilus Influenzae B
Vaccine: Hib conjugated
Effectiveness/Efficacy*: 95%-100%
Reduction in peak incidence: 99.8%
Rate of serious adverse events^: <0.1%
Common adverse events: Pain, fever, rash
Pathogen: Pneumococcus
Vaccine: PCV-20
Effectiveness/Efficacy*: 97%
Reduction in peak incidence: 80%
Rate of serious adverse events^: <0.1%
Common adverse events: Pain, malaise, fever
Pathogen: Human Papillomavirus
Vaccine: HPV-9
Effectiveness/Efficacy*: 99%
Reduction in peak incidence: >80%
Rate of serious adverse events^: <0.1%
Common adverse events: Pain, fever
*Estimates of vaccine effectiveness or efficacy when completing the entire recommended series.
^Serious adverse events that are related to the vaccine in clinical trials or causal associations determined by postmarketing surveillance.
See CDC Pink Book, available online, for more details on vaccine efficacy, safety, and recommendations.
data may overestimate the vaccination rates by excluding homeschooled children. The most recent telephone interview-based National Immunization Survey demonstrated that among children under 3 years old surveyed, only 90.6% had received at least one dose of MMR by 24 months of age. 2
So, if vaccination rates are going down, are vaccine-preventable infection rates increasing? Well, yes, they are. For highly transmissible diseases like measles, over 95% of the population needs to be immune to prevent outbreaks and endemic transmission. Predictably, as measles vaccination rates have declined, the number and size of measles outbreaks have increased substantially. In 2025, there were over 1,200 confirmed measles infections in the United States, the most since measles was eliminated in 2000. Compared to most years when nearly all measles cases in the USA are associated with travel to an endemic country, in the current outbreak, most infections were acquired here in the USA. 3 A recent modeling study predicted that at current vaccination rates, measles will likely become endemic in the USA again in the upcoming decades. 4 Pertussis, another vaccine-preventable illness, has also seen a resurgence this spring and summer. It is too early to tell if this trend will continue, or if the rise in cases is due to decreased vaccine uptake, but it does raise the specter of a future where children frequently suffer from vaccine-preventable illnesses in the USA.
There are many factors contributing to the decline in vaccination rates. These include limitations in access to care (that were exacerbated by the COVID-19 pandemic) and vaccine hesitancy. But before we can address vaccine misinformation, we need to be clear on the facts.
VACCINE SAFETY AND EFFICACY
Vaccines are one of the most successful public health innovations in history. The efficacy of vaccines in preventing infection and transmission with extremely minimal risk to the recipient is a marvel of biomedical sciences and reflects centuries of work to combat ailments that were once commonplace and dangerous. See Table 1 for a summary of some vaccine-preventable illnesses and refer readers to the CDC Pink Book 5 for more information on vaccine-preventable illnesses.
However, depending on what sources you trust for information, you may be hearing a very different story about these and other vaccines.
VACCINE HESITANCY
There is a wide variety of attitudes that may be labeled “vaccine hesitancy.” This ranges from parents who refuse all vaccines for their children to parents who have their children up to date with vaccinations but have concerns. The WHO developed a framework to categorize determinants of vaccine hesitancy into three categories: contextual influences, individual and group influences, and vaccine-specific issues. 6 Contextual influences include history and culture, such as opposition to vaccines due to religious objections, or distrust of the medical establishment due to a history of injustice. Individual and group influences include personal experience with vaccines and the attitude
toward vaccines in peer groups. Vaccine-specific issues include an assessment that the risks of a vaccine outweigh the benefits. All these determinants are influenced by access to trusted sources of information, misinformation, and perceived risk of disease. Identifying and characterizing the source of a family’s vaccine hesitancy may help set the stage when counseling them on vaccine hesitancy.
VACCINE MISINFORMATION
One of the biggest changes in the landscape of vaccine misinformation has been the forums and the pace at which the misinformation propagates. Over the past two decades, organized anti-vaccine movements have grown, often with savvy use of social media, marketing, and campaigns of intimidation and harassment. The anti-vaccine movement seized on a growing distrust of the medical establishment during the COVID-19 pandemic, which amplified its reach. Exacerbating this problem even further, anti-vaccine movements have become more “mainstream” with vaccine skeptics appointed to high-ranking federal government public health positions, and more state laws passed in line with the anti-vaccine agenda. Public health leaders and vaccine experts have been trying hard to combat misinformation, but it tends to spread faster than trusted information can get out.
All providers who offer vaccinations should be aware of common misconceptions about vaccinations. As an example, some common misconceptions include: 7
• Natural infection provides stronger immunity than a vaccine – In most cases, that is false, and vaccine-induced immunity is similar or stronger with a much lower risk of morbidity than natural infection.
• Vaccines don’t prevent disease, and the reduction in the incidence of vaccine preventable illnesses is due to other factors such as hygiene and nutrition – While hygiene and nutrition have played a large role in reducing many common infectious diseases, there were dramatic decreases in the incidence of nearly all vaccine-preventable diseases shortly after routine vaccination began against those diseases.
• Vaccines cause autism or other chronic diseases – There is strong evidence to refute any causal connection between vaccines and autism or other chronic diseases.
INDIVIDUAL APPROACHES TO PROMOTE VACCINE UPTAKE
Despite patients’ families often holding deeply rooted beliefs for or against childhood vaccination, pediatricians play a large role in determining whether their patients are up to date with the recommended vaccine schedule. The American Academy of Pediatrics Red Book 2024-2027 provides a collection of evidence-based approaches to improve vaccine uptake. 8 These
include the following:
• Use a strong vaccine recommendation and the “presumptive” format – make it clear that your medical recommendation is for the child to receive their vaccines and use language that presumes the patient will get their vaccines, rather than open-ended questions about their vaccination intent.
• Use additional evidence-based communication strategies –these include motivational interviewing, pursuing adherence, and bundling the discussion of multiple vaccines together.
• Leverage systems, organizational approaches, and initiatives to improve access to vaccines – these include standing orders for vaccination, use of immunization information systems, school/ child-care entry requirements, and others.
COMMUNITY APPROACHES TO IMPROVE VACCINE UPTAKE
Beyond the impact you can have on your patients, medical providers also play an important role in public health efforts to increase vaccine uptake more widely. Despite growing mistrust in the medical establishment and in expertise more generally, surveys continue to show that overall, people in the USA do consider physicians to be trustworthy sources of health information. 9 You can play a key role in advocacy and education. Advocate for school-entry vaccination requirements, public funding to make vaccinations free or low-cost, and to improve access to medical care. Educate through outreach with trusted vaccine information, including community lectures and social media engagement.
In conclusion, vaccine hesitancy is a growing global public health threat that may worsen in the upcoming years. But not all hope is lost. We physicians and all medical providers still play a crucial role in aiding our patients to make informed medical decisions, and we should all familiarize ourselves with evidencebased strategies to combat misinformation and promote vaccine uptake. DMJ
REFERENCES
1. World Health Organization. Ten threats to global health in 2019. https://www.who.int/news-room/ spotlight/ten-threats-to-global-health-in-2019. Accessed July 11, 2025.
2. Hill HA, Yankey D, Elam-Evans LD, et al. Decline in Vaccination Coverage by Age 24 Months and Vaccination Inequities Among Children Born in 2020 and 2021 — National Immunization SurveyChild, United States, 2021–2023. Morbidity and Mortality Weekly Report 2024;73:844-844.
3. Mathis AD, Raines K, Filardo TD, et al. Measles Update — United States, January 1–April 17, 2025. MMWR. Morbidity and Mortality Weekly Report 2025;74:232-238.
4. Kiang MV, Bubar KM, Maldonado Y, Hotez PJ, Lo NC. Modeling Reemergence of Vaccine-Eliminated Infectious Diseases Under Declining Vaccination in the US. JAMA 2025.
5. Centers for Disease Control and Prevention. Epidemiology and Prevention of Vaccine Preventable Diseases. 14th ed2021.
6. MacDonald NE, Eskola J, Liang X, et al. Vaccine hesitancy: Definition, scope and determinants. Vaccine 2015;33:4161-4164.
7. Committee on Infectious Diseases; American Academy of Pediatrics. Understanding Vaccine Evaluation and Safety as an Approach to Addressing Parental Concerns. In: David W. Kimberlin M, FAAP; Ritu Banerjee, MD, PhD, FAAP; Elizabeth D. Barnett, MD, FAAP; Ruth Lynfield, MD, FAAP; Mark H. Sawyer, MD, FAAP, ed. Red Book: 2024–2027 Report of the Committee on Infectious Diseases: American Academy of Pediatrics; 2024:27-32.
8. Committee on Infectious Diseases; American Academy of Pediatrics. Evidence-Based Communication Strategies to Increase Uptake of Childhood Vaccines. In: David W. Kimberlin M, FAAP; Ritu Banerjee, MD, PhD, FAAP; Elizabeth D. Barnett, MD, FAAP; Ruth Lynfield, MD, FAAP; Mark H. Sawyer, MD, FAAP, ed. Red Book: 2024–2027 Report of the Committee on Infectious Diseases: American Academy of Pediatrics; 2024:32-36.
9. Perlis RH, Ognyanova K, Uslu A, et al. Trust in Physicians and Hospitals During the COVID-19 Pandemic in a 50-State Survey of US Adults. JAMA Network Open 2024;7:e2424984-e2424984.
Navigating the Complexities of Pediatric Mental Health Early Identification and Intervention Strategies
by Sabrina Browne, MD, Assistant Professor, Department of Psychiatry, University of Texas Southwestern Medical Center
IN 2021, THE AMERICAN ACADEMY OF CHILD and Adolescent Psychiatry, the American Academy of Pediatrics, and the Children’s Hospital Association declared a national emergency for pediatric mental health. While the COVID-19 pandemic was the catalyst for this declaration, it exacerbated an already existing crisis that continues to this day. In the five years prior to the pandemic, the prevalence of anxiety and depression among children and adolescents aged 3-17 increased by 29% and 27%, respectively. According to 2023 data from the CDC, 20% of high school students reported seriously considering suicide in the past year.
A nationwide shortage of pediatric mental health providers means that many cases go untreated. Primary care physicians are positioned on the front lines with an opportunity to identify at-risk children and intervene early. The American Board of Pediatrics has made improving training and competence in mental health care for future pediatricians a national priority. For those already in practice, there are steps that you can take today to incorporate evidence-based mental health care.
Screening
The American Academy of Pediatrics and the US Preventive Services Task Force (USPSTF) recommend screening for depression and suicidality starting at age 12. The PHQ-2 is a brief and freeto-access tool that can be easily incorporated into annual well-child
visits. It screens for anhedonia and depressed mood, and if positive, a full PHQ-9 should be administered. Scores of 5, 10, and 20 on the PHQ9 are indicative of mild, moderate, and severe depression, respectively. After intervention is started, the PHQ is helpful to give at follow-up appointments to track progress and inform treatment decisions. The ASQ is a suicide-specific screening tool that can be administered in approximately 20 seconds, according to the NIH. This can be given together with the PHQ for a more in-depth suicide risk assessment, along with the PHQ’s evaluation of depressive symptoms.
Another screening option is the PSC-17, whose internalizing score includes symptoms of mood and anxiety disorders. The GAD-7 is a commonly used screening tool for anxiety in those 12 years and older. Scores of 5, 10, and 20 are indicative of mild, moderate, and severe anxiety, respectively. It is a brief 7-item questionnaire that can be quickly administered and is useful for tracking symptoms during the course of treatment at follow-up appointments. The USPSTF recommends screening children 8 years and older for anxiety disorders. The SCARED is a screening tool that can be used for those 8 years and older and provides more in-depth information as to the subtype of anxiety.
Intervention
For those with mild depression, the AAP recommends a period of active support and close monitoring before initiating treatment. The MacArthur Foundation offers a supportive counseling fact sheet for clinicians, providing helpful guidance. It is essential to engage in active listening
and validate the child’s concerns while also focusing on solutions. After identifying a challenging situation, physicians can help patients recognize whether it can be changed or not and subsequently assist the patient in problem-solving. You can encourage the patient to identify two or three coping strategies that may be helpful and have them track their use of those strategies between follow-up appointments. If there is no improvement in 6-8 weeks, treatment should be initiated.
For those with persistent mild depression, psychotherapy should be considered as a first-line treatment. Cognitive Behavioral Therapy (CBT) has been well studied in youth and is often the go-to intervention. It teaches patients about the connection between thoughts, emotions, and actions. It can help people recognize distortions in their thinking and equip them with coping skills. For those with moderate depression, psychotherapy is also recommended, but the addition of medication may be considered. Medicines may be helpful for those who have been in psychotherapy with limited or no improvement, or those with symptoms causing significant distress or impairment in functioning. For those with severe depression, combination therapy with psychotherapy and medication at the outset of treatment should be considered. The recommendations for mild, moderate, and severe anxiety mirror those of depression.
For both depression and anxiety, selective serotonin reuptake inhibitors (SSRIs) are the medication of choice. It is recommended that two SSRIs be trialed before considering an alternative class, such as a serotonin-norepinephrine reuptake inhibitor (SNRI). Based on data from adults, it’s advisable to continue SSRIs for at least a year after the resolution of depression and/or anxiety symptoms.
If a patient screens positive for suicidality, a risk assessment should be performed. The ASQ toolkit includes a brief suicide safety assessment. The Columbia Suicide Severity Rating Scale (CSSR-S) is another tool that can be used. Assessing the frequency and intensity of suicidal thoughts, the presence of a suicide plan, and past suicide attempts can help identify high-risk patients who need emergency care.
The primary care setting is positioned to not only respond to issues as they occur but also to promote resilience, provide education, and destigmatize mental health issues. By incorporating mental health care into primary care, children and families may feel more comfortable discussing their concerns and are more likely to seek help early. PCPs can encourage children and families to strengthen their family and community relationships, which serve as protective factors during difficult times. By introducing stress management strategies, such as physical activity and deep breathing, as part of standard wellness education, children may be better equipped when stresses or crises arise.
Collaboration and Behavioral Health Integration
Integrating behavioral health into the primary care setting can be a way to increase access to care for patients and provide support to PCPs. The level of integration can range from coordinating care between medical and behavioral health clinics to having a behavioral health specialist embedded within the primary care practice. Coordinated care involves coordinating between separate teams at separate locations. While care remains siloed, this can be an effective and easily accessible way to integrate behavioral health support. In Texas, pediatric primary care providers have access to the Child Psychiatry Access Network (CPAN). This service is provided by the Texas Child Mental Health Care Consortium
(TCMHCC), established by the 86th Texas Legislature. It provides PCPs with real-time phone consultations with child psychiatrists and other behavioral health professionals. PCPs can receive assistance with questions about screening, diagnosis, and treatment, as well as referral resources.
Co-located care represents the next level of behavioral health integration, involving the medical and behavioral health teams being located at the same site, although they maintain separate schedules and treatment plans. Co-location may facilitate warm hand-offs between the medical and behavioral health teams, and families may feel more comfortable following up on care in a familiar and trusted setting. Collaborative care is an evidence-based practice and the highest level of integration. In this model, the PCP leads an interdisciplinary team that includes a care manager and collaborating psychiatrist. The American Medical Association has put together a BHI Compendium with detailed information for PCPs interested in employing this model.
Schools are another important partner in identifying and supporting high-risk children and their families. Mental health conditions like depression and anxiety often become apparent in the school setting as they may lead to disruptions in academic performance, social functioning, and behavior. TCMHCC provides services to children through the schools via Texas Child Health Access Through Telemedicine (TCHATT). Enrolled schools can refer children to the program, where they can access telehealth services with their parents’ consent. TCHATT providers offer shortterm services and can connect students with long-term services if required. PCPs cannot directly refer children, but they can encourage the child’s parents to speak with their school counselor if the service is available. The consortium maintains a searchable online database with the enrollment status of all eligible schools. As our children face unprecedented mental health challenges, collaboration between medical teams, behavioral health specialists, schools, and families to fill gaps and provide support is more crucial than ever.
DMJ
REFERENCES
Amy H. Cheung, Rachel A. Zuckerbrot, Peter S. Jensen, Danielle Laraque, Ruth E.K. Stein, GLADPC STEERING GROUP, Anthony Levitt, Boris Birmaher, John Campo, Greg Clarke, Graham Emslie, Miriam Kaufman, Kelly J. Kelleher, Stanley Kutcher, Michael Malus, Diane Sacks, Bruce Waslick, Barry Sarvet; Guidelines for Adolescent Depression in Primary Care (GLAD-PC): Part II. Treatment and Ongoing Management. Pediatrics March 2018; 141 (3): e20174082. 10.1542/ peds.2017-4082.
Ask Suicide-Screening Questions (ASQ) Toolkit. National Institute of Mental Health . January 22, 2024. Accessed July 6, 2025. https://www.nimh.nih.gov/research/research-conducted-atnimh/asq-toolkit-materials.
Behavioral Health Integration Compendium. American Medical Association 2024. Accessed July 7, 2025. https://www.ama-assn.org/system/files/bhi-compendium.pdf
Bright Futures Guidelines (Hagan JF, Shaw JS, Duncan PM, eds. Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents. 4th ed. American Academy of Pediatrics; 2017 Data and statistics on children’s Mental Health. Centers for Disease Control and Prevention. June 5, 2025. Accessed July 7, 2025. https://www.cdc.gov/children-mental-health/data-research/ index.html.
A Declaration from the American Academy of Child and Adolescent Psychiatry, American Academy of Pediatrics, and Children’s Hospital Association. American Academy of Child & Adolescent Psychiatry . Published online October 19, 2021. Accessed July 1, 2025. https://www.aacap.org/ App_Themes/AACAP/Docs/press/Declaration_National_Crisis_Oct-2021.pdf. Depression Management Tool Kit. THE JOHN D. & CATHERINE T. MACARTHUR FOUNDATION’S INITIATIVE ON DEPRESSION & PRIMARY CARE AND 3CM. 2009. Accessed July 7, 2025. https://www. macfound.org/media/article_pdfs/macarthur-depression-toolkit.pdf
Figas K, Giannouchos TV, Crouch E. Child and Adolescent Anxiety and Depression Prior to and During the COVID-19 Pandemic in the United States. Child Psychiatry Hum Dev. 2025 Feb;56(1):5262. doi: 10.1007/s10578-023-01536-7. Epub 2023 Apr 24. PMID: 37093526; PMCID: PMC10123555. Hostutler C. Considerations for Integrating Behavioral Health and Primary Care. Pediatrics Nationwide. November 14, 2017. Accessed July 6, 2025. https://pediatricsnationwide.org/2017/11/14/ considerations-for-integrating-behavioral-health-and-primary-care/.
Jane Meschan Foy, Cori M. Green, Marian F. Earls, COMMITTEE ON PSYCHOSOCIAL ASPECTS OF CHILD AND FAMILY HEALTH, MENTAL HEALTH LEADERSHIP WORK GROUP, Arthur Lavin, George LaMonte Askew, Rebecca Baum, Evelyn Berger-Jenkins, Thresia B. Gambon, Arwa Abdulhaq Nasir, Lawrence Sagin Wissow, Alain Joffe; Mental Health Competencies for Pediatric Practice. Pediatrics November 2019; 144 (5): e20192757. 10.1542/peds.2019-2757
AI for Pediatricians Why AI Literacy Matters Today
THE
RAPID INTEGRATION OF ARTIFICIAL
INTELLIGENCE
(AI) into healthcare systems necessitates a paradigm shift in medical education, particularly for practicing and future pediatricians. A 2025 McKinsey survey revealed that a staggering 85% of healthcare systems are actively piloting or adopting AI tools.1 Despite this widespread adoption, a significant challenge remains: a lack of preparedness among physicians to critically evaluate and effectively utilize these technologies. The increasing influence of AI on every facet of medical care underscores a crucial point: developing AI literacy is no longer a supplementary skill but an indispensable requirement for providing safe, equitable, and effective patient care. While AI technologies have steadily advanced over several decades, the emergence of Generative AI represents a pivotal moment, transforming AI into a foundational general-purpose technology, similar to the revolutionary impact of smartphones.
This new era was dramatically ushered in with the release of OpenAI’s chatbot, “ChatGPT,” in November 2022.2 This groundbreaking development sparked a fierce competition among technology giants, including Google, Anthropic, Meta, and X, to develop their own sophisticated generative AI models. The implications for healthcare are profound. Generative AI, capable of creating novel content such as text, images, and summarizing reports, has the potential to revolutionize diagnostics, treatment planning, and administrative tasks.
For pediatricians, understanding and navigating this evolving technological landscape is paramount. AI tools offer significant benefits to pediatricians, enhancing both their professional and personal productivity. However, without a strong foundation in AI literacy, pediatricians risk misinterpreting AI-generated insights, perpetuating biases embedded within algorithms, or inadvertently compromising patient safety. Equipping pediatricians with AI education is crucial for their ability to use these powerful tools responsibly and ethically, ultimately improving child health outcomes.
What Is AI Literacy in Healthcare?
Why It Matters to Pediatricians
by Jawahar Jagarapu, MD, MS, Associate professor, pediatrics, neonatal-perinatal medicine, UT Southwestern Medical Center, Vice Chair of Pediatrics, Texas Health Dallas Presbyterian Hospital, Member of TMA Committee on Health IT and AI
AI technologies aren’t just for software professionals—they’re general-purpose tools with wide applications in healthcare. Understanding how AI works, including basic concepts such as algorithms, machine learning, and especially large language models (LLMs), helps physicians adopt new technologies in both their professional and personal lives. This knowledge enables them to evaluate benefits and risks while safely incorporating AI into clinical workflows. Like EHR literacy a decade ago, AI literacy is now a critical competency for all pediatricians, whether in primary care or subspecialty practice. Ultimately, it’s not about programming —it’s about informed use and oversight.
While AI influences many aspects of our personal lives, from selecting what to buy next to choosing a movie on Netflix, I will focus primarily on its professional applications.
If you haven’t heard yet, Ambient AI technology, also known as AI Scribes, is a type of AI that can seamlessly record conversations in a clinic setting between physician and patients and prepare a note for you by the end of the session. Think of it as an assistant that records all the details and then compiles a note afterward, filtering out unnecessary information. Microsoft’s DAX Copilot and Abridge are examples of Ambient AI technologies.3,4 Other tools are gradually emerging within electronic health records, such as Epic, where AI helps with chart summarization, drafting automated patient messages, and assisting with billing documentation.5
AI as a clinical decision support system is rapidly evolving, with major companies experimenting with clinical decision support models.6 In a study, the Google AMIE assistant outperformed physicians in a conversational, text-based diagnostic encounter. We will continue to see AI evolve to support clinical decision-making at the point of care. For example, based on patient symptoms input and context,
large language models like ChatGPT can provide a relatively accurate differential diagnosis, evaluation, and management approach.
Medical literature continues to grow exponentially, making it increasingly difficult for practicing physicians to keep pace with the ever-expanding body of medical knowledge. AI tools like Open Evidence and Scopus AI have a significant ability to answer clinical questions by aggregating up-to-date literature and summarizing information for physicians.7,8 They significantly reduce the time required to search for evidence, find the correct answers, and facilitate the provision of appropriate patient care. For example, Open Evidence is a literature search model trained on a large volume of biomedical literature; it’s capable of producing evidence summaries with source citations, directly linking to PubMed.
AI tools can significantly streamline and enhance many practice-related administrative tasks that traditionally consume valuable physician time. These include automatically generating well-structured prior authorization letters with appropriate clinical justifications, addressing insurance claim denials by identifying missing information or coding errors, creating personalized patient information leaflets tailored to specific conditions and demographics, and managing appointment scheduling with intelligent prioritization based on clinical urgency. Customized agents, such as custom copilots, can be effectively developed and integrated into the operational workflows to address various pain points associated with administrative tasks. Additionally, AI can assist with documentation compliance checks and even help optimize billing practices to reduce rejected claims. Platforms like Doximity offer a free HIPAA-compliant AI platform version to generate prior authorization letters and other use cases.
physicians believed AI scribes had a positive influence on their visit interactions, a sentiment echoed by 56% of patients.9 This technological advancement exemplifies the humanization of medicine by fostering direct physician-patient interaction, free from the screenbased distractions and interruptions that can hinder conversations.
Understanding AI Limitations
• AI tools, especially Generative AI chatbots, can produce inaccuracies and “hallucinations.” Always verify information from AI chatbots, particularly for biomedical literature searches, as they may generate fake citations.
Training Opportunities and How to Get Started
Professional Organizations
American Board of Artificial Intelligence in Medicine (ABAIM): Offers basic and advanced educational programs and certifications for physicians (https://abaim.org/)
AAP Council on Information Technology: Provides AI resources (https://www.aap.org/AI)
Texas Medical Association: The Committee on Health IT and AI has developed AI learning resources for the members (https://www.texmed.org/Verondi/ Templates/TmaPage.aspx?pageid=64335)
Educational Events
Local grand rounds or AI symposia
Online Resources
YouTube channels, such as StatQuest (https://www. youtube.com/@statquest)
Book Resources
In my book, “ChatGPT for Pediatricians” (available on Amazon, amazn.so/DMExEnq), I have outlined the basics and some advanced use cases of ChatGPT as they pertain to pediatricians. I also mentioned some of my favorite books on my blog site, https://www.chatgptforpediatricians.com/ books-for-understanding-ai-in-healthcare
Society Role
County and state medical societies can facilitate workshops, discussion groups, and demonstrations of AI tools to foster collaboration and knowledge sharing among members.
Today, parents often turn to AI for medical advice, arriving at their pediatrician’s office with AI-generated diagnoses and treatment suggestions. An AI-literate physician is better equipped to understand and serve these technology-savvy consumers. Generative AI models can currently offer a wide range of differential diagnoses, suggest investigations, and propose management strategies based on inputted symptoms, always with a disclaimer to seek professional medical advice. Consequently, physicians now face the challenge of explaining why AIgenerated diagnoses, evaluations, and management plans may not apply to a specific case. This trend is further amplified by recent advancements, such as Google’s AI mode in search functions, which summarizes answers and provides source citations for its recommendations.
Core Areas of AI Literacy for Pediatricians
Understanding Clinical Use Cases (Example: Ambient AI)
Ambient AI, leveraging natural language processing and speech-to-text functionalities, records, summarizes, and translates physician-patient encounters. Tools such as DAX CoPilot and Abridge demonstrate the significant evolution of this technology. Numerous studies evaluating AI scribes reveal overwhelmingly positive impressions from both physicians and patients. For instance, a study by Kaiser Permanente indicated that 86% of
• Avoid over-reliance on AI without independent validation.
• HIPAA Compliance Is Paramount:
• Never input Protected Health Information (PHI) or identifiers into AI chatbots.
• Unpaid versions of these tools may use your data for future model training, which constitutes a clear HIPAA violation if PHI is involved.
• Companies like Microsoft offer enterprise-level Copilot architecture that is HIPAA-compliant, thereby reducing the risk of HIPAA violations.10
Ethical Awareness
• Bias, Transparency, and Accountability: The outputs of AI systems can vary significantly depending on the quality and diversity of their training data. For example, a predictive model trained on demographically imbalanced data may produce different results when applied to diverse populations. Understanding the data sources behind model development is crucial. Additionally, some AI systems are “black boxes,” meaning their decision-making processes are not easily explainable.
• Informed Consent and Explainability with Families: Transparency is key when using AI systems, such as AI scribes, in your practice. Parents and families need to be informed about their use.
In conclusion, current AI technologies hold substantial promise for enhancing physician efficiency and practice. Physicians who embrace these innovations are well-positioned to improve both their professional performance and personal productivity. DMJ
REFERENCES
1. https://www.mckinsey.com/industries/healthcare/our-insights/generative-ai-in-healthcarecurrent-trends-and-future-outlook
2. https://en.wikipedia.org/wiki/ChatGPT
3. https://blogs.microsoft.com/blog/2024/09/26/a-year-of-dax-copilot-healthcare-innovation-that-refocuses-on-the-clinician-patient-connection/
4. https://www.abridge.com/
5. https://www.epic.com/software/ai/
6. https://research.google/blog/amie-a-research-ai-system-for-diagnostic-medical-reasoningand-conversations/
7. https://www.openevidence.com/ 8. https://www.elsevier.com/products/scopus/scopus-ai 9. https://catalyst.nejm.org/doi/full/10.1056/CAT.25.0040
10. https://techcommunity.microsoft.com/blog/securitycopilotblog/microsoft-copilot-for-security-now-covered-by-hipaa-business-associate-agreement/4220174
The Economic Cost of Sexually Transmitted Infections in Dallas County
by Ali Dadpay, PhD and Philip Huang, MD, MPH, Dallas County Health and Human Services
DALLAS COUNTY, WITH A POPULATION OF OVER
2.6 million, ranks second in population size and STI burden among Texas counties. The demographic distribution—balanced between men and women—and increasing urban density create conditions ripe for STI transmission.
High rates of Chlamydia, Gonorrhea, and Syphilis persist despite decades of public health efforts. Dallas County also leads the state in the number of people living with HIV. These trends carry significant economic, social, and healthcare implications, especially for underserved and high-risk populations.
In addition to clinical impacts, STIs impose a heavy financial toll on public systems and individual lives, contributing to lost productivity, increased medical spending, and a growing need for long-term care services.
Methods
This study adopts a comprehensive Cost-of-Illness (COI) framework to estimate the financial impact of STIs in Dallas County. The methodology integrates:
Epidemiological Data: Data on STI incidence were obtained from the Texas Department of State Health Services (DSHS), disaggregated by sex and year (2021–2022).
Direct Medical Costs: Includes diagnostics, treatment, follow-up, hospitalization, medications, and long-term care. HIV-related costs reflect the full continuum of care, including antiretroviral therapy (ART).
Indirect Costs: Calculated from productivity losses due to absenteeism, disability, and premature mortality. Informal care (e.g., unpaid caregiving by family/friends) is also considered.
Cost Estimates per Infection: Sourced from national studies including Chesson et al. (2021), Kumar et al. (2021), and Schnitzler et al. (2021). These were applied to Dallas County’s case counts via linear extrapolation.
Monte Carlo Simulation: Using WinBUGS, we ran 10,000 simulations to derive confidence intervals around total cost estimates. This approach allows for uncertainty in unit costs and case variation.
Inflation Adjustment: All cost estimates were adjusted to 2022 U.S. dollars using the Consumer Price Index for medical care.
Congenital Syphilis Costs: Based on the National Governors Association’s estimate of $58,000 per case, accounting for neonatal care, developmental disability support, and lifetime health interventions.
Results:
STI Cases and Burden in Dallas County (2022):
• HIV: 21,065 individuals living with HIV; 910 new diagnoses.
• Chlamydia: 22,073 cases; incidence rate 848.7/100,000—above the state average.
• Gonorrhea: 10,696 cases—11% increase since 2020.
• Syphilis: 2,027 cases—a 45% increase since 2020.
• Congenital Syphilis: 148 cases—a 147.84% increase since 2018.
Limitations:
This report is subject to several limitations that may affect the precision and generalizability of the findings:
Use of National Average Cost Estimates: The cost per STI case was derived from national studies due to the unavailability of localized Dallas County-specific cost data. These national averages may not fully reflect the true healthcare utilization patterns, service costs, or insurance structures in Dallas County.
Omission of Non-Monetized Indirect Costs: Although productivity losses were incorporated into the analysis, several important indirect costs—such as caregiver burden, long-term social stigma, reduced quality of life, and mental health impacts—were not monetized due to methodological challenges and lack of local data. This likely results in an underestimation of the total societal burden.
Lack of Granular Subpopulation Analysis: The report does not disaggregate costs by race/ethnicity, socioeconomic status, or geography within the county. These factors are known to influence STI burden and access to care and would be valuable in designing targeted interventions.
Assumptions in Simulation Models: The Monte Carlo simulation
Save theDate 2025
DALLAS COUNTY MEDICAL SOCIETY PRESIDENTIAL GALA
SATURDAY, DECEMBER 13, 2025
GEORGE W. BUSH HALL OF STATE SMU CAMPUS
Summary of STI Economic Cost in Dallas County (2022):
assumes normally distributed inputs and stable cost structures. While these simulations provide a range for uncertainty, they may not fully capture unexpected economic shocks, treatment disruptions, or healthcare delivery changes.
Exclusion of Co-infections and Reinfections: Individuals may be diagnosed with multiple STIs within a year, which can amplify medical and societal costs. This analysis assumes independent cases and does not account for co-infections, which may underestimate the total economic burden.
Limited Data on Informal and Community-based Care: The cost and contribution of informal caregiving, community health services, and harm reduction programs (e.g., condom distribution, PrEP and PEP access) were not included. These are critical components of the STI prevention and treatment ecosystem and may affect long-term costs.
Data Reporting Lags and Incompleteness: Epidemiological data from DSHS may be subject to underreporting or delays in case confirmation, particularly for syphilis and congenital syphilis. As a result, the incidence figures used may be conservative.
Conclusions and Recommendations
In 2022, Dallas County faced nearly $400 million in STI-related costs— most from HIV. With rising incidence across multiple STIs, the financial and human cost of inaction is high. By prioritizing prevention, investing in early treatment, and strengthening partnerships, the county can reduce the burden of disease and improve population health outcomes.
Based on the significant and rising economic burden of STIs—particularly HIV and congenital syphilis—Dallas County should prioritize the following targeted and cost-conscious public health actions:
Invest in Prevention as a Cost-Saving Strategy: With HIV alone accounting for over $382 million in economic burden annually, expanding evidence-based prevention (e.g., PrEP, condom access, behavioral interventions) could yield substantial healthcare savings and reduce long-term disability costs.
Scale Early Detection and Rapid Treatment Programs: Earlier diagnosis and timely treatment can prevent disease progression and transmission, thus reducing the lifetime treatment costs. Routine screening programs—
especially for syphilis in prenatal care and chlamydia in sexually active youth—can generate both clinical and economic benefits.
Prioritize High-Burden Populations for Cost-Effective Impact: Targeting interventions to disproportionately affected populations (e.g., young adults, men who have sex with men, and communities of color) can achieve a more efficient return on investment by preventing the highest-cost cases.
Enhance Data Systems to Reduce Avoidable Costs: Improved STI surveillance, reporting accuracy, and real-time data integration can support faster public health responses and reduce the lag between diagnosis and intervention, which is critical for curbing costly outbreaks such as congenital syphilis.
Integrate STI Services Across Healthcare Touchpoints: Embedding STI testing, education, and referral into primary care, emergency departments, and maternal health clinics reduces missed opportunities for early intervention and cost escalation.
Secure Dedicated Funding Streams for STI Infrastructure: Stable funding enables local health departments to maintain contact tracing, case management, and community outreach teams—all of which are cost-effective tools in reducing incidence and lifetime care costs.
Evaluate and Expand Harm Reduction Programs: Programs like condom distribution, syringe services, and peer education have proven to reduce STI incidence at a fraction of treatment costs and should be included as part of an economically rational public health strategy.
These recommendations are grounded in economic rationale and aim to reduce the nearly $400 million annual burden STIs place on Dallas County’s healthcare system, workforce productivity, and public health infrastructure. DMJ
REFERENCES
Chesson, H. W., Blandford, J. M., Gift, T. L., Tao, G., & Irwin, K. L. (2004). The estimated direct medical cost of sexually transmitted diseases among American youth, 2000. Perspectives on Sexual and Reproductive Health, 36(1), 11–19.
Chesson, H. W., Peterman, T. A. (2021). The estimated lifetime medical cost of syphilis in the United States. Sexually Transmitted Diseases, 48, 253–259. Chesson, H. W., Spicknall, I. H., Bingham, A., Brisson, M., Eppink, S. T., Farnham, P. G., ... & Gift, T. L. (2021).
The estimated direct lifetime medical costs of sexually transmitted infections acquired in the United States in 2018. Sexually Transmitted Diseases, 48(4), 215–221. Dean, L. T., Montgomery, M. C., Raifman, J., Nunn, A., Bertrand, T., Almonte, A., & Chan, P. A. (2018). The affordability of providing sexually transmitted disease services at a safety-net clinic. American Journal of Preventive Medicine, 54(4), 552–558.
Eppink, S. T., Kumar, S., Miele, K., et al. (2021). Lifetime medical costs of genital herpes in the United States: Estimates from insurance claims. Sexually Transmitted Diseases, 48, 266–272. Fernandes, N. (2020). Economic effects of coronavirus outbreak (COVID-19) on the world economy. SSRN Electronic Journal. https://doi.org/10.2139/ssrn.3557504
Hauben, E. I., & Hogendoorn, P. C. (2015). Epidemiology of primary bone tumors and economical aspects of bone metastases. In Bone Cancer (pp. 5–10). Elsevier. Jo, C. (2014). Cost-of-illness studies: Concepts, scopes, and methods. Clinical Molecular Hepatology, 20(4), 327.
Kennedy, A. K., Kaushik, G., Dubinsky, E. L., Huseynli, A., Jonson-Reid, M., & Plax, K. (2022). Direct and indirect cost savings from sexually transmitted infection testing, treatment, and counseling among foster youth. Sexually Transmitted Diseases, 49(1), 86–89. https://doi.org/10.1097/ OLQ.0000000000001511
Kreisel, K. M., Spicknall, I. H., Gargano, J. W., Lewis, F. M., Lewis, R. M., Markowitz, L. E., ... & Weinstock, H. S. (2021). Sexually transmitted infections among US women and men: Prevalence and incidence estimates, 2018. Sexually Transmitted Diseases, 48(4), 208. Kuhlmann, J., Keaei, M., Conde, R., Evers, S. M., Gonzalez, J., Govers, M., et al. (2017). A cost-of-illness study of patients with HIV/AIDS in Bogotá, Colombia. Value in Health Regional Issues, 14, 103–107. Kumar, S., Chesson, H., Spicknall, I. H., et al. (2021). The estimated lifetime medical cost of Chlamydia, Gonorrhea, and Trichomoniasis in the United States, 2018. Sexually Transmitted Diseases, 48, 238–246.
National Governors Association. (2024, January 9). Issue brief: Congenital syphilis. https://www.nga. org/publications/issue-brief-congenital-syphilis/#:~:text=If%20left%20untreated%2C%20congenital%20syphilis,cost%20an%20average%20of%20%2458%2C000.
National Institute for Health and Care Excellence (NICE). (2013). Guide to the methods of technology appraisal 2013. National Institute for Health and Care Excellence. Owusu-Edusei, K. Jr, Chesson, H. W., Gift, T. L., Tao, G., Mahajan, R., Ocfemia, M. C. B., et al. (2008). The estimated direct medical cost of selected sexually transmitted infections in the United States, 2008. Sexually Transmitted Diseases. Schnitzler, L., Jackson, L. J., Paulus, A. T., Roberts, T. E., & Evers, S. M. (2021). Intersectoral costs of sexually transmitted infections (STIs) and HIV: A systematic review of cost-of-illness (COI) studies. BMC Health Services Research, 21(1), 1–10. Tarricone, R. (2006). Cost-of-illness analysis: What room in health economics? Health Policy, 77(1), 51–63.
Thompson, D. (n.d.). Increasing awareness of sexually transmitted infection through education: A quality improvement initiative. Texas Woman’s University. World Health Organization. (2019). Sexually transmitted infections (STIs). https://www.who.int/newsroom/fact-sheets/detail/sexually-transmitted-infections-(stis) Zorginstituut Nederland. (2018). Richtlijn voor het uitvoeren van economische evaluaties in de gezondheidszorg, 2016. www.zorginstituutnederland.nl
On behalf of the DCMS Foundation, we are deeply grateful for the incredible generosity of our donors. Your remarkable support fuels our mission and makes everything we do possible. Thank you for standing with us—your commitment truly makes a meaningful difference in the lives of many.
$100,000+
Donna L. Casey, MD; Lisa Casey, MD; Ms. Mary Casey & Ms. Cindy Brown
Samuel J. Chantilis, MD
Richard W. Snyder, MD & Shelley A. Hall, MD
$50,000-$99,999
Donna L. Casey, MD & Gary L. Weinstein, MD
DCMS Alliance Foundation 'Beyond Duty' Gala
The Steven R. Hays, MD and Suzanne I. Ahn, MD Legacy Gift
$15,000-$49,999
Baylor Scott & White Health
Hoblitzelle Foundation
Methodist Health System
A. Joe Saad, MD and Rana D. Saad, PhD
Southwestern Medical Foundation
Roy & Christine Sturgis Charitable Trust, Bank of America, N.A., Trustee
Texas Health Resources Dallas
$10,100-$14,999
Mark Casanova, MD
(in honor of Dr. Robert Fine & DCMS Staff )
H. Gordon Green, MD
(in memory of Drs. James Black, James Homan, & AJ Gill)
Dr. Beth & Mr. Mick Kassanoff-Piper, MD
$5,100 - $10,000
Anesthesia Partners of Dallas, PLLC
Dr. Jack Bankhead
(In memory of Dr. AJ Gill)
Carolee D. Estelle, MD
Dr. Raymond L. Fowler
Dr. & Mrs. Robert Haley
Laboratory Physicians Association
Lee Ann Pearse, MD
Mr. Jon and Ms. Liz Roth
Cynthia Sherry, MD and Dean Sherry, PhD
Lisa Swanson, MD
Ruben Velez, MD
$5,000
Dr. Jeffrey and Barbara Adelglass
Justin M. Bishop, MD
John Carlo, MD
Dr. Alex and Jeanie Chuang
Drs. Wendy M. and Andrew Chung
Dr. Maynard and Rosemarie Ewton
Robert L. Fine, MD, FACP, FAAHPM
Deborah Fuller, MD
Warren Lichliter, MD
Todd Moen, MD
Wendy Parnell, MD
Karl Rathjen, MD
TMA Insurance Trust
$1,100-$4,999
Robert K. Bass, MD
Sue Bornstein, MD
(in honor of Richard W. Snyder, II, MD)
James G. Brooks, Jr., MD
William Bruck, MD
Evangeline Cayton, MD
Drs. Tuoc Dao & Calvin Chan
Dr. & Mrs. Fred Ciarochi
BM Cohen Mb, Ch, B, MD
Gates Colbert, MD
Kenneth H. Cooper, MD
Cindy Lou Corpier, MD
Randall Wayne Crim, MD
Rebecca Euwer, MD
Dr. Stanley Feld
Sharon Gregorcyk, MD
Philip Huang, MD
Philip Huber, MD
County Judge Clay Lewis Jenkins
Drs. Rainer & Anita Khetan
Roger Khetan, MD
William R. Lumry, MD
Dustin Manders, MD
Mary Moren-Favrat (in memory of Tony Favrat)
Dennis E. Newton, MD
Dr. Lee and Mrs. Angelique Reagor
Richard Sachson, MD
Dr. Thomas Schlieve
Anil Kumar Tibrewal, MD
Dr. Charles and Barbara Van Duyne
Dr. Robert & Jane Viere
Dr. A. Worsham
$1,000
Cesar A. Albarracin, MD
American Muslim Women Physicians Association
Amy S. Anderson, MD & Paul A. Neubach, MD
Anonymous
Martin Russel Berk, MD
Sita M. Boppana, MD
Albert Broders, III, MD
Drs. John Gilmore & Linda Burk
Remigio Capati, MD
Drs. Ravi and Darshna Chandrasekhara
Kwok Wai Chiu, MD
Michael & Anne Darrouzet
Joy Lo Chen & Albert Lo Donation Fund
Dr. M. Brett Cooper & Mr. Matthew Mirizzi
Byron Cryer, MD
J. Michael Desaloms, MD
Shaina Drummond, MD
Dr. and Mrs. Robert Dyo
Dr. Paul & Macki Ellenbogen
Edwin Escobar-Vazquez, MD (in honor of DCMS Wellness Program)
Mark Fleschler, MD
Jeri Beth Foshee, MD
Danielle Ford, MD
Dr. & Mrs. John R. Foster
Murray Gordon, MD
Maureen Shevlin Guitterrez, MD
Amit Guttigoli, MD
Dr. J. Kent & Lynn Hamilton
Munir Hazbun, MD
H.A. Tillmann Hein, MD
Michelle M. Ho, MD
Dr. Joel and Wendy Holiner Family
Philanthropic Fund of the Dallas Jewish Community Foundation
Rajeev Jain, MD
Rehana Kausar, MD
Ronald Kerr, MD
Haskell Kirkpatrick, MD
Cheryl Cox Kinney, MD (in honor of Samuel Chantilis, MD)
Kevin Klein, MD
Dr. & Mrs. Stephen Landers (in honor of Donna Casey, MD)
Ann Marilyn Leitch, MD
Benjamin C. Lee, MD & Jodi D. Jones, MD
Alexandra Dresel Lovitt, MD
Kristi McIntyre, MD
Michael S. Milner, MD
Chander and Narinder Monga, MD
Thomas Neary
Dr. Mel Platt
Matthew Pompeo, MD
Dr. R. Lynn & Cynthia A. Rea
Kim Rice, MD
Marcial Andres Oquendo Rincon, MD
Dr. Randall and Barbara Rosenblatt
Karen Roush, MD
Dr. L. Keith and Lori K. Routh
Thomas K. Russell, MD
Ann Heard-Sakhaee and Khashayar Sakhaee, MD
Terilyn Scott-Winful, MD
Linda and Les Secrest, MD
William Shutze, MD
The Physicians of Health Central Women's Care
Albert Tesoriero, MD
Dr. George and Carolyn Toledo
Christopher Vesy, MD
Bruce Wall, MD
Drs. Brad & Rebecca Weprin
Dr. Barry & Shana Wilcox Donor Advised Fund at Schwab Charitable
Elizabeth Wilder, MD
David Winter, MD
Megan M. Wood, MD (in memory of Dr. Alison Laidley)
Timothy N. Zoys, MD
$500-$999 Anonymous
Katrina Bradford, MD
Sheila Chhutani, MD
Stephanie Elmore, MD
Dr. & Mrs. Alan Frankfurt
(in honor of Donna Casey, MD)
Grady G. Goodwin, MD
Kaela Jill Gordon, MD
Robert Gross, MD
Richard Joseph, MD
Charles Levin, MD
Aekta Malhotra, MD
Maranatha R. Mclean, MD
Mark Miller, MD
John D. Minna, MD
Bruce Phillips, MD
William Stevens, MD
Laurie Jayne Sutor, MD
Brent Walker, DO
Dr. & Mrs. Peter Walling
Dr. William R. & Katie Weaver Charitable Trust
Claudia Werner, MD
$0-$499
Anna Acuna and Elevance Health Anonymous
Bagyalakshmi Arumugham, MD
Jean McClintock Bratcher, MD
Paul and Jackie Campbell (in memory of Tony Favrat)
Allan Chernov, MD
Stephanie Copeland, MD
Jason Davis, MD
Emma Dishner, MD
Pat Fox Fulgham, MD - Foundation for Urology Research & Education
Robert Garrett, MD (in honor of Donna Casey, MD)
Dr. Joe & Ann Gaspari
Lauren A. Gillory, MD
Elliot Ginchansky, MD
Jennifer Delia Heffernan, MD
Drs. Pratik Kapadia and Nazish Islahi
Thomas Myers, Jr.
Thomas W. Newsome, MD
David E. Ostrow, MD
Archana Rao, MD
Dr. Philip and Sandy Raskin
Michele Diane Reynolds, MD
Wyatt Easterling Rousseau, MD
Charles Rubey, MD
Zarina Sharalaya, MD
Susan Michaelle Smart, MD
Cedric Spak, MD
Charles Tandy, MD
Gary Lee Tunell, MD
Kim Vernon, MD
Kim Bruce Yancey, MD
Surgery
Patrick H. Pownell, MD, FACS
Plastic and Reconstructive Surgery
Dallas Office
7115 Greenville Ave. Ste. 220 (214) 368-3223
Plano Office
6020 W. Parker Road, Ste. 450 (972) 943-3223
www.pownell.com
Continuing Education Compliance
CE Broker - Compliance with Confidence
Easily understand your specific CME requirements and compliance status, find and take renewal-ready courses, and report your course completions directly to the Texas Medical Board for a hassle-free renewal.
Benefits:
Find, complete, and report approved CME; View your forever course history; Take CME on the go with the free mobile app; Access to 24/7 support and more!
Fertility Specialists
Dallas-Fort Worth Fertility Associates
Growing Family Trees Since 1999
Certified, American Board of Plastic Surgery TMLT - Inside front cover
www.dallasfertility.com
Samuel Chantilis, MD
Karen Lee, MD
Mika Thomas, MD
Ravi Gada, MD
Laura Lawrence, MD
Jennifer Shannon, MD
Monica Chung, MD
Melanie Evans, MD
Dallas: 5477 Glen Lakes Drive, Ste. 200, Dallas, TX 75231, 214-363-5965
Baylor Medical Pavilion: 3900 Junius Street, Ste. 610 Dallas, TX 75246, 214-823-2692
Medical City: 7777 Forest Lane, Ste. D–1100 Dallas, TX 75230, 214-692-4577
Southlake: 910 E. Southlake Blvd., Ste. 175 Southlake, TX 76092, 817-442-5510
Plano: 6300 W Parker Road, Ste. G26 www.cebroker.com
Dallas County Medical Society (DCMS) does not endorse or evaluate advertised products, services, or companies nor any of the claims made by advertisers. Claims made by any advertiser or by any company advertising in the Dallas Medical Journal do not constitute legal or other professional advice. You should consult your professional advisor.
Children’s Health Rehabilitation & Therapy Symposium – Page 5 Texas Health and Human Services/ Texas Health Steps – Page 11
Southwest Diagnostic Center for Molecular Imaging – Page 22
Christopher Bell, MD, FACS – Page 23
Cara East, MD – Page 23
TMA Insurance Trust - Inside back cover SWMIC – Back cover
Leading provider of compliance-based medical waste solutions.
Still using cardboard boxes for your medical waste collection?
Let Biogenic Solutions upgrade your facility with our OSHAcompliant, mobile waste disposal containers & reusable Sharps program for DCMS members.
|
Retina Institute of Texas, PA
Vitreous and Retina Diagnosis and Surgery www.retinainstitute.com
Maurice G. Syrquin, MD
Marcus L. Allen, MD
Gregory F. Kozielec, MD
S. Robert Witherspoon, MD
3414 Oak Grove Ave. Dallas, TX 75204 | (214) 521-1153
Baylor Health Center Plaza I 400 W. Interstate 635, Ste. 320 Irving, TX 75063 | (972) 869-1242
3331 Unicorn Lake Blvd. Denton, TX 76210 | (940) 381-9100
1010 E. Interstate 20 Arlington, TX 76018 | (817) 417-7769
and Vitreous www.DrPruitt.com (817) 966-0235 | partners@dallas-cms.org www.dallas-cms.org
Robert E. Torti, MD
Santosh C. Patel, MD
Henry Choi, MD
Steven M. Reinecke, MD
Philip Lieu, MD, FASRS
1706 Preston Park Blvd., Plano, TX 75093 | (972) 599-9098
2625 Bolton Boone Drive, DeSoto, TX 75115 | (972) 283-1516
1011 N. Hwy 77, Ste. 103A Waxahachie, TX 75165 | (469) 383-3368
18640 LBJ Fwy., Ste. 101 Mesquite, TX 75150 | (214) 393-5880
10740 N. Central Expy., Ste. 100 Dallas, TX 75231 | (214) 361-6700
James R. Sackett, MD
Daniel E. Cooper, MD
Paul C. Peters Jr., MD
Andrew B. Dossett, MD
Eugene E. Curry, MD
Daniel A. Worrel, MD
Kurt J. Kitziger, MD
Andrew L. Clavenna, MD
Holt S. Cutler, MD
Mark S. Muller, MD
Todd C. Moen, MD
J. Carr Vineyard, MD
M. Michael Khair, MD
William R. Hotchkiss, MD
J. Field Scovell III, MD
Jason S. Klein, MD
Brian P. Gladnick, MD
8315 Walnut Hill Lane, Ste. 125, Dallas, TX (214) 363-6000
H. Pruitt, MD, FACS ADVERTISE YOUR PRACTICE HERE!
Bradford S. Waddell, MD
William A. Robinson, MD
Tyler R. Youngman, MD
Justin Cardenas, MD
9301 N. Central Expy., Ste. 500, Dallas, TX 75231
3800 Gaylord Pkwy., Ste. 710, Frisco, TX 75034
Phone: (214) 466-1446 Fax: (214) 953-1210
BIOGENIC SOLUTIONS,
based in Dallas, Texas, is a leading provider of medical waste management and compliance solutions with over 60 years of combined expertise in logistics, customer service, sales, and operations. The company is dedicated to transforming the medical waste management industry through innovation, strict compliance, and outstanding customer service.
By modernizing waste collection, Biogenic Solutions offers reusable, leakproof mobile bins designed to enhance safety, reduce labor, and improve compliance with federal and state regulations. Their advanced bins minimize risks from leaks and odors while reducing the physical strain on healthcare staff. In addition, Biogenic Solutions simplifies regulatory compliance with expert support in meeting OSHA, HIPAA, and DOT standards. They provide training modules, safety plans, safety audits, and SDS management, ensuring healthcare facilities maintain a safe and compliant environment.
Renowned for their customer-centric approach, Biogenic Solutions offers a single point of contact for all service needs, enhancing customer satisfaction and efficiency. Their easy-to-use online platform enables clients to manage service schedules, manifests, and invoices. As the fastestgrowing privately-owned medical waste service provider in the U.S. and the exclusive partner of the Dallas County Medical Society, Biogenic Solutions has earned the trust of healthcare facilities throughout Texas.
For more information on how Biogenic Solutions can transform your medical waste management processes, visit their website: https://biogenic.us/
MEDICAL SPACE ADVISORS is the foremost provider of healthcare tenant representation services in Texas when you want to lease or buy medical office space. We also specialize in helping medical tenants strategically negotiate office lease renewals. We have helped numerous health care systems, group practices, and solo practitioners since our founding in 2001. We understand your unique space requirements and the challenges associated with operating in an evolving and highly regulated industry. These space requirements have ranged from highly technical clean rooms and sterile compounding laboratories to a small clinic space in a retail strip center.
Medical Space Advisors manages every aspect of the leasing or buying process including demographic and competition analysis, extensive market research and strategic negotiations to ensure that we secure the most optimal real estate for your specific requirement. We entirely represent your interests in the process and our fee is paid by the building owner.
Please contact Evan Reynolds to learn more about our services at 214.718.6777 or ereynolds@medicalspaceadvisors.com.
Helping to Protect Your Income Just Got Easier
Medical Specialty Own Occupation Disability Insurance Without Having to Verify Your Income When Enrolling
Here’s what’s included in this plan at no additional cost:
• Own occupation coverage for your medical specialty.
TMA members under age 65 have access to $5,000 of TMA Member Long Term Disability Insurance without having to confirm their salary or submit any financial information when enrolling. This “own occ.” plan, issued by the Prudential Insurance Company of America, can pay claims until you reach your Social Security retirement age.
• Simple underwriting – no income verification when enrolling for a $5,000 per month benefit.
• Significant savings compared to an individual policy.
• No benefit reduction due to any other coverage you have or for payouts you receive.
• Includes Partial/Residual benefit allowing you to practice and receive benefits.
• Includes Catastrophic Coverage that can increase your benefits by 20%.
• Includes ability to increase coverage in the future without the need for underwriting.
• Includes additional Student Loan Reimbursement up to $250,000.
• 25% Savings Credit from TMA Insurance Trust – reduces already affordable member rates.
• Higher benefit amounts available with underwriting.
Need to easily boost your income protection plan? Want affordable coverage? Scan the QR code or call 800-880-8181, Monday to Friday from 8:00 AM to 5:00 PM, CST to speak with one of our experienced income protection advisors. You can also visit us online at tmait.org. For decades we have been guiding Texas physicians to better coverage. It will be our privilege to serve you.
SCAN TO CALL
TMA Member Long Term Disability plan coverage is issued by The Prudential Insurance Company of America, Newark, NJ. The Booklet-Certificate contains all plan information, including limitations and exclusions. CA COA #1179, NAIC #68241. Contract Series 83500 1086323-00001-00
