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TrendsMD podcast: Introduction to the Texas Medical Association (TMA)

Learn how the TMA and TMLT work together to defend tort reform; help physicians with their practice; and partner with county medical societies throughout Texas. Special guests: Sylvia Salazar and Mari Hosek of the TMA.


Also available on Apple, Google Podcasts, and Spotify


Anthony Passalacqua, 0:08: Hello and welcome to this edition of TMLT’s podcast TrendsMD: Answers for health care’s digital trends. I am your host, Tony Passalacqua. Today I have special guests, Sylvia Salazar and Mari Hosek from the Texas Medical Association, but during this podcast, we are just going to refer to it as the TMA. And our topic today is the introduction to the Texas Medical Association.  

Anthony Passalacqua, 0:28: Sylvia, can you tell us a little more about yourself?  

Sylvia Salazar: Well, thanks for inviting me today. My name is Sylvia Salazar and I’m the associate vice president for membership and leadership development at Texas Medical Association. I’ve been with the association for 20 years and my team and I are responsible for all recruitment and retention activities.  

Anthony Passalacqua, 0:49: Mari, can you tell us a little more about yourself?  

Mari Hosek: Hi, I’m Mari Hosek, and I have been with TMA for a little over six years and I work on Sylvia’s team as a membership development manager.  

Anthony Passalacqua, 1:00: Thank you guys for your introductions. Can you tell me a little more about who is the TMA?  

Sylvia Salazar: Yes, TMA is a professional membership organization representing physicians and medical students in all medical specialties and practice settings. TMA is the largest state medical association in the country with more than 56,000 physician and medical student members. In addition, TMA has a conjoint membership with the county medical societies. This means that members must join both TMA and the local medical society — either where they practice or reside.  TMA has  proven legislative, regulatory, and legal advocacy successes; valuable practice management benefits and expert services; as well as support for physicians throughout their professional career, in whatever practice setting they choose.  

Anthony Passalacqua, 1:52: Sylvia, it was kind of interesting, as I was researching some of the relationships between TMA and TMLT. They have a very unique history. Can you give us a brief description on how that history started?  

Sylvia Salazar: Sure. In 1977 a new law was enacted allowing certain membership associations to create professional liability insurance trusts. TMA formed TMLT in 1978 as a self-insured trust. In the midst of a severe liability crisis, TMLT was established to provide coverage against health care liability claims for members of TMA. The Trust was capitalized by TMA and by TMA members. In addition, TMA guaranteed a loan of $350,000 to secure a line of credit for the Trust.  

Anthony Passalacqua, 2:38: One of the questions that we sometimes get is, why does a TMLT insured have to pay TMA membership? Sylvia, can you answer that?  

Sylvia Salazar: TMLT coverage is a benefit offered to TMA members only. The Trust is authorized to self-insure physician members of TMA against health care liability claims and related risks. TMLT’s business structure is uniquely tailored for this purpose, so access to coverage must be restricted to TMA members.  

Anthony Passalacqua, 3:06: Mari was discussing earlier that you also have to be a member of their local medical society. Is there any sort of reason behind that?  

Sylvia Salazar: The short answer is that our bylaws require it. However, there are very tangible and intangible benefits provided by both. The local county medical society’s ability to mobilize grassroots efforts when needed, build relationships with key legislators, and respond to local issues on behalf of the profession are just a few examples. As a state organization it is often difficult for TMA to move as quickly as we would like due to geographic constraints, the sheer size of our membership, and the time it takes to hear about an issue or concern. Additionally, the member benefits like the local membership directory for referrals and community-based, physician-led initiatives to improve wellness are most effective locally.  

Anthony Passalacqua, 3:55: Mari, Sylvia was talking about the relationship with medical societies. Is there any way that those relationships help our physicians?  

Mari Hosek: Well, Anthony, working together with the county medical societies, we can accomplish so much more than would be possible independently. The strength of the association’s membership increases our leverage and collective ability to address the most important professional and public health issues of the day.  

Anthony Passalacqua, 4:21: What are some of the benefits of the Texas Medical Association?  

Sylvia Salazar: The number one reason physicians join is advocacy — legislative, legal, and regulatory. The more members we represent, the stronger our collective voice, and the more we can accomplish for every Texas physician and the patients they serve. Some of the other top benefits include resources such as the latest in billing and coding, compliance assistance, quality payment programs, and help resolving insurance payments. TMA assisted with the recovery of nearly $700,000, saving practices nearly $220,000 in employee expense last year. Many large groups use this also as an extension of their own billing dept. In addition, TMA members receive free access to hundreds of hours of CME each year, including mandated state and federal CME, thanks to the generous sponsorship of TMA Insurance Trust. TMA also offers Ask the Expert virtual sessions where members can have access to professional experts who can answer questions on legal, practice management, advocacy, and regulatory topics.  

Anthony Passalacqua, 5:36: The TMA not only offers help to physicians that are currently in their career field, do they do anything to help any of our physicians who are getting out of their residency?  

Sylvia Salazar: Yes, the TMA Career Center is a central, one-stop location for physicians and medical staff to find job opportunities in Texas; connect with top health care employers; and to get assistance with resumes, job skills, and more. Additionally, practices can find and recruit medical staff and qualified Texas physicians across all specialties.  

Anthony Passalacqua, 6:08: During my research, I found something called the TMA Leadership College. Can you describe that me?  

Sylvia Salazar: Yes, the TMA Leadership College was created for young physicians, under 40 or within their first 8 years of practice, to ensure strong and sustainable physician leadership. Programming is designed to help physicians to further develop and build their leadership skills; boost their career; and gain an understanding as to how they can make a positive impact in their field, association, and their community.  

Anthony Passalacqua, 6:39: Sylvia, I know a lot of our physicians are always looking for help with their practices. Do you guys offer any sort of written policies and procedures?  

Sylvia Salazar: Actually, we do and it’s one of our most popular resources. So, back by popular demand, “Policies and Procedures: A guide for medical practices” is now available in a new edition for download in a fully customizable Word format. It’s been vetted by legal advisors and this guide contains more than 625 pages of up-to-date sample policies and procedures, tools, letters, forms, and a HIPAA Guide to tailor for your practice.

Anthony Passalacqua, 7:15: The policy and procedure manual, does it still focus mostly on the Texas physician market?  

Sylvia Salazar: It does. I mean, it’s been vetted by legal professionals here for Texas rules and law. So, yes, it is specific to our Texas practices.  

Anthony Passalacqua, 7:31: Mari, are there any other resources that we can get from the knowledge center? 

Mari Hosek: Yes. The TMA Knowledge Center staff can find answers to all your questions about practicing medicine in Texas. In addition, members can search TMA’s collection of journals and publications and access materials organized by topics or perform an integrated PubMed search. In 2021, the TMA Knowledge Center answered more than 10,000 questions!  

Anthony Passalacqua, 7:59: Sylvia, what recent legislation has directly benefited our physicians?  

Sylvia Salazar: Well, first of all, TMA monitors approximately 2,000 health care related bills each session. Our priority is physicians, their patients, their practice, and their profession. Some of our recent wins include: 

  • We successfully sued federal agencies over unfair surprise billing arbitration rules.
  • We’ve worked with Congress to avert a nearly 10 percent Medicare physician payment cut.
  • Prevented and statutorily eliminated a state sales tax on outsourced medical billing services.
  • Stopped dangerous scope-of-practice and anti-vaccination legislation.
  • We extended continuous Medicaid coverage for postpartum women to six months and for children to 12 months with one income check at six months. 
  • We protected physicians from liability during the pandemic.
  • We advanced telehealth infrastructure.
  • We regulated vaping products.
  • And we boosted graduate medical education funding and future residency slots.
  • And lastly, we exempted physicians from prior authorization roadblocks with “gold card” status.  

Anthony Passalacqua, 9:06: Sylvia, I have few questions. What is prior auth for gold card status?  

Sylvia Salazar: Under a law that took effect last September and is the first of its kind in the U.S., thanks to TMA efforts, physicians who have a 90 percent prior authorization approval rate over a six-month period on certain services will be exempt — or “gold carded” — from prior authorization requirements for those services. Additionally, for adverse determinations, a peer-to-peer review must be done by a physician of a same or similar specialty licensed to practice medicine in the state of Texas.   

Anthony Passalacqua, 9:42: Sylvia, we are embarking on the 20-year anniversary of Tort Reform. How does the TMA continue to protect Tort Reform?  

Sylvia Salazar: So, preserving that access is a continuing battle. In fact, every year TMA fights off attempts to weaken tort reform. Liability reform passed over the opposition of trial lawyers. Unsurprisingly, since 2003, plaintiff attorneys have fought the law both in the courthouse and at the Capitol. But efforts to weaken it legislatively have failed, and it has withstood numerous court challenges as well, even recently. In fact, we have seen states like California and New York have their own tort reform laws chipped away.  

Anthony Passalacqua, 10:23: Well, there is a lot that the TMA does for advocacy. What are the cost of dues?

Sylvia Salazar: The active physician dues amount is $573 plus county medical society dues, which can range from $0 to $425 depending on the county. The resident/fellow dues amount is $20 plus county medical society dues, which is typically between $10 and $20. So, the average dues of a residents and fellows is $40. There are some resident programs where dues are paid for by the program. Medical student dues are complimentary, and they typically join at orientation during their first year for all four years. All of the medical schools currently participate in TMA’s 100 percent member program. There are price breaks for first year in practice which is first year out of residency, and for “never a member” physicians.  

Anthony Passalacqua, 11:17: Sylvia, how are those membership dues billed?  

Sylvia Salazar: Membership dues are based on a calendar year, so they would begin in January and take you through December 31st. Both the county and the Texas Medical Association dues are all on one invoice, so you pay the total together.  

Anthony Passalacqua, 11:35: Mari, tell me about group practices interested in TMA membership.  

Mari Hosek: TMA has 245 group practices that pay for 100 percent of their physicians to be members of TMA. TMA does not offer discounts for these groups. They pay full dues for their physicians to be members. If you ever need to know the exact amount for a particular physician, resident/fellow, or group practice, please contact your local county medical society or the TMA Knowledge Center at 800-880-7955 or by email at  

Anthony Passalacqua, 12:14: Thank you, Mari and Sylvia for your help on this podcast. And thank you for listening to this podcast. If you are a policyholder, please feel free to contact us with any questions by calling 1-800-580-8658 or check out our resources at and clicking on our Resource Hub. Also, for more information on the TMA’s legislative advocacy efforts, please visit www.