A spokesman for the specialty
Story by Kate Alfano
Photos by Samantha White
When he was TAFP president in 2001, Justin V. Bartos III, M.D., promoted a campaign he called “Take Back Medicine.” It was based on three premises, three directives for himself and his fellow family medicine colleagues: Be a role model, be politically active, and expand your capabilities to be successful in the future.
Although a decade has passed, he believes this still holds true. “I think family physicians by nature try to be role models. I don’t think they’re politically active enough; I don’t know if you can be too politically active. Then expanding your capabilities to be successful in the future, I think that’s true of most businesses or occupations, but particularly for family physicians. We have to keep reinventing ourselves and our role in the health care environment.”
As the 2012-2013 Texas Family Physician of the Year talks about the evolution of his own career in northeast Tarrant County and beyond, it’s clear that this has been a very successful model for him, firmly establishing his place as a pillar in his community and a leader in the profession.
Ever humble yet incredibly driven, Bartos credits many role models who helped shape his family medicine career. It all began in La Grange, Texas, a small community halfway between Austin and Houston, where he grew up. His father, the late Justin Bartos Jr., was a pharmacist for 55 years and a highly respected figure in the town, and his mother, Laura, taught high school math.
One day his mother returned from an educational seminar having decided that her oldest son must choose his career. Bartos was in eighth grade. “So I lay awake in bed for several nights wondering what I would be when I grew up,” he recalls. “I told her I wanted to be a family physician. Her response was, ‘What? Don’t you want to be an engineer?’ I said, ‘No, I want to be a family physician.’ I explained that the people I admired were the local family physicians. I had a strong background in science and loved the role of a physician in the community, and I thought that would be a great fit.”
One local physician in particular, Herb Smith, M.D., the father of one of his classmates, strongly influenced this decision. “He treated my asthma in the middle of the night, he removed my appendix, he repaired my lacerated heel and my fractured arms,” Bartos says. Smith also organized the local medical explorers, an extension of the scouting program, and led a group of a dozen high school students on a trip to St. Luke’s Hospital in Houston to see Denton Cooley perform open heart surgery. “Things were never the same. I now had a vision of the future and the path I would follow.”
View the Physician of the Year
Bartos entered the University of Texas at Austin as a pre-med student majoring in mechanical engineering with a focus on biomedical engineering. While there he married Sheryl, whom he met in high school, and the young couple looked for a medical school that would provide high-quality education and be supportive of families. They settled on the University of Texas Medical Branch in Galveston, which at the time was the alma mater for half the physicians practicing in the state of Texas.
While in medical school he studied under two more extraordinary family physicians, Paul Young, M.D., chair of the family practice department at the time and “one of the founders of the family practice movement,” Bartos says, and Barbara Thompson, M.D., current chair of the UTMB family medicine department, who at the time conducted his medical school interview and served as Bartos’ faculty advisor and preceptor during his formative years in Galveston.
Though he briefly considered other specialties, he pursued a family medicine residency at John Peter Smith Hospital in Fort Worth, led by program director Bruce Jacobson, M.D., who would serve as another role model. “JPS at the time was and still is considered the premier family medicine program in the state of Texas,” Bartos says. “Unlike Parkland or Baylor or places like that, in those locations you were competing for patients with internal medicine, pediatrics, and all of the subspecialties. At JPS, you basically had family medicine, a few ob-gyns, and a few ortho residents, and that was it. So that made your experience that much more intense.”
The training prepared him to join a practice that would later be known as North Hills Family Medicine, founded by David Pillow, M.D., a former residency director, well-respected family physician, and icon in the northeast Tarrant County medical community. Pillow became Bartos’ greatest mentor, instilling in him the characteristics of an exemplary physician. “He’s a very unique individual and has a storyteller personality,” Bartos says of Pillow.
“Most of what he taught me was the importance of establishing relationships with your patients, the importance of good relationships and support among members of a group practice, and the importance of fairness in all feelings with the monetary aspects of the practice.”
Pillow also stressed that even when you’re seeing your partner’s patients, you must care for them like your own; don’t ever do less service for them than you’d normally provide.
And Bartos recalls that while Pillow was always interested in the latest technology, he was practical about it: “We talked about electronic records and whether they would replace paper and he said, ‘What if everyone’s records were on an 8-track player? Would you be able to look at it? Paper has been the only thing that has stood the test of time. It’s been around since the Egyptians.’ That was a typical Pillow statement. He made a lot of similar comments, but I always remember the one about if you jump on the latest technology it will probably be replaced by something else soon.”
The wisdom imparted by Pillow has stuck with him and the traits instilled in early practice have become his greatest qualities. Again and again, those who speak of Bartos say he’s compassionate, thorough, and sincere in his clinical care, forward thinking in the business aspects of medicine, and always willing to recruit, inform, or promote the specialty.
His wife Sheryl says it is evident that he truly cares for his patients. “He takes the time to listen to them, regardless of how long it takes, and he goes the extra yard to make sure that they receive the best care possible whether it be by him or someone that he refers them to. … His patients know that he is compassionate, caring, and thorough. He will laugh at their jokes and hold their hands when they need it most. He is a family physician in every sense of the word.”
Bartos with Kim Odell, L.V.N.
Kim Odell, L.V.N., has been his nurse for nearly 15 years and says he accepts patients who feel helpless and like there’s no one who will listen, or complicated patients other doctors might not want. But he gives each his full attention and the time they need until he can work through their condition.
“There’s times, even as a nurse, that I’m thinking ‘oh please come out of that [exam] room!’ But you know what, that’s what that patient needs. I trust him to stay in there and take care of everything even if we’re getting really behind in the schedule,” Odell says. “Most of our patients have been with us for a long time and they understand that he’s there for whatever amount of time needs to be taken to take care of the situation.”
Patient Jan Jacobson wrote in a nomination letter that Bartos has been the “epitome of integrity when it comes to the care of my whole being—body, mind, and spirit.”
“He thoroughly examines me first, rather than relying only upon sophisticated diagnostic tests or shuffling me off to a specialist. He talks to me, he looks me in the eye, and he makes sure that I understand all aspects of whatever it is that he wants me to know before I leave his office. With every question I ask—and, boy howdy, I ask them—he answers with both patience and wisdom. Such exemplary care requires his valuable time, and not once in 25 years has he ever rushed through any appointment I have had with him.”
In his early years under Pillow, Bartos began to expand his outreach and community service. Pillow encouraged him to teach nurse practitioner students, which later included medical students; he encouraged him to become the medical director of a local nursing home, a post he held for two decades that evolved into co-ownership and led to the startup of a hospice service; and he encouraged him to get involved in organized medicine.
Surprisingly, Bartos’ decorated service in the Academy started on a sour note. Pillow took him and another young physician to a monthly meeting of the Tarrant County Chapter of TAFP, which was held in a small classroom in a tower of St. Joseph’s Hospital in downtown Fort Worth. He recalls there were five total in attendance, the speaker was unintelligible, and “then we had something to eat which consisted of going through the line and eating institutional food at the cafeteria. I was not very impressed with that encounter.”
A year later, Ronnie Irwin, M.D., a local physician, asked Bartos if he would consider organizing the programs for the local chapter. “I said I would consider it but I wasn’t going to have any of them in a hospital classroom with food from the cafeteria hospital food line.” He approached some of the local pharmaceutical representatives—far before sponsored meetings were commonplace—and told them the chapter needed a large meeting room and speakers of national caliber.
“It was based on the concept of good food, good fellowship, and a good educational program. Soon we had meetings that were held at good restaurants, we had great speakers from around the country, we had attendance of between 40 and 50 physicians, and everyone looked forward to them. They became a big part of the social interactions of physicians to meet and discuss issues in how the practice of medicine was evolving.”
As he moved up in the ranks as a Tarrant County chapter officer, he also began attending state meetings, having seen his former JPS colleague, Roland Goertz, M.D., get involved in TAFP. “As I went and watched, I realized I could be seated as Tarrant County delegate, so I started asking to be seated as a Tarrant County delegate. Then I realized I could become involved in committees, so I became involved in committees.”
“At that time I had developed a lot of experience in managed care because I was involved in starting up the first IPA at the North Hills Hospital site where I was, so I became more involved with that process, trying to raise the level of concern and expertise at TAFP regarding managed care, IPAs, HMOs, the gatekeeper model, and how that could benefit patients and physicians.”
Bartos first joined the TAFP Bylaws Committee, but what had the greatest impact on his trajectory into the TAFP leadership was when Leah Raye Mabry, M.D., and Stephen Benold, M.D., tapped him to join the Task Force on Governance, which exposed him to the top TAFP leadership. He continued serving on Bylaws, and also joined the Commission on Membership and Member Services and the Executive Committee, moving up the ranks to serve as president in 2001 and expanding his service from there.
“I think family physicians have more to offer than almost any other health care entity out there and that they should be rewarded sufficiently for doing so, so they’ll be happy and healthy and persuade others to follow our lead.” –Justin Bartos III, M.D.
During his presidency, Bartos led a successful campaign to elect James Martin, M.D., as the first AAFP president from Texas in decades. “That was an exciting time to be president and evolve,” he says.
In his own community he became more politically active, attending town hall meetings held by his state representative, Bill Carter, to alleviate fears in the general public about the AIDS epidemic. Speaking on clinical topics initially, “that rapidly evolved into my concerns about the changes that were occurring with managed care,” he says. He also became a regular campaign supporter of local lawmakers state Rep. Vicki Truitt and state Sen. Jane Nelson, and supported U.S. Rep. Michael Burgess’ initial campaigns.
All of these factors contributed to his desire to become more active in AAFP, and he joined the AAFP Commission on Practice Enhancement, later renamed the Commission on Quality and Practice. “I had the opportunity to work with many impressive individuals that make up the leadership of the AAFP and many people with a lot of expertise from across the country. This was one of the highlights of my time with AAFP.”
In 2003, Bartos became an alternate delegate and then delegate to the AAFP Congress of Delegates, following Martin, Mabry, and Goertz as they ascended to higher office. He says of his time as delegate, “I always enjoy the interaction and I enjoy the discussions. It’s something I hope many other members have an opportunity to participate in because you do feel like you’re helping to set policy for the organization, especially with an active group like we have in Texas.”
Considering his involvement in his community, organized medicine, as a leader in his practice, and as a dedicated husband and father to three daughters, one might wonder how he had enough hours in the day. In a nomination letter for the award, Erica Swegler, M.D., a longtime friend, practice partner, and TAFP leader, wrote that one of her mentors frequently said it is important to give back to your profession, your church, and your community—but you do not have to do them all simultaneously.
“Dr. Bartos has managed to serve all three at the same time,” she wrote. In addition to his service to TAFP and AAFP, “he has served on multiple committees for the Texas Medical Association and the Tarrant County Medical Society. He served as the administrative physician for North Hills Family Medicine from 1993-2010.”
“When John Peter Smith Health Network/Tarrant County Hospital District needed a family physician’s input, Dr. Bartos stepped up and served on the Board of Managers and Quality Committee from 2004-2006; a demanding and very time-consuming role. He has served as medical director for a nursing home and hospice, and as chief of staff for North Hills Hospital. Additionally, his service includes being physician advisor for the catholic schools in the Diocese of Fort Worth since 1995.”
Bartos meets with a post-operation patient
“While doing all of this, Dr. Bartos has been an outstanding clinician and a caring friend to his patients. While he is not infrequently behind on his schedule, his patients remain loyal to him because they know that once he is in the exam room with them, he will give them the full measure of time and attention of their needs.”
Bartos says it was possible because the practice of medicine used to be much less time consuming. “We worked in an environment with fewer documentation requirements, fewer compliance issues, fewer billing and administrative hassles, and fewer referral hassles; all of the things that are now present in practice. In that environment we could see patients more efficiently.”
“At that point in time it was still relatively easy to see people, implement a plan and finish your treatments, and end your day in a timely manner. It did allow you to do more things. You had more time for the hospital and nursing home, and maybe a round of golf every once in awhile, and an opportunity to participate in other things in the community. As these compliance items have built up, it’s now consuming a major portion of physicians’ time and we find ourselves pretty much confined to the office and doing less of these things that we used to do.”
“That’s a change I’m hoping will swing back the other way because I think the younger physicians would enjoy practicing even more in the type of environment that existed in the mid-1980s and early 1990s.”
As his career has progressed, he has kept a keen eye to the practice environment. He says the key to long-term successful practice is not just the clinical aspect of care; you have to be in an economically friendly setting as well. “That motivated me to pursue policies that I thought would help family physicians survive in whatever environment they try to practice in, and to this day that is something that motivates me to get involved in all of the political activities. I think family physicians have more to offer than almost any other health care entity out there and that they should be rewarded sufficiently for doing so, so they’ll be happy and healthy and persuade others to follow our lead.”
Continually attuned to the evolving practice environment and the family physician’s role in it, he found his latest practice endeavor. Just under two years ago, as he saw that many of his patients at North Hills Family Medicine had aged into Medicare, he looked for a viable model to take care of a large senior population. He found the David Pillow Senior Clinic at North Hills Hospital, aptly named for his longtime mentor, which had been left without any permanent physicians following recent mergers in the community.
Bartos approached the hospital administrator, where he’d had privileges for many years, and asked if it would be possible for him to practice part time in the senior clinic. They pointed him to the Medical Clinic of North Texas, newly responsible for the clinic’s staffing. He resigned from NHFM and began practicing full time at the senior clinic in April 2011, adding two more physicians in September and November to handle increasing demand.
“It took almost a year to get the clinic back to its previous status; patient visits had dropped to a third of what they were under the previous group. But I represented a consistent provider, a known entity in the area, and it started to build back up.”
“I think he has a good eye for the trends and the direction that the health care system in general is going. I’ve worked with him in a couple of different capacities and he’s always been on the cutting edge of what is new in health care and he’s willing to take those chances when new things come around.” –Stacey Howard
That time was “pretty hectic,” says Stacey Howard, who served as the director of the clinic at the time. “He definitely brought stability to the clinic and that was important to the patients as well as the staff. That helped with morale and that helped with perseverance.”
“I think he has a good eye for the trends and the direction that the health care system in general is going,” she says. “I’ve worked with him in a couple of different capacities and he’s always been on the cutting edge of what is new in health care and he’s willing to take those chances when new things come around.”
“He’s always trying to find a better way to provide care that works for all the parties involved because you have to provide good patient care, but at the same time you have to have people who want to provide that care, feel good about it, and are able to do their very best. That’s what’s always hit me is that he’s always looking for the best way to do that so everybody’s needs are met.”
The senior clinic uses a team-based model to care for the population, the only way you can see large numbers of Medicare patients, Bartos says. He works with an L.V.N. and an RN part of the time, as well as an in-house social worker, administrative support staff, and the director of the facility. “With that type of team, you can take on older people with multiple medical problems and social needs and address those concerns.”
The average age of his patients in the senior clinic is 85 and he says most have six to 10 medical problems for which they’re receiving treatment. “Seniors require a lot of resources. They require people to not only arrange visits with their doctors and arrange their diagnostics, but they frequently have issues trying to arrange appropriate follow up, ensuring they’re receiving the appropriate medications, and ensuring they understand the treatments that have been recommended for them. So in this population that has so many different problems, so many different medicines, so many different services that you’re trying to arrange for them, having a team to tackle that is of great benefit to both the practice and the patient.”
While he was building the senior practice, Bartos had a large following of non-Medicare patients from NHFM who were eager to see him. He again approached MCNT, this time about starting a commercial clinic to continue to care for them. A few months after transitioning to full-time practice at the Pillow clinic, he opened MCNT North Richland Hills.
He now works part time at both clinics. “It’s challenging but also satisfying to see how quickly I’ve been able to reestablish the senior clinic population and now grow a commercial population.”
“I’ve always had the feeling that if medicine became more sophisticated and more complicated, there will be an even greater need for someone like a family physician to serve as a coordinator and a liaison through complicated medical treatment protocols.” –Justin Bartos III, M.D.
Bartos’ practice has slowed somewhat from the years when he’d have to read over his schedule to know where he had to be and when, but he remains active with the Academy and with his church. He has made more time for old hobbies like golf and to start new hobbies like cycling, and to travel overseas to new and unfamiliar places. And now that his daughters are grown and married, he and Sheryl frequently spend time with their family, going on “adventures” with their four grandchildren and sharing their excitement in their first experiences.
And even as physicians face the challenges of technical and process-oriented changes, implementation of new care models and quality initiatives, and reforming the payment model, Bartos is hopeful for the future. “I’ve always had the feeling that if medicine became more sophisticated and more complicated, there will be an even greater need for someone like a family physician to serve as a coordinator and a liaison through complicated medical treatment protocols.”
His career has exceeded his expectations. “When I started I had a relatively narrow view of the capabilities of family physicians. I was from a small community where the local physician was a health care resource, but he was also a role model in community and a supporter of a lot of different initiatives. I envisioned myself being in a relatively confined community serving their health needs and participating in other opportunities within the community. I didn’t look at the family physician as having political influence, having the ability to interact on multiple levels with policymakers and with leaders in larger communities that are affecting the delivery of health care on a national basis.”
In all of these ways, he has been and continues to be the embodiment of his “Take Back Medicine” campaign, advocating for the specialty of family medicine, stepping up to lead even in challenging circumstances, and continually expanding his capabilities to be successful with his practice and to serve his patients.