When a disturbing trend emerged in the Lubbock emergency department where Eman Attaya, MD, works, it sparked the idea for what has become the Texas Medical Association’s newest public health campaign designed to help families better control how much their kids interact with electronic devices.
“When I was covering the [emergency room] as a radiologist in 2018, I had been in practice for about seven years at that time, and I had never seen such an uptick in suicide and suicidal attempts in young adults,” she said.
A review of medical literature showed that one of the factors driving suicides – as well as depression, anxiety, and other psychological problems – was increased use of digital devices by young people.
“More and more research is proving that increased screen time – i.e., time spent on digital media such as smartphones, tablets, computers, TV, and gaming consoles – is associated with poor health outcomes in children, adolescents, and even adults,” she said.
So, in March 2020, Dr. Attaya launched what is now a statewide educational campaign called Turn It Off Today, which the TMA Council on Health Promotion approved in May. But that would not have been possible without the help of medicine’s massive volunteer force: the Texas Medical Association Alliance.
Sponsoring a community outreach program would have been unthinkable in 1918 for the women who created the TMA Alliance (then the TMA Women’s Auxiliary), and not just because technology changed. While those women were mostly educated and accomplished, they created the auxiliary two years before women had the right to vote and at a time when it was assumed every woman wanted to be a homemaker.
The TMA Alliance was always created to support TMA’s mission to improve the health of all Texans. Over time, this group of doctors’ wives morphed into a political and community service organization that relies on the volunteer efforts of women and men, physicians and spouses. And the ways to carry out those tasks keep evolving.
“We’ve worked in the last few years on recruiting men – pulling them in and giving them leadership positions and figuring out what motivates them to join,” said TMA Alliance President Jennifer Lewis, whose husband is San Antonio colorectal surgeon W. Cannon Lewis, MD.
But the changes are based on more than just demographics, she says. As the creation of Turn It Off Today shows, the TMA Alliance is always looking for new ways to promote TMA’s goals at the local and state levels.
“We’re a living organism,” Ms. Lewis said. “We have to continue to adapt.”
Today’s TMA Alliance members are core organizers for political advocacy in local government as well as events at the Texas Legislature.
“They’ve done a superb job in every project they’ve touched,” said Dan Finch, TMA’s vice president for advocacy. “They’re not a secret weapon anymore but an established part of medicine’s advocacy.”
In fact, alliance members created TMA’s award-winning advocacy program, First Tuesdays at the Capitol, in 2003. (See “Ways to Get Involved,” page 32.) Susan Todd, alliance president in 2002-03, came up with the idea as a way to boost lobbying on behalf of health care liability reforms.
“We had to get the legislators to not only pass [the reforms] but also a constitutional amendment that could be voted on by the public,” she said. “We’d been working on that for a good many years and felt like our time was right, so we felt like we needed to make our presence known much more regularly.”
Until then, the TMA Alliance had held a once-a-session health fair for legislators and their staff members each year in the Capitol basement, Ms. Todd says. TMA Alliance members wanted instead to create a monthly lobbying presence, and that brought to mind the First Monday Trade Days held at Texas flea markets.
Since many legislators are not in the office on Monday mornings, Ms. Todd hit upon the idea of starting First Tuesdays at the Capitol.
“We did it that year, and it was very successful, so we just decided to keep doing it,” she said.
Now, on the first Tuesday of every month during state legislative sessions, hundreds of physicians, medical students, and alliance members descend on Austin to share their views with lawmakers.
TMA Alliance members who are not physicians often make effective lobbyists for medicine precisely because they can explain medical issues to lawmakers in layperson’s terms, Ms. Todd says.
“They understand it frequently from a nonmedical perspective, and they also can speak to what it can be like to be in a medical family and the impact of some of the legislation that affects a medical family,” she said.
Talking to physician spouses also humanizes physicians in the eyes of legislators, Ms. Lewis says.
“We provide that buffer that allows nonmedical legislators to see that physicians are not insurance companies and big pharmacies,” she said. “They are health care professionals who just want to be allowed to do what’s best for their patients on a case-by-case basis.”
With the 2021 legislative sessions concluded, TMA and alliance members now are focused on local First Tuesdays in the Districts events to continue to build relationships with lawmakers before the next legislative session begins.
“Especially during COVID, [alliance members] are trying to get that First Tuesdays at the Capitol experience at the county level,” Ms. Todd said. “Go talk to your legislators when they’re at home.”
But the alliance’s advocacy work doesn’t stop with lobbying, Ms. Todd says. Members also serve on the boards of TEXPAC and the TMA Foundation, and they are voting members of many TMA councils and committees.
Legislative committees for the county medical societies – which include alliance members – frequently interview local candidates and pass on their recommendations for endorsements to TEXPAC, Ms. Todd says. That also helps alliance members become more familiar with local lawmakers. (See “PAC-ing a Punch for Medicine,” page 22.)
“It works well if every county [society and alliance] is active on the county level,” she said. “Then when you’re in session … you’ve already got that relationship.”
Each alliance chapter has the option to take part in popular TMA community programs that promote public health, like Vaccines Defend What Matters, Hard Hats for Little Heads, and now Turn It Off Today – or to create their own programs.
The alliance’s ability to adapt to the changing times has been made easier by the fact that each local chapter has its own personality based on members’ interests and local needs, Ms. Lewis says.
“You can’t expect the needs in Corpus Christi to be the same as the needs in Lubbock,” she said. That individualism also allows county alliance chapters to serve as incubators for new ideas.
A passion for literacy motivated Chris McGilvery, the husband of family physician Taryn McGilvery, MD, to create a new literacy program that involves local physicians. He is founder and executive director of The Leaders Readers Network, a nonprofit that provides children in low-income communities with access to books, school supplies, and leadership development.
While living in Bell County, Mr. McGilvery worked with the TMA Alliance chapter to start Texas BookShare. Local physicians began prescribing books to their young patients that are designed to teach about healthy living. Each book comes with an encouraging note from a TMA Alliance member.
Like Turn It Off Today, the program was approved by the Council on Health Promotion, and, thanks to a grant from the TMA Foundation, has been launched by several other alliance chapters. Mr. McGilvery has since moved with Dr. McGilvery to the Amarillo area, where he started a Texas BookShare program as well.
“I wanted to get more books to kids across the state, and the alliance is the perfect organization to be able to be a part of that,” he said. “One of the reasons I joined [was] because the Family of Medicine is diverse, and I wanted to be part of it. [I also wanted] to connect with other dads who are married to doctors and to be part of this community because there’s fellowship, there’s service, and there’s advocacy work we can do together.”
Some alliance chapters also create projects that help strengthen physician families as they promote community involvement. For example, the Smith County Medical Society Alliance formed a Junior Health Ambassadors program, which gets Tyler-area children of physicians involved in health-related community projects, says Li-Yu Mitchell, MD, a TMA Alliance member who created the initiative.
The children – and in many cases their parents – have done trash cleanup, worked at a food bank, recycled plastic bags into mats for people who are homeless, and held a Hard Hats for Little Heads event.
Junior Health Ambassadors also is designed to bring physician families together – giving parents and children some time to share while allowing them to form closer ties to families that have similar concerns, Dr. Mitchell says. She grew up as a daughter of a physician, and her husband is a physician, so she understands the unique stresses faced by physician families.
“The idea is to give some bonding experience for doctors and their families,” she said. “It also helps generate more membership opportunities and awareness of the alliance as well as the [county medical] society when you can get people from competing systems and practices together in a more family-oriented way.”
Some of the societal changes that allowed the Women’s Auxiliary to become the TMA Alliance have evolved to make it more challenging for the alliance to recruit new members in some areas, Ms. Lewis says. More families have two working parents, and in many cases – like Dr. Mitchell’s – both are busy physicians.
“It’s important for [the alliance] to become more of a couple’s organization,” Ms. Lewis said.
For example, she pointed to one TMA Alliance chapter that has many early career physicians and spouses, and one of its top priorities is finding ways to organize playgroups for children as a way of meeting other physician families.
“They want to get together with their kids and other female physicians and just hang out and have a peer group,” she said.
And while COVID-19 has put on display the extra stresses physician families face, it has also highlighted the TMA Alliance’s ability to help members respond to those stresses, says TMA Alliance President-Elect Libby White.
Many physicians, like her husband, Lubbock radiologist Steven White, MD, dealt directly with COVID-19 patients early in the pandemic. When he came home, he had to strip down in the garage and immediately shower before he could interact with his family.
Once TMA Alliance members adjusted to these and other changes, like masking and social distancing, they quickly looked for a way to help other TMA Alliance members and people in the community.
“It was hard for the leadership of our medical society and alliance to figure out where we could make a difference and should we even ask our members to volunteer that during this time,” Ms. White said. “But our members came up to us and said, ‘What can we do?’”
TMA Alliance members all over the state joined with physicians to round up personal protective equipment. Others helped with blood drives and even grew gardens to provide food for people who were struggling economically.
Early in the pandemic, Ms. Lewis could not visit any TMA Alliance chapters, and all interactions had to be done through phone or Zoom meetings. But the development of vaccines and antiviral medications to combat COVID-19 has allowed her to finally visit some chapters and talk directly to TMA Alliance members about their needs.
“It almost feels like a guilty pleasure,” she said, adding that many members are looking forward to more local meetings and statewide meetings in 2022.
“When we come together, we get ideas from one another about what seems to be working, and that’s a beautiful thing,” she said. “There’s no requirement that everyone have the same approach to fundraising or community service … so you can get ideas and develop them to fit the personality of your group.”
Many chapters focus on recruiting medical students and residents to ensure that younger physicians and their families remain engaged with the TMA Alliance, Ms. White says. But students frequently move for residencies, and residents frequently move to take jobs or set up a practice. When that happens, she wants to ensure that a person moving in state gets a warm handoff to his or her new medical society and alliance chapter.
“We want to show them that no one knows what you’re going through as well as another physician or physician spouse,” she said.
Still, the problems created by the pandemic are likely to linger, Ms. Lewis says. The best way to attract and keep new members is to make sure that each community is attentive to the needs of current members.
“My focus really has been that we need to take care of the members that we have,” she said. “And we need to make sure that we’re real intentional about who we are, what our values are, and build up that community.”
Tex Med. 2022;118(1):28-33
January/February 2022 Texas Medicine Contents
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