Three specialties transforming care from the inside out
EXECUTIVE
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
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Shaina Drummond, MD, President
Gates Colbert, MD, President-elect
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Neerja Bhardwaj, MD
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Philip Huang, MD, MPH
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Riva Rahl, MD
Anil Tibrewal, MD
NEW DCMS HEADQUARTERS IN THE HEART OF UPTOWN
CAMPAIGN FOR THE FUTURE
Specialization, Shortages, and Solutions: A Look at Medicine’s Changing Landscape
Shaina Drummond, MD
THIS MONTH’S DCMS JOURNAL EXPLORES THE diverse array of specialties that define modern medicine. The evolution of medical specialization is a relatively recent chapter in the history of our profession, shaped by the increasing complexity of healthcare and the rapid pace of scientific advancement. Although early physicians in ancient civilizations often practiced as generalists, evidence suggests that rudimentary forms of specialization did exist. In ancient Egypt, for instance, some doctors focused on specific ailments such as eye diseases. Greek and Roman physicians, particularly Hippocrates and Galen, laid the intellectual foundation for rational medical practice, even though clearly defined specialties had not yet taken hold.
During the Islamic Golden Age, which spanned from the eighth to the 13th century, scholars like Avicenna and Al-Razi expanded medical understanding by categorizing diseases and developing distinct areas of focus such as surgery, pharmacology, and internal medicine. This momentum slowed somewhat in medieval Europe, where medicine was typically divided among physicians, surgeons, and apothecaries. However, religious and cultural constraints often limited more specialized development. A renewed interest in anatomy and scientific inquiry during the Renaissance and Enlightenment helped pave the way for more defined medical disciplines. By the 19th century, the Industrial Revolution and major breakthroughs in fields like pathology, microbiology, and surgery catalyzed the emergence of formal specialties including psychiatry, internal medicine, obstetrics, and ophthalmology. Hospitals became hubs for education and research, and professional societies began organizing and legitimizing various branches of practice.
Specialization became more structured in the 20th century, particularly in the United States following the release of the Flexner Report in 1910. This landmark reform reshaped medical education by introducing rigorous standards and formal
training pathways. The establishment of board certifications and residency programs helped define an ever-expanding landscape of specialties and sub-specialties. With continued advancements such as the introduction of medical imaging, anesthesia, and antibiotics, physicians were equipped to deliver more precise and effective care. Today, the medical field encompasses both foundational specialties and highly targeted areas, including interventional cardiology, pediatric endocrinology, and other precision-based disciplines. The rise of digital health, genomics, and personalized medicine continues to push the boundaries of specialization. Yet, amid this progress, the need for interdisciplinary collaboration and coordinated care remains essential. As medicine continues to evolve, striking a balance between deep expertise and holistic, patientcentered practice is critical. Reflecting this shift, the 2025 National Resident Matching Program offers medical students the opportunity to choose from 54 core residency specialties. These include general fields like internal medicine, pediatrics, and family medicine, as well as more specialized areas such as neurology, dermatology, orthopedic surgery, and emergency medicine. Additional fields such as anesthesiology, psychiatry, obstetrics and gynecology, pathology, and radiology offer further depth, alongside combined programs like internal medicine and pediatrics or family medicine and psychiatry. There are also niche specialties, including aerospace medicine, preventive medicine, and nuclear medicine. All of these residency programs are accredited by the Accreditation Council for Graduate Medical Education, which sets national training standards. In total, the council recognizes 146 specialties and sub-specialties covering both core training and advanced fellowship opportunities. This robust array of options enables future physicians to align their training with both personal interests and the
shifting needs of the healthcare system, ensuring that the next generation of specialists is well equipped to meet the demands of a rapidly changing medical landscape.
Addressing the Physician Gap in a Rapidly Growing North Texas
North Texas is one of the fastest-growing metropolitan regions in the United States, with the population projected to increase by nearly 1 million residents over the next five years. The Dallas-Fort Worth metroplex alone is expected to grow from approximately 7.8 million in 2023 to 8.5 million by 2028 — a nearly 9% rise — driven by strong economic growth, a business-friendly climate, and relatively affordable living costs (Site Selection Group, 2024; Dallas Express, 2024). This rapid expansion is reshaping the region’s infrastructure needs, particularly in healthcare, where the strain on medical systems is becoming increasingly evident. Physician shortages are already a pressing concern across Texas, and the Dallas area is among the most affected. According to the Texas Department of State Health Services (DSHS), the state is projected to experience a 41% shortfall in primary care physicians by 2036, equating to roughly 12,800 full-time equivalent (FTE) positions. In the North Texas Public Health Region, which includes Dallas, the numbers are even more troubling — primary care demand is expected to outpace supply by 45%, with a deficit of approximately 4,427 FTEs. The shortage is even more acute in psychiatry, where a 53% shortfall is anticipated, translating to an unmet need for around 1,120 FTE psychiatrists (DSHS, 2024). Specialties beyond primary care and psychiatry are also under mounting pressure. Obstetrics and gynecology services have been significantly impacted by legal and regulatory changes, resulting in fewer specialists and reduced access to maternal healthcare, particularly in underserved areas. Texas is confronting a significant shortage of obstetricians and gynecologists (OB-GYNs), a challenge that has been intensified by legal and regulatory changes surrounding reproductive healthcare. According to a report by the March of Dimes and the American College of Obstetricians and Gynecologists, projections indicate that by 2030, Texas will have 15% fewer OB-GYNs than needed to meet patient demand, with the most severe deficits expected in rural areas where access to maternal care is already limited (March of Dimes and ACOG, 2023). Pediatrics is another area where demand is rising quickly. The child population in North Texas is expected to double by 2050, prompting major investments in pediatric care. One of the most ambitious projects underway is the new Moody Children’s Hospital, a $5 billion joint venture between Children’s Health and UT Southwestern. Built on a 33.7-acre site in the Southwestern Medical District, the hospital will replace the existing Children’s Medical Center Dallas and expand inpatient capacity by nearly 40%, with 552 beds, a Level I trauma center, and advanced surgical and fetal care services. The new campus will bring thousands of healthcare jobs and significantly increase the need for pediatric specialists, including those in neonatology,
cardiology, and pediatric surgery (Axios Dallas, 2024; Children’s Health and UT Southwestern, 2024). Emergency medicine, meanwhile, has seen a rebound in popularity post-pandemic; however, the growing volume of emergency room visits in rapidly expanding urban areas like Dallas is expected to outpace capacity. This concern is particularly acute in public and safety-net hospitals, where burnout and staffing shortages are already prevalent (Texas Hospital Association, 2024). Parkland Health, Dallas County’s primary safety-net hospital, exemplifies this challenge; it recorded more emergency department visits than any other hospital in the United States in 2024, with over 235,000 visits for the third consecutive year (Becker’s Hospital Review).
Addressing the physician shortage in Texas will require a multifaceted approach that expands training opportunities, improves retention, and ensures equitable distribution of the workforce. One key solution is increasing the number of graduate medical education (GME) positions across the state to match the growing number of medical school graduates. Expanding funding for residency programs, particularly in underserved and rural areas, can help ensure that more physicians are trained and remain in the communities where they are needed most. Strengthening incentives such as loan repayment programs, competitive compensation, and professional development opportunities can also encourage physicians to enter high-need specialties and practice in critical regions. Additionally, supporting physician-led care models, reducing administrative burdens, and leveraging technologies like telemedicine can help extend access to care. Collaboration between state policymakers, academic institutions, hospital systems, and professional organizations like the Texas Medical Association is essential to implement sustainable, long-term strategies that address both current gaps and future demand.
The Role of DCMS in Shaping the Future
With North Texas growing rapidly and the demand for healthcare outpacing the supply of physicians, the value of organized medicine is more important than ever. The Dallas County Medical Society (DCMS) gives doctors a place to connect, stay informed, and advocate for meaningful change. As medical specialization increases and the healthcare system becomes more complex, it’s essential for physicians to have access to resources that help them lead effectively. DCMS supports its members through education, local advocacy, and leadership development, while also working to strengthen specialty training pathways and influence health policy at the local and state levels. In a time of growing pressure on the medical workforce, being part of DCMS ensures that physicians have a voice in shaping the future of care in Dallas — and the tools to keep doing what they do best: caring for their patients and community. DMJ
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“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.”
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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 &
How Medical Specialization Orchestrates Modern Healthcare
Jon R. Roth, MS, CAE
THE EVOLUTION OF MEDICINE FROM THE general practitioner model of the early 20th century to today’s highly specialized healthcare ecosystem represents one of the most profound transformations in medical history. This shift toward specialization has fundamentally reshaped how our physicians deliver care, creating a complex but remarkably effective system where physicians with deep expertise in specific domains collaborate to address the multifaceted health challenges facing modern patients.
The
Foundation of Specialized Care
Medical specialization emerged from necessity. As our understanding of human physiology, pathology, and therapeutic
interventions expanded, it became impossible for any single physician to maintain expertise across all domains of medical knowledge. For example, today’s cardiovascular surgeon possesses knowledge about coronary anatomy, hemodynamics, and surgical techniques that would have been inconceivable to physicians just decades ago. Similarly, the modern neurologist draws upon sophisticated understanding of neurotransmitter pathways, advanced imaging modalities, and targeted therapeutic agents that require years of focused training to master.
This depth of knowledge translates directly into improved patient outcomes. Studies consistently demonstrate that patients treated by specialists for their specific conditions experience better clinical results, reduced complications, and enhanced quality of life compared to those receiving generalized care for complex conditions. Whether it is the oncologist’s expertise in cancer staging, treatment protocols and therapeutics, or the endocrinologist’s mastery of metabolic disorders, each one contributes essential components to comprehensive patient care.
The Interconnected Web of Modern Medicine
Perhaps the most remarkable aspect of contemporary medical specialization is not the depth of individual expertise, but the sophisticated coordination between specialties that enables truly comprehensive care. Consider the management of a patient with diabetes who develops cardiovascular complications. The endocrinologist provides glycemic optimization, the cardiologist addresses coronary artery disease, the nephrologist manages diabetic kidney disease, the ophthalmologist monitors for retinopathy, and the wound care physician prevents foot complications. Each specialist contributes their unique perspective while communicating with colleagues to ensure cohesive, patient-centered care.
This collaborative model extends beyond chronic disease management into acute care settings. The modern trauma center exemplifies specialized coordination at its finest. Emergency physicians provide initial stabilization, trauma surgeons address life-threatening injuries, anesthesiologists manage perioperative care, radiologists provide critical imaging interpretation, and intensivists oversee post-operative recovery. The seamless integration of these specialties can mean the difference between life and death for critically injured patients.
Sub-specialization and Precision Medicine
The trend toward sub-specialization represents the next evolution in medical expertise. Sticking with our earlier example, cardiology now encompasses interventional cardiologists who specialize in catheterbased procedures, electrophysiologists who focus on heart rhythm disorders, and heart failure specialists who manage advanced cardiac dysfunction. This granular specialization allows physicians to develop extraordinary expertise in specific domains, leading to innovations in treatment approaches and improved outcomes for patients with specific conditions.
Sub-specialization has been particularly transformative in oncology, where medical oncologists now focus on specific cancer types or treatment modalities. The breast cancer specialist possesses intimate knowledge of hormone receptor status, genetic markers, and targeted therapies that would be impossible to maintain across all cancer types. This focused expertise has contributed significantly to the dramatic improvements in cancer survival rates observed over the past two decades.
Technology and Specialized Practice
Modern medical specialization is inextricably linked with technological advancement. Radiologists now interpret images with resolution and detail that reveal pathology invisible to previous generations, while interventional radiologists perform minimally invasive procedures that replace traditional surgery. Pathologists utilize molecular diagnostics and genetic sequencing to provide precise diagnostic information that guides targeted therapy selection. These technological capabilities require specialized training and ongoing education that reinforce the importance of focused expertise.
The integration of artificial intelligence and machine learning into specialized practice promises to further enhance the capabilities of medical specialists, if used appropriately. Dermatologists are beginning to utilize AI-assisted pattern recognition for skin cancer detection, while radiologists employ machine learning algorithms to identify subtle abnormalities in medical imaging. These tools augment rather than replace specialized expertise, requiring physicians who understand both the capabilities and limitations of advanced technologies.
Challenges and Opportunities
The remarkable success of medical specialization has created new challenges. Communication between specialties must be seamless to prevent fragmentation of care, and patients need clear guidance navigating complex healthcare systems. The rise of hospitalists who coordinate inpatient care and the growing emphasis on care coordination represent important responses to these challenges. Technology can also assist with bridging the communication gaps where patient electronic health records that contain care plan summaries, imaging, medication history, and procedures performed can be shared among physicians in integrated or collaborative institutions.
Within the realm of specialization, primary care physicians play a vital role as the conductors of this specialized orchestra, maintaining longitudinal relationships with patients while coordinating appropri-
ate specialist referrals and ensuring that specialized interventions align with patients’ overall health goals and preferences. The most effective healthcare systems recognize that specialized expertise and primary care coordination are complementary rather than competing approaches to patient care.
The Future of Specialized Medicine
Looking ahead, medical specialization will continue evolving in response to advancing scientific knowledge and changing population health needs. The aging population will drive demand for geriatric sub-specialists who understand the unique physiology and care requirements of older adults. Precision medicine initiatives will create new sub-specializations focused on genetic counseling and personalized therapeutic selection. Telemedicine capabilities will enable specialized expertise to reach underserved populations previously unable to access sub-specialty care.
The success of modern medicine has been the result of and will depend fundamentally on the depth of knowledge and expertise that medical specialization provides. While the complexity of contemporary healthcare systems presents coordination challenges, the remarkable outcomes achieved through specialized care demonstrate that this evolution represents genuine progress in our ability to heal and help patients.
As we continue to push the boundaries of medical knowledge and therapeutic capability, the role of specialized physicians will only become more crucial. The symphony of modern medicine, with each specialist contributing their unique expertise while working in harmony with colleagues across disciplines, represents significant milestones in the pursuit of health and healing. The future of medicine lies not in choosing between specialized and generalized approaches, but in optimizing the integration of both to serve the complex health needs of our patients and communities. DMJ
Jon R. Roth, MS, CAE DCMS EVP/CEO
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Christie Davis Keith Dugger Avi Kerendian
James (Mac) Stewart
Chandani Patel
Miles Moody
Brandon Kulwicki
Rights, Risks, Repercussions
Abortion
Bans
and the American College of Obstetricians and Gynecologists’ Response
by Brandon Kulwicki and Chandani Patel, Attorneys with Hall, Render, Killian, Heath & Lyman, P.C.
UPON PASSING SENATE BILL 8, MORE FAMOUSLY known as the Texas Heartbeat Law, the state of Texas banned abortions as soon as fi ve weeks after the start of a patient’s last menstrual cycle. Less than a year later, in Dobbs v. Jackson Women’s Health Organization, the Supreme Court overturned Roe v. Wade and held that there was no constitutional right to abortion. As a result, legal access to abortion care remains volatile across the states. Hospital systems, physicians, and other providers must now operate under unclear regulatory frameworks and face uncertain risks of liability while maintaining their commitment to provide quality care to their patients.
Two years later, the lack of clarity surrounding state abortion restrictions continues to cause confusion; in many instances, this confusion has resulted in delays in care, and in some instances has resulted in serious negative patient outcomes. Some patients must travel outside of their resident states to obtain access to care, and doctors report feeling that they are forced to stand by as their patients, whose conditions do not worsen enough to enable their providers to legally take action, get sicker and sicker. As a result, pregnant women are increasingly experiencing severe and irreversible health consequences, endangering both themselves and their unborn children. However, despite the recent shift in political climates toward the anti-abortion movement, the American College of Obstetricians and Gynecologists (ACOG) maintains
that abortion bans prevent health care practitioners from providing essential reproductive health care to their patients. ACOG strongly believes that denying, and even delaying, care “is the direct result of harmful abortion bans that confuse and harm clinicians and the patients they treat.”
In its most recent statement on abortion bans, ACOG condemned the exploitation of medical emergencies, complications, and deaths of pregnant women resulting from criminalization of providing abortion services. Additionally, ACOG cited an Associated Press analysis which found that more than 100 women in medical distress were unable to obtain care across states with restricted or banned abortions since the Dobbs decision. Along with this analysis, ACOG cites stories of pregnant patients airlifted out of state to obtain necessary and legal care, miscarriages in public restrooms, or pregnant patients waiting in parking lots to hemorrhage or develop sepsis before gaining access to emergency care.
ACOG also emphasizes the nuanced and complex situations of many pregnant patients that are often dismissed because they do not fall within the legislatively mandated limits on care. ACOG’s ultimate focus is on maintaining access to safe and reliable reproductive care, and it maintains the position that legislative interference is simply diverting attention from the damage rather than getting patients the care they need. DMJ
by Lauren Williams, Assistant Vice President of Publications and Digital Communications, Editor, Dallas Medical Journal
From psychiatry and nephrology to geriatric care, meet three DCMS member physicians pioneering patient-centered solutions in the most demanding corners of modern medicine.
In a healthcare system constantly balancing innovation and access, the leaders working quietly behind the scenes often hold the key to its evolution. In this special feature, we shine a light on three medical specialties — psychiatry, nephrology, and geriatrics — and the Dallas County Medical society member physicians at their helm who are shaping care in profound and personal ways. Their work spans clinical insight, community transformation, and visionary planning for a more humancentered future.
Dr. John Burruss, CEO of Metrocare, offers a bold blueprint for reimagining mental health access across Texas, merging academic rigor with compassionate service for the most vulnerable. Nephrologist Dr. Gates Colbert outlines the hidden epidemic of chronic kidney disease, tackling both systemic funding challenges and groundbreaking therapies poised to redefine renal care. Meanwhile, Dr. Ravindra M. Bharadwaj presents a deeply human approach to geriatric medicine — one that bridges high-tech advances with what truly matters to aging patients and their families.
Together, their stories illuminate the future of medicine: one that’s as focused on equity, empathy, and interdisciplinary care as it is on technology and treatment. As we spotlight these specialties, we also celebrate the kind of leadership that is quietly — but powerfully — reshaping healthcare from the inside out.
From Emergency Rooms to Executive Leadership Dr. John Burruss’s Mission to Transform Community Mental Health
IN THE WORLD OF MENTAL HEALTH CARE,
few leaders have dedicated their careers as singularly to serving the most vulnerable populations as Dr. John Burruss. As CEO of Metrocare, one of the largest community mental health centers in Texas, Burruss has transformed his early experiences as a general practitioner into a comprehensive vision for expanding psychiatric care to those who need it most.
THE MAKING OF A MENTAL HEALTH ADVOCATE
Dr. Burruss’s journey to mental health leadership began in an unexpected place: the general practice rooms of Houston. Working as a general practitioner early in his career, he witnessed firsthand the broad spectrum of medical needs across diverse patient populations. It was there, seeing “many people in the acute stages of mental health need,” that psychiatry’s appeal crystallized for him — particularly in emergency and inpatient settings where intervention could make the most immediate difference.
This foundational experience shaped what would become the defining characteristic of his career: a commitment to serving individuals with the greatest psychiatric needs. “Seeing many people in the acute stages of mental health need heightened the appeal of psychiatry for me,” Burruss reflects, explaining how this early exposure guided his subsequent specialization and leadership philosophy.
FROM CLINICIAN TO COMMUNITY LEADER
After completing his psychiatry residency, Burruss took a position at Ben Taub Hospital, where his career took a pivotal turn. While maintaining his clinical focus on emergency and inpatient psychiatry, he gradually assumed administrative responsibilities, first as chief of service and then as one of Baylor’s clinical deans. This transition proved transformative, not just for his career trajectory but for his understanding of healthcare’s broader impact.
“Those experiences made me understand that administrators create the circumstances for many more to be seen clinically than any single clinician can, thereby spreading psychiatric and other
medical care to whole communities,” Burruss explains. This realization — that leadership could multiply his impact beyond what was possible in direct patient care — would later drive his decision to lead Metrocare.
BUILDING ACADEMIC EXCELLENCE IN COMMUNITY CARE
When Burruss transitioned from his signifi cant tenure at Ben Taub Hospital and Baylor College of Medicine to become CEO of Metrocare, he brought with him a unique vision: combining community mental health service with academic excellence. Unlike Baylor’s decades-long track record of academic achievement, Metrocare was just beginning its pursuit of education and research.
“It was quite appealing to try and help build a serious training program in a community mental health center that would help provide the workforce for this region in the years to come,” Burruss notes. His background at Baylor proved invaluable in understanding the dynamic between academic medical centers and community mental health providers, enabling him to forge partnerships with UT Southwestern and other regional medical education institutions.
STRATEGIC GROWTH THROUGH INNOVATION
Under Burruss’s leadership, Metrocare has experienced remarkable expansion, nearly doubling its budget while launching new programs for veterans, first-episode psychosis, and autism. This growth reflects his strategic approach to resource allocation in a field where needs always exceed available resources.
“The role of a community center CEO is always focused on applying finite resources to an infinite array of potential needs and gaps,” Burruss explains. His strategy involves diversifying funding sources through philanthropy, federal and state grants, and new commercial avenues while remaining vigilant for opportunities to broaden and deepen services.
Metrocare’s growth has been particularly notable in filling service voids — adding specialty services beyond routine care levels and expanding into underserved geographic areas. This expansion philosophy aligns with Burruss’s core mission of reaching those with the greatest need, regardless of their circumstances.
NAVIGATING THE MEDICAID LANDSCAPE
As a fundamentally Medicaid-based provider, Metrocare’s success depends heavily on understanding and adapting to changes in federal and state Medicaid programs. Burruss emphasizes that “staying abreast of developments within the Medicaid program federally and locally is of utmost importance to maintain and grow services.”
Each new waiver program, supplemental payment resource, or grant represents an opportunity to “open new doors to people and provide a richer service array to our patients.” This Medicaid-centric approach has proven resilient, with Burruss noting that anticipated federal changes appear likely to leave Metrocare largely unscathed.
CORRECTIONAL HEALTHCARE: A DIFFERENT PERSPECTIVE
Burruss’s involvement with the Correctional Managed Healthcare Committee for the Texas Department of Criminal Justice (TDCJ) has provided him with unique insights into psychiatric care across diff erent settings. Managing healthcare for a population of over 115,000 incarcerated individuals — many of whom are aging and will remain in the system long term — presents extraordinary challenges.
“Being able to see fi rsthand how our exceptional colleagues at TDCJ, UTMB Galveston, and Texas Tech manage these heavy demands has been rewarding,” Burruss observes. The experience has shown him how healthcare systems can adapt to deliver “the right care to the right person at the right time,” even across vast geographic distances and complex logistical challenges.
SCIENCE, COMPLEXITY, AND THE FUTURE OF MENTAL HEALTH
With a background in biochemistry and a medical degree from Baylor College of Medicine, Burruss brings a scientifi c perspective to mental health leadership. However, he’s quick to acknowledge the fundamental complexity of mental illness. “The scientifi c basis of mental illness is still far from certain,”
he notes, calling brain-based conditions “some of the most complicated questions in the universe.”
This scientifi c humility informs his approach to program development and patient care. Understanding conditions like bipolar disorder — which he describes as “not likely to be one single illness but rather many that look the same in their presentation” — requires grappling with the complexity of billions of neurons and trillions of brain interactions.
Despite these challenges, Burruss remains optimistic about the future. He anticipates that advances in computational science, artifi cial intelligence, and biological understanding will provide better pathophysiologic mechanisms for mental illness, leading to improved treatments. “Our treatments, which are already as eff ective as other areas of medicine, will become even better, allowing greater success with those in need.”
A DAILY MISSION OF IMPACT
Today, as CEO of Metrocare, Burruss fi nds himself in a position to facilitate care for thousands of the most vulnerable community members daily. “On a daily basis, I am fortunate to facilitate the care for thousands of the very most needy across our community no matter their circumstances,” he refl ects.
This daily impact represents the culmination of a career arc that began with individual patient encounters in Houston emergency rooms and evolved into systemic leadership aff ecting entire communities. Through strategic growth, academic partnerships, and unwavering focus on the most vulnerable populations, Burruss has demonstrated how clinical expertise can translate into transformative organizational leadership.
His story illustrates a fundamental truth about healthcare leadership: The greatest impact often comes not from treating individual patients, but from creating systems that ensure comprehensive care reaches those who need it most. In a fi eld where resources are fi nite but needs are infi nite, leaders like Dr. John Burruss show how strategic vision, scientifi c understanding, and unwavering commitment to service can multiply the healing power of medicine throughout entire communities. DMJ
Dr. John Burruss has spent his entire psychiatric career in the service of those with the greatest need. He became CEO of Metrocare in 2013 after a lengthy career at Ben Taub Hospital and Baylor College of Medicine in Houston. At Metrocare, Dr. Burruss has shepherded enormous change and growth leading to a near doubling of the Agency’s budget with new programs for veterans, first episode psychosis, and autism. He has also served the State of Texas on the Correctional Managed Healthcare Committee for TDCJ while attaining Fellow status with the American College of Psychiatrists and the American Psychiatric Association. Dr. Burruss received a biochemistry degree from the University of Texas at Austin and earned his medical degree from Baylor College of Medicine.
The Silent Crisis A Nephrologist’s Perspective on Kidney Disease
THE KIDNEYS ARE AMONG THE BODY’S MOST vital, yet underappreciated, organs.
Working tirelessly around the clock, they filter blood, remove toxins, produce hormones, and help maintain cardiovascular health. Yet, their failure often goes unnoticed until it’s nearly too late. Dr. Gates Colbert, a practicing nephrologist, offers insights into the evolving landscape of kidney care, from early detection challenges to promising therapeutic breakthroughs
THE SILENT THREAT OF CHRONIC KIDNEY DISEASE
Chronic kidney disease (CKD) has earned its reputation as a “silent killer” for good reason. Patients typically experience no symptoms until their kidney function drops below 15% of normal capacity—a measurement called the estimated glomerular filtration rate (eGFR). By this point, the damage is often irreversible.
“Patients do not have any symptoms of kidney failure until usually it’s below 15 mL/min/m² called the glomerular filtration rate,” Dr. Colbert explains. This silent progression makes early detection critical, yet challenging.
The key to catching CKD early lies in routine screening. Dr. Colbert emphasizes that annual laboratory work should be standard practice for everyone. “The best way to monitor kidney function is to have annual lab work, which the population should be doing as a routine basis,” he notes. Importantly, both blood and urine tests are necessary, as patients can develop chronic kidney disease with only microalbuminuria, despite maintaining normal eGFR levels.
Once abnormalities are detected, prompt referral to primary care or nephrology specialists opens doors to interventions that can slow disease progression and potentially avoid the need for dialysis or transplantation.
THE CURRENT STATE OF DIALYSIS CARE
For patients who progress to end-stage renal disease (ESRD), di-
alysis options have never been more varied or accessible. When kidney function drops below 10% of normal, dialysis consideration becomes necessary, based on symptoms and life-threatening laboratory results.
A significant shift has occurred toward home-based dialysis modalities, supported by Medicare’s prioritization of these treatments. Home hemodialysis, performed 5-6 times per week in shorter sessions, and peritoneal dialysis, conducted nightly while patients sleep, offer unprecedented freedom. “Both of these therapies allow greater freedom for patients during the day, allowing for travel and the ability to keep working and earning income,” Dr. Colbert observes.
However, traditional in-center hemodialysis remains the predominant choice, providing highly coordinated care with nursing and technical staff for four-hour sessions three times weekly. Despite these advances, Dr. Colbert identifies two major concerns for dialysis care’s future: shrinking reimbursement rates and stagnant mortality improvements.
The funding challenge represents what Dr. Colbert calls “America’s great experiment with a single payer experience.” While care costs and overhead continue rising, reimbursement increases often lag behind, forcing physicians and providers to find creative ways to maintain quality while controlling costs. More troubling is the lack of significant improvement in patient survival rates, despite advances in individual components like infection control and anemia management.
WORKFORCE CHALLENGES AND BURNOUT
Nephrology demands exceptional dedication from its practitioners. Nephrologists must juggle hospital rounds, outpatient clinics, and dialysis unit visits, creating a schedule that requires constant movement and availability. The complexity of advanced kidney disease care requires large, highly reliable teams, which can strain all caregivers.
“Nephrology work is not for the weary,” Dr. Colbert acknowledges. “This leads to a Nephrologist and PA/NP to be on the move and constantly needed everywhere, but with the ability to only be somewhere.”
What sustains most nephrology providers is patient appreciation and the knowledge that they’re helping people not just survive, but thrive. However, Dr. Colbert notes that burnout exists in nephrology as it does throughout medicine, with many providers wishing their healthcare colleagues appreciated their work as much as their patients do.
ADDRESSING HEALTH DISPARITIES
Kidney disease disproportionately affects certain populations, with Hispanic and Black patients experiencing the highest rates of chronic kidney disease in the United States. Native American communities are also significantly affected, though Dr. Colbert notes that geographic factors limit his exposure to these patients in Texas.
Access to regular healthcare remains a critical factor in CKD development and progression. “We must be vigilant to screen these groups, knowing their higher risk status, and know that we can intervene and prevent CKD progression early,” Dr. Colbert emphasizes.
The good news is that early intervention tools and medications can dramatically alter a patient’s health trajectory over decades. In areas like Dallas-Fort Worth, excellent access to nephrology care means patients should be referred whenever questions arise about proper CKD management.
REVOLUTIONARY THERAPEUTIC ADVANCES
The 2020s have brought unprecedented excitement to CKD treatment. For years, nephrologists relied primarily on ACE inhibitors, ARBs, beta-blockers, and diuretics to preserve kidney function. Now, newer drug classes, including SGLT2 inhibitors, GLP-1 receptor agonists, and upcoming endothelin antagonists are showing remarkable promise.
These medications work synergistically to slow kidney disease progression, though their rapid development means clinicians and guideline writers are still determining optimal combinations. “The most important part is to start these FDA-approved medications to provide a better chance of avoiding progression and improving their outcomes,” Dr. Colbert advises.
Diabetic nephropathy treatment has particularly benefited from improved glycemic control using GLP-1 and SGLT2 inhibitor classes, with nonsteroidal mineralocorticoid receptor antagonists and longer-lasting GLP-1 drugs showing future promise.
Looking further ahead, the wearable kidney being researched at UCSF represents a potentially game-changing technology. Similar in size to a left ventricular assist device (LVAD), this device could provide dialysis patients with unprecedented freedom and improved outcomes.
THE PROMISE OF XENOTRANSPLANTATION
While transplant care has steadily improved with better allograft and patient survival rates, the organ shortage remains a critical challenge. Dr. Colbert is particularly optimistic about xenotransplantation—specifically, pig kidney transplants.
Two companies have developed genetically modified pigs capable of producing kidneys that human bodies can tolerate with appropriate immunosuppression. “We have already seen at least three published cases of pig kidney transplantation, with one patient having her kidney survive for several months,” Dr. Colbert reports.
Though still in early stages, with over 100,000 Americans on kidney transplant waiting lists, Dr. Colbert predicts that “the 2030s are going to be dominated by pig kidney implantation.”
OPPORTUNITIES FOR THE NEXT GENERATION
For medical students considering nephrology, Dr. Colbert offers an encouraging perspective. The specialty combines rigorous science with meaningful patient relationships, allowing physicians to serve as coaches and counselors in helping patients maintain productive lives, despite incurable disease.
The next generation of nephrologists will inherit an arsenal of new tools and opportunities. Increasingly, nephrology collaborates with cardiology and endocrinology as these specialties recognize their overlapping disease states. With 10% of adults having CKD, and 30% of Americans having hypertension, the need for strong nephrology care will only grow as populations age and survive with multiple chronic conditions.
Dr. Colbert’s insights reveal a specialty in transition—facing significant challenges, but positioned for remarkable advances. The silent nature of kidney disease demands vigilant screening and early intervention, while emerging therapies offer hope for dramatically improved outcomes. Though workforce pressures and healthcare disparities remain concerns, the combination of technological innovation, expanding treatment options, and growing collaborative care models suggests a promising future for both patients and providers in nephrology.
The kidneys may work silently, but the specialty dedicated to their care is anything but quiet about the opportunities ahead. DMJ
Dr. Gates Colbert is a practicing nephrologist with Kidney and Hypertension Associates of Dallas, and a Clinical Associate Professor with Texas A&M College of Medicine. Dr. Colbert also serves as the nephrology program co-director at Baylor University Medical Center in Dallas. He is triple board-certified with internal medicine and nephrology certifications and is a certified hypertension specialist. Dr. Colbert is a fellow of the American Society of Nephrology and serves on the International Society of Nephrology Cardio-Renal Steering Committee and on the Board of the National Kidney Foundation Texas Chapter. Dr. Colbert will serve as president of the Dallas County Medical Society in 2026.
Bridging High Tech and High Touch A Geriatrician’s Vision for Patient-Centered Care
IN A HEALTHCARE LANDSCAPE INCREASINGLY
dominated by specialized, single-organ approaches, geriatric medicine stands as a beacon of holistic care. Dr. Ravindra M. Bharadwaj, associate professor in the Division of Geriatrics at UT Southwestern Medical Center, embodies this philosophy in his work with perioperative geriatric care — a field that requires both deep clinical expertise and profound understanding of what truly matters to older adults.
THE ART OF COMPLEXITY
Dr. Bharadwaj’s journey into geriatric medicine was driven by a fundamental recognition: Older adults don’t fit neatly into traditional clinical pathways. “They present with complexity: multiple comorbidities, polypharmacy, frailty, cognitive vulnerability, and unique goals of care,” he explains. His specialization in perioperative geriatric care exemplifies this challenge, requiring evaluation not just of surgical diagnoses, but of delirium risk, functional reserve, social support, and how a patient’s overall health trajectory aligns with proposed interventions.
This complexity is what drew him to the field. “What draws me most is the opportunity to bridge the gap between high-tech surgical care and high-touch, personalized medicine — ensuring that the older adult is not lost in the process, but is at the center of it,” Dr. Bharadwaj notes. It’s a philosophy that extends far beyond the operating room, encompassing what he calls “optimizing not just surgical success, but long-term quality of life.”
TACKLING THE POLYPHARMACY CHALLENGE
Perhaps no issue illustrates the complexity of geriatric care better than polypharmacy. Dr. Bharadwaj describes it as “one of the most significant and persistent challenges in caring for older adults,” particularly in perioperative settings where patients often arrive with complex medication regimens prescribed by multiple specialists.
The risks are substantial — adverse drug events, drug-drug interactions, functional decline, delirium, and increased fall risk. But the challenge extends beyond clinical complexity to include patient and provider psychology. “Deprescribing can be met with hesitation — by both patients and clinicians — due to fear of destabilizing chronic conditions or the perception that discontinuation signals withdrawal of care,” he observes.
Dr. Bharadwaj’s approach is both systematic and patient-centered, grounded in geriatrics’ foundational “5Ms” — What Matters, Medication, Mentation, Mobility, and Multi-morbidity. His team prioritizes time-sensitive medication reconciliation during preoperative evaluations, targeting high-risk medications like benzodiazepines and anticholinergics known to increase delirium risk. They utilize evidence-
based tools like the Beers Criteria and STOPP/START guidelines to guide decisions.
The solution, he argues, requires system-level changes: embedding pharmacists in perioperative clinics, integrating medication alerts into electronic medical records, and creating institutional protocols that prompt medication reevaluation. Most importantly, it requires “a culture shift, from seeing medication management as a static list to viewing it as a dynamic, ongoing conversation, centered on the patient’s current health, function, and goals.”
BEYOND THE CLINIC WALLS
Dr. Bharadwaj emphasizes that much of an older adult’s health is determined by factors outside clinical settings. His practice deliberately addresses social determinants like isolation, nutrition, caregiver support, and access to follow-up care — factors that significantly affect both surgical recovery and long-term outcomes.
“We incorporate comprehensive geriatric assessments that screen for these risks — evaluating living situation, support systems, nutritional status, and mobility,” he explains. When concerns arise, his team involves social workers, case managers, dietitians, and physical therapists early in the process.
Patient and family education plays a crucial role, particularly around postoperative delirium prevention. “We educate patients and caregivers about delirium signs and prevention strategies and strongly encourage the presence of a familiar caregiver — particularly on the first night after surgery — when patients are most vulnerable.”
The biggest obstacles include time constraints, limited community resources, and fragmented care systems. Yet Dr. Bharadwaj maintains that addressing social determinants “isn’t ‘extra’ — it’s essential. Our goal is not only a successful surgery, but a meaningful recovery aligned with what matters most to the patient.”
WORKFORCE CHALLENGES AND SOLUTIONS
The shortage of geriatricians creates daily practice challenges, limiting comprehensive geriatric care to the most complex cases despite broader need. Dr. Bharadwaj sees this as reinforcing the importance of team-based care, where geriatricians work alongside primary care providers, surgeons, and allied health professionals to integrate geriatric thinking into broader workflows.
At UT Southwestern, they’ve addressed this through educational innovation. Programs like HELP for students, MSTAR for medical students, and structured clinical experiences for residents expose learners to geriatrics’ complexity and human dimension. “These experiences not only build clinical competence but also reframe geriatrics as a dynamic, intellectually challenging field that blends high-stakes decision-making with patient-centered care.”
System-level disincentives also need addressing. “Geriatricians routinely manage polypharmacy, multimorbidity, frailty, functional decline, cognitive impairment, and complex goals-of-care discussions — often in a single visit,” Dr. Bharadwaj notes. “Yet current reimbursement models undervalue this complexity, especially when compared to procedural or single-organ specialties.”
TECHNOLOGY’S PROMISE AND PITFALLS
While Dr. Bharadwaj doesn’t currently provide telehealth services, he recognizes technology’s growing role in geriatric care. He sees particular promise in remote monitoring for post-acute or perioperative settings, artificial intelligence for risk stratification, and AI-assisted medication review tools.
However, his enthusiasm is tempered by important concerns. Digital literacy and access disparities pose real barriers for many older adults. “Not all patients are comfortable using smartphones, portals, or video platforms, and some lack the cognitive or sensory abilities to engage with them meaningfully,” he cautions.
More fundamentally, he warns against over-reliance on technology. “Older adults are not algorithmic — they are complex individuals with layered health, functional, and social needs. Overreliance on technology risks depersonalizing care or missing subtleties that matter greatly to outcomes and quality of life.”
His philosophy is clear: “Technology should augment, not replace, the human connection and critical thinking at the heart of geriatric care.”
ENVISIONING THE FUTURE
Dr. Bharadwaj’s vision for geriatric care’s future centers on healthcare systems redesigned around older adults’ unique needs and values. He envisions “Geriatric Centers of Excellence” — hospitals and health systems that are geriatric-certified, meeting high standards for agefriendly practices, interdisciplinary care, and outcomes prioritizing function, cognition, and quality of life.
In this future, subspecialties would integrate geriatric co-management models. Surgery patients would automatically receive delirium risk assessment, frailty evaluation, and polypharmacy review. Cancer treatment decisions would reflect not only tumor biology but also cognitive reserve, functional status, and social support.
Home-based care would be central, combining house calls, telehealth, remote monitoring, and wraparound support services. “Hospi-
tal-at-home, home-based primary care, and virtual multidisciplinary rounds will be the norm rather than the exception,” he predicts.
Technology would assist but not replace clinicians. AI would support risk prediction and personalized treatment planning, but compassionate, welltrained healthcare professionals would remain at care’s core.
REDEFINING SUCCESSFUL AGING
Dr. Bharadwaj advocates for an evolved concept of “successful aging” that moves beyond disease absence to encompass function, independence, purpose, and quality of life on individual terms. “Aging with multiple chronic conditions or even physical limitations can still be ‘successful’ if the care aligns with what matters most to the individual,” he argues.
Success should be measured through person-centered outcomes: maintaining independence in daily activities, preserving cognitive and emotional well-being, staying socially engaged, living in preferred environments, and participating in meaningful activities.
The healthcare system can better support successful aging by shifting from reactive, disease-focused care to proactive, goal-directed care. This means routinely asking patients, “What does living well look like for you?” and building care plans around that answer.
A CALL TO ACTION
For medical students and residents considering geriatric medicine, Dr. Bharadwaj offers this advice: “Lean into the complexity, because that’s where the most meaningful medicine lives. Geriatrics isn’t about managing ‘old age’ — it’s about mastering the art and science of caring for people with layered medical, functional, cognitive, and social challenges.”
He reminds future geriatricians not to underestimate their potential impact: “You won’t just help patients live longer — you’ll help them live better, and you’ll often be the one voice in the system truly advocating for what matters to them.”
Dr. Bharadwaj’s work exemplifies geriatric medicine’s fundamental principle: In a world increasingly focused on technological solutions and specialized interventions, sometimes the most profound medicine happens when we ask not “What procedure can we offer?” but “How can we help this person live the life they value — safely, independently, and with dignity?”
This patient-centered philosophy, grounded in clinical expertise and deep humanity, offers a roadmap for healthcare’s future — one where technology serves compassion, complexity is embraced rather than simplified, and the goal is not just longer life, but better living. DMJ
Dr. Ravindra Bharadwaj is an Associate Professor of Internal Medicine at UT Southwestern Medical Center, specializing in the care of older patients. A board-certified geriatric medicine physician, he focuses on geriatric oncology and dementia/Alzheimer’s disease through his work in clinical care, education, and research. After earning his medical degree in India, he completed a residency and a fellowship in geriatric medicine. Before joining the UT Southwestern faculty in 2021, he held an Endowed Chair of Excellence in Geriatric Oncology at Texas Tech University. He is an active member of several professional organizations and has authored numerous academic articles and presentations.
Clinical Integration and Impact The Expanding Scope of HospitalBased OB-GYN Subspecialties
by Brandon Kulwicki and Chandani Patel, Attorneys with Hall, Render, Killian, Heath & Lyman, P.C.
OBSTETRICIAN-GYNECOLOGISTS (OB/GYNS) provide a broad range of services to women, from routine prenatal care to complex oncologic care. They possess expertise in the medical and surgical care of the female reproductive system and associated disorders, placing them in a unique position for leadership and collaboration with other physicians. With the rising complexity of women’s health and maternal comorbidities, OB/GYNs play a critical role in inpatient care, acute consults, and surgical innovation essential to gynecological disease management.
The vast majority of OB/GYNS are generalists who provide frontline coverage in labor and delivery, emergency care, gynecologic surgical units, and inpatient units. However, there is an increase in OB/GYNS obtaining board certifications in the following recognized subspecialties: critical medicine care, complex family planning, female pelvic and reconstructive surgery, gynecologic oncology, hospice and palliative medicine, maternal-fetal medicine, and reproductive endocrinology
and infertility. When the complexity of a diagnosis surpasses the generalist scope, such as in cases of malignancy, high-risk pregnancies, and advanced pathology, subspecialists are critical to co-managing these conditions, improving diagnostic precision, maintaining procedural safety, and enabling the continuity of care.
Maternal-Fetal Medicine
Perinatologists, or obstetricians with a maternal-fetal medicine subspecialty, manage high-risk obstetric patients with medical comorbidities, fetal anomalies, or obstetric complications, focusing on pregnancy complications that affect both the mother and her baby. They often treat complications including amniotic fluid disorders, ectopic pregnancies, fetal growth problems, gestational diabetes, infections, placental abruption, preeclampsia, preterm labor, and thyroid problems. Additionally, perinatologists also address general health problems that are often associated with these pregnancy-specific complications, such as blood disorders, cancer, heart disorders, and immune diseases or infections. Perinatologists will often perform prenatal ultrasonogra -
phy, noninvasive diagnostic procedures such as genetic testing, fetal surveillance, and in utero therapies to ensure the health of the mother and baby. A perinatologist may also assist in delivering a baby if the mother’s condition warrants it or if complications arise. They often work with hospitalists to provide antepartum services, co-manage patients in labor and delivery, and collaborate with critical care teams to manage critical pregnant patients in the intensive care unit.
Gynecologic Oncology
Gynecologic oncologists provide diagnosis and surgical management of ovarian, cervical, uterine, vaginal, and vulvar cancers and masses. These specialty oncologists perform radical oncologic resections, staging procedures, minimally invasive robotic surgeries, and radiation therapy to treat patients with increased precision and accuracy while minimizing trauma to surrounding organs and tissues. Gynecologic oncologists often assist with inpatient surgical consults and post-operative oncology care. They can also work alongside genetic counselors to help patients understand risks of hereditary diseases and provide follow-up recommendations. Additionally, they work closely with other hematologists and oncologists to create comprehensive treatment plans for their patients based on new developments and research in these fields.
Reproductive Endocrinology and Infertility
Reproductive endocrinologists are OB/GYNs who specialize in hormonal and reproductive disorders, recurring pregnancy loss, and fertility. They create treatment plans for patients struggling with fertility by checking blood levels and thyroid abnormalities, conduct tests on specimens and hormone levels, and order X-rays of the reproductive organs to identify abnormalities. They then make diagnoses and can prescribe medicine or follow-up procedures such as laparoscopies or hysteroscopies. Additionally, reproductive endocrinologists can perform intrauterine insemination or in vitro fertilization to help patients get pregnant. Reproductive endocrinologists are largely outpatientbased, but their interface with hospital services in managing complications and complex endocrinopathies allows them to promote continuous and comprehensive care for their patients. Through increased collaboration with endocrinology, genetics, and embryology hospital units, reproductive endocrinologists can more holistically support patients dealing with infertility and other hormonal conditions.
Case Study – Treating Endometriosis via a Multidisciplinary Care Model
Endometriosis, an inflammatory disease in which endometriallike tissue grows outside the uterus and often causes severe abdominal pain, is a complex diagnosis to make with even more complexity in available treatment options. Currently, the singleprovider model of treating endometriosis focuses on mitigating symptoms temporarily through acupuncture, nutrition, and pelvic physical therapy. The goal of improving long-term clinical
outcomes for women with endometriosis will require shifting from a single-provider model of care – where patients are primarily taken care of by their primary care provider and generalist complementary strategies – to a more patient-focused, comprehensive multidisciplinary chronic care model. The chronic care model, which packages resources, policies, and self-management support from the community and decision support, clinical information systems, and delivery system design from health systems, encourages informed patients to work with a prepared, proactive team to improve outcomes overall.
A 2010 case study conducted by Sanjay Agarwal, Warren Foster, and Erik Groessl illustrates the role that different providers play in providing optimal long-term management of endometriosis in patients. Central to this team is the gynecologist, who determines whether referrals to other specialties are needed and educates the patient to make informed decisions regarding their care. Complementary therapies, such as acupuncture, nutrition, and mind-body programs, target inflammation and reduce symptoms of pain. By reducing chronic pain and bringing in a psychologist to encourage overall psychological well-being, patients can reduce their risk of depression. Pain medicine is also necessary to determine the source of pain, while physical therapy and gastroenterology can improve pain and bloating/constipation. The patient’s primary care provider is available for general health concerns and pain management while providing opportunities for early detection and management of endometriosis-related comorbidities. A research team composed of clinicians, scientists, and subject matter experts enhance training and facilitate developments in treatment options. Last but not least, the community-support group, along with the nursing staff, are critical in providing support and education as well as coordinating care and addressing emotional needs.
While a single-provider model for treating endometriosis and other OB/GYN issues often leave women dissatisfied with their care, a multidisciplinary approach would allow patients to take charge of their care and pool together resources from varying providers, creating a tailored and more effective approach to individualized treatment. In sum, sub-specialization has become an essential pillar of contemporary hospital-based obstetric and gynecologic care. By providing targeted clinical expertise, subspecialists contribute significantly to the management of complex maternal, hormonal, and reproductive conditions by providing coordinated, multidisciplinary care that is effective, enhances efficiency, and produces better patient outcomes. However, sustaining a multidisciplinary approach will require continued investment in subspecialty training programs, strategic collaborations across disciplines, and a commitment to ensuring equitable access to specialized care. These efforts are critical to maintaining high standards of care and addressing the increasingly complex demands of modern OB/GYN practice. DMJ
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Overworked, Underrested, Burning Out Physicians Work More, Take Less Vacation, Multiple Burnout Studies Find
by Alisa Pierce, Texas Medical Association
NEARLY HALF OF PHYSICIANS WORK OFTEN WITH an incomplete care team — and are experiencing higher rates of burnout because of it, leading some to consider leaving medicine altogether.
That’s according to a May research letter published in JAMA Network Open, and dovetails with related findings that physicians take less vacation time and frequently do work-related tasks when they do.
The JAMA cross-sectional study, conducted from December 2022 to March 2025, examined the prevalence of physicians who work with an incompletely staffed team and their associated levels of burnout, intentions to reduce clinical hours, and desires to leave their organizations.
Nearly half (47.9%) of physicians — most in primary care — reported working with understaffed teams more than 25% of the time.
Among all respondents, almost half met the criteria for burnout, and 15.4% indicated they will “likely or definitely leave” their organizations — demonstrating a significant connection between
incomplete team staffing and negative outcomes.
“Our findings emphasize the importance of adequate staffing. When interpreted alongside evidence that work overload is associated with physician burnout and intent to leave … our results underscore the central role of healthcare teams in shaping physician experiences,” the study states.
Meanwhile, physicians seeking to take time away from these challenges may fail to do so due to another medical heavy hitter — the electronic health record (EHR), which many physicians are forced to pack into their carry-on bags when taking vacation time. According to a May study published in JAMA Network Open, primary care physicians spend 16.1 minutes of each vacation day on EHR tasks, reducing their meaningful time away from work.
Additionally, physicians are taking less paid time off on average, per January 2024 findings, with 70.4% of physicians reporting working during vacations and 59.6% taking 15 or fewer vacation days a year. The study also found that EHR inbox volume remains an obstacle to physicians seeking time off, with less vacation time associated with increased rates of burnout.
Hoping to change this, the Texas Medical Association has adopted numerous policies over the years to combat EHR-related burnout. At its annual conference earlier in May, TexMed, TMA adopted policy advocating for the acceptance of EHR-generated health care forms — such as
The policy supports:
school and camp physicals and other state and federal forms — to eradicate lengthy manual processes and unnecessary expenses placed upon physician practices.
And last year, TMA took steps to address EHR burnout by adopting a resolution that sought pathways for physicians to get paid for time spent on after-hours documentation.
•Increasing the relative value unit — used by Medicare, Medicaid, and insurance companies to determine how much physicians should be paid for their services based on time spent with the patient — to account for time physicians spend responding to inbox messages related to clinical care; and
•EHR vendors developing functionality to calculate the amount of time physicians spend managing the inbox both in aggregate for management purposes and per patient for billing purposes.
“The inability of most physicians to completely disengage from patient care while on vacation should be considered a system failure — one with consequences for both the patient and the physician,” the January 2024 JAMA study said.
TMA offers physicians multiple burnout resources, including downloadable brochures on stress and substance use disorders, selfassessments, CME, local medical society wellness programs, and more from its Wellness First webpage. DMJ
Republished with permission from the Texas Medical Association. This article first appeared in Texas Medicine Today, June 2, 2025.
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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!
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.
TMLT - Inside front cover
Broadway Bank – Page 5
Southwest Diagnostic Imaging Center – Page 9
Hall Render – Page 10
Texas Health and Human Services/
Texas Health Steps – Page 24
Christopher Bell, MD, FACS – Page 26
Schifano Realty Group/Bolder Vision Group – Page 29
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.
| 469-460-9660
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
H. Pruitt, MD, FACS
8315 Walnut Hill Lane, Ste. 125, Dallas, TX (214) 363-6000
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
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
ENVISION RADIOLOGY WAS FOUNDED IN 2000 WITH our first center in Colorado Springs, Colorado. Because of the immediate success of our first center, and relationships we had in other markets, we expanded into Oklahoma in 2002, Denver and Dallas/Fort Worth in 2003, and Louisiana in 2004 and Utah in 2022. Over the years, we have built a strong brand, and we’re still growing!
Our mission is “To improve lives through unmistakable quality and spectacular service”. Our employee-owners are passionate about enhancing the health and quality of life for our patients. We serve our patients and their families with humility, empathy and compassion. Not only will your imaging procedure be completed by technologists that care about you, but it will also be completed using the latest technology available in this field.
One of Envision Radiology’s founding partners set a guiding principle that still is the foundation of our company culture when he said, “If we do the right things, in the right way, for the right reasons, we will succeed.” The values that we live by reflect this principle.
Physician and Patient Services:
We are proud to provide the following services: MRI/MRA; CT/CTA;
Ultrasound; X-Ray; PET/CT; Nuclear Medicine; Mammograms; Bone Density; Neuroscience: DaTscan, DTI, SWI, Neuroquant; along with additional specialty tests.
Physicians can connect with us in various ways, and we provide an online portal for reports and image viewing. The Physician Access Link (PAL) allows our referring physicians to:
• Schedule patients online from any internet browser and check on scheduling status
• Access images and reports for your patients seen at our centers through Images Anyware or our PACS
• View Images and reports on any tablet or smartphone
• Receive alerts via text or email when reports, images, and STATs are ready
We invite you to visit one of our conveniently located imaging centers to experience our hospitality and expertise and to see for yourself why we are the market leaders in quality of care and patient satisfaction! For more information, please visit our website at www.envisionimg.com to see how we are making a difference.
SKYTALE GROUP IS A LEADING MANAGEMENT CONSULTING
firm and investment bank offering a range of strategic and financial advisory services to healthcare businesses nationwide. Skytale Management Consulting provides services centered around evidenced based strategy to grow healthcare organizations, while Skytale Investment Banking consists of licensed investment bankers who have extensive experience in mergers and acquisitions and private capital advisory capabilities within healthcare. Together, we are committed to helping growth-minded business owners in the healthcare industry by equipping them with the advice, information, and perspective needed to achieve lasting value.
Founded in 2018 and headquartered in Dallas, Texas, Skytale Group has a national presence providing guidance and perspective to clients across multiple healthcare specialties. At Skytale, we treat our client’s business like it’s our own, and we are dedicated to becoming a trusted partner by delivering tailored solutions designed to grow, scale, or sell your business.
Our team of financial professionals and C-level executives have decades of hands-on, industry experience and are equipped to take your business to the next level. Using the intersection of business intelligence and your personal goals, our team can help guide your business to meet your vision.
For more information, visit skytalegroup.com
Supporting Texas Physicians Has Always Been Our Policy
You know what it means to show up. So do we. And the protection you rely on should live up to that.
You’ve made important choices about how you practice medicine—whether as an owner, independently as a locum tenens, or within a hospital system—and no matter your path, it takes commitment and sacrifice. That’s why it matters who’s standing behind your coverage.
TMA Insurance Trust was created by physicians for physicians. Because of that we recognize what other agencies often miss—and we’re committed to our TMA members not just through insurance alone, but by helping fuel programs and resources that serve physicians across Texas. That includes free CME, confidential one-on-one support through the Anticipate Joy program, contributions to the Physicians Benevolent Fund, and backing for county medical societies and statewide initiatives. It’s how we help physicians care for themselves, for one another, and for the communities that count on them.
From residency to retirement, your TMA membership gives you exclusive insurance products, member-only discounts and benefits, and select plans that don’t base your rate on gender. You’ll also get real help from our advisors with coverage choices, paperwork, and admin tasks—with no sales pressure. They stay involved with answers, follow-through, and guidance that respects your time and judgment.
It’s support that goes beyond a policy, bringing you options and insight that align with how you make decisions for your practice, your family, and yourself.
For 70 years, TMA Insurance Trust has been here for Texas physicians. If you’re ready to make the most of what your TMA membership offers, explore your benefits at tmait.org, scan the QR code, or call 800-880-8181, Monday through Friday, 8:00 AM to 5:00 PM CST.
