Q&A: Texas Medical Association President Dr. Diana L. Fite

Dr. Diana L. Fite was sworn in as the 155th president of the Texas Medical Association (TMA) – America’s largest state medical society – last week. An emergency medicine physician with over 40 years of experience practicing, Dr. Fite begins her term in a time when emergency medicine is one of a select few fields standing between people and the calamitous effects of a global pandemic. 

Just a few days into her term, I called Dr. Fite to hear her assessment of where the Texas health care system is as the state begins to re-open its economy. We also discussed the ways electronic medical record keeping could be improved and Medicaid payment increases for doctors.



Michael Goldberg: You’re taking the reins at TMA at a tumultuous time. From your standpoint as the President of America’s largest state medical society, how should TMA prioritize the myriad challenges it faces now and in the future with respect to COVID-19? 

Dr. Diana L. Fite: We represent 54,000 physicians as members and another 20,000 that are not TMA members but are practicing in Texas. Many of them are seeing major problems with their office practices due to patients being afraid to come in and offices not having enough PPE to use. But we’ve succeeded thanks to Texans doing a great job with social distancing. We’ve seen a great number of hospital beds open up and we have enough ventilators. We’re ready if we see a bit of a surge from Texas opening up as Gov. Abbott has started to do, though we’ll be in trouble if there’s a huge surge as the whole nation will be.” 

MG: Being an emergency medicine doctor yourself, can you walk me through the psychological wherewithal you think it takes to be a health care worker on the front lines of this crisis?

DLF: Well, I think you can see that reflected in the extreme measures physicians will take in this moment. They’re totally donned in protective gear head to toe at the hospital. After their shift, they change out of their gear, shower, put on fresh clothes, go home, shower again and put on fresh clothes; this is all before they even see their family. There’s also a bunch that stay at a hotel, just out of fear of bringing the virus home to their family. So that fear surrounding this virus is very real, even for physicians, but I think they do just want to do everything they can to help their patients out.”

MG: You cited “bureaucratic interference in medicine” as one of the top issues you’d like to focus on during your term. How do you see this bureaucratic interference bearing down on physicians and what can be done to rein it in?

DLF: A huge interference occurred years ago when they required us to use electronic medical records which has been a real burden to many physicians. Yes, we all like the technology but these multiple clicks they expect us to make, you can’t imagine how much time it takes up to do these electronic medical records. Studies have shown that you spend far more time doing records than you spend face to face with patients. And yet, the records are not interoperable; they don’t go between hospital systems, which we were told was the purpose of this in the beginning. You can’t see what other systems have done in terms of testing, diagnoses a patient has, etc; it’s useless in that respect. It comes down to the fact that this was primarily a tool for billing purposes for facilities. It imposes a huge bureaucratic burden which can definitely be improved by making the systems interoperable, and letting some data processing clerks work with the technology.

Bureaucracy is also a factor in a “metric focussed” type of system where administrators require physicians to see a certain number of patients per hour, order a certain number of tests through a hospital system rather than, perhaps, ordering tests from a different place that might save the patient money or be a patient’s preference. If you don’t go along with it, you can risk losing your job or decreasing your salary.”

MG: I think there is a sense in the health care sector and beyond that the implementation of new technology is always, unquestionably, a net positive. Do you think there needs to be more careful thought applied when a new technology comes to the fore?

DLF: Doctors embrace technology, of course, but work with us to make it a net positive rather than having the bureaucracy suddenly come down and order things to be done a certain way. It happens, often in the Legislature, where they decide to connect these systems with payment to ways to keep our office going and care for our patients. It’s almost threatening; if you don’t do what they’ve decided, it’s going to hurt you. This happens instead of us working together to do what’s best for our patients in the long run.”

MG: What would you tell legislators in Texas to focus on right now?

DLF: They need to increase Medicaid payments, to the extent they can do that as it’s so connected to the federal government. But physicians overall, with a couple of tiny extensions that were pretty much taken back after they were given, have not received a Medicaid pay increase in 20 years. The amount they get is so minimal – it’s essentially paying out-of-pocket for some patients just to take care of them. Some doctors have to try to get quite a few Medicaid patients just to take any Medicaid patients. Let’s get our Medicaid payment at least up to par with Medicare, if not more decent than that.” 

MG: In your view, why haven’t Medicaid payments been increased in 20 years?

DLF: I think it’s twofold. Texas is very proud of the fact that they try to keep a good budget. They don’t want to be a state known for not meeting their budget. They always find it easier to not increase Medicaid payments because they feel so confident that the physicians will continue to take care of patients no matter what. So, they find it too easy not to increase the rates.”

This conversation has been edited and condensed for clarity.