MD Students on Melding Advocacy with Medicine

Competing in tennis since the age of 7 gave Maryann Zhao the “mental fortitude to stay determined and not falter,” she says. “When you’re out there playing on your own, you have to figure out how to solve whatever’s happening in the match at that moment. It gave me the confidence to feel there’s no problem I can’t overcome.”

What led this rising third-year medical student to consider science as a career was the other side of the same coin. “There’s a lot of problem-solving in science,” she says. “There’s so much in science that is not yet understood, and as a researcher you’re trying to figure out how the world works. That part is really satisfying to me.”

Zhao had always done well in her science classes in middle school and high school, but it wasn’t until her undergrad years at Pomona College, a small liberal arts institution in Claremont, California, that her future came into focus. “I took biology, chemistry, math, physics, computer science, and economics,” she says, “but my real interest was in how science affects people and their health, so that started pushing me toward pre-med.”

As the daughter of parents born in China — her father has a PhD in physics and her mother has worked as a software engineer — Zhao volunteered for a program called Health Bridges, which helps new immigrants in the emergency department gain access to health insurance.

She got involved with Partners In Health and learned more about advocacy, community outreach, and global health, including “what it means to advocate for patients, to make calls to Congress, to organize people at a grassroots level.” She and her classmates started talking about how physicians can influence politics after witnessing the inequities exposed by COVID.

“As physicians,” she says, “we’re privileged to be able to connect with patients and hear what issues are impacting them most and then advocate for change to improve those issues. Medical students come in with bright eyes seeing things they want to change, but it’s hard to actually have the skills to make a change on a systemic level.”

Zhao believes it’s important to enhance medical students’ policy and political literacy and “pull back the curtain on the political process.” She’d like to see the “innovative research” being done in areas like gene therapy translate into helping more people. “These innovations are incredibly expensive when they hit the market,” she says. “How can we ensure that the very patients these therapies are designed for are able to access them?”

She sees her future as a clinician involving some aspect of research and interaction with the legislative process to influence policy as an expert in her field. “What that field is going to be is something I’m still trying to figure out,” she says.

Inam Sakinah

“In college I was interested in science but also in social science and public policy,” says Inam Sakinah, a rising third-year medical student. “I wanted to approach my future less in terms of what title I wanted to hold than what problems I wanted to solve.” She chose to get an MD because she saw it as placing her at the intersection of medicine, health policy, and advocacy — and she chose HMS because when she interviewed at the School, “one of the administrators talked about the concept of the ‘physician-and.’ He said, we want you to practice medicine but also go beyond that to make a difference in another field that can benefit the lives of your patients. That’s what I was looking for.”

Sakinah comes by her advocacy bent naturally. Her parents were both “on the front lines of civil rights efforts working to protect our rights as Muslim Americans,” Sakinah says. Watching them work on humanitarian and civil rights advocacy initiatives — and discussing the issues that led to their actions with her and her younger brother during family dinners — gave her a clear sense that she wanted a career working toward a more equitable country.

She built a mentorship program for a low-resource school in Gadsden County, Florida, and worked in the Florida Department of Health as one of twelve college students selected statewide for a gubernatorial fellowship. A service trip she led in college was especially formative for it brought her to the Edmund Pettus Bridge in Selma, Alabama, on the 50th anniversary of the Bloody Sunday march from Selma to Montgomery. “It crystallized for me,” she says, “that we have a collective responsibility to bring the promise of America into being.”

While in pandemic lockdown at HMS, Sakinah helped found Future Doctors in Politics, along with Anjali Misra, Maryann Zhao, and several other classmates, and she serves as the group’s national president. “COVID-19 forced a reckoning among a new generation of students to think of the consequences of not advocating,” she says. “We saw in stark terms that the decisions our politicians make can often have a bigger impact on patient outcomes than anything physicians do at the bedside.”

She thinks the joint MD-MBA she’s pursuing will be crucial in moving toward her ultimate goal: to establish an ideas lab that will “position physicians with the advocacy, leadership, and management skills to drive progress toward equity in health care.”

“If we train the next generation of physicians to have the mindset and skillset to be physician-advocates, we can empower them to be the change we need to ensure better, more equitable health outcomes for all.”

Anjali Misra

“My parents have definitely had a big influence on me,” says third-year medical student Anjali Misra. Her mother, a journalist, taught her “how every interaction is an opportunity to learn someone’s story.” Her father, a physician in India before moving to the United States, was working as a gastroenterologist in Cedar Rapids, Iowa, when he died unexpectedly. Misra was still in high school. “It’s hard for me to talk about that,” she says. “But his empathy for and understanding of his patients is something I continually try to emulate. His people skills — special doesn’t seem like a big enough word to describe them. He gave so much to his patients, but it was also clear how much he got out of his work.”

Misra came to Boston to attend MIT, where she received her bachelor’s in brain and cognitive sciences and worked with the mobile clinic The Family Van and in a student-run ambulance service. Then, a Mitchell Scholarship, which aims to facilitate connection between Ireland and the United States, took Misra to the Emerald Isle. “I always had an interest in rural medicine and in learning about health systems that are different from our own,” she says, “so I got an MPH at University College Cork. I wanted to be primed to understand the bigger picture all the way through medical school.” She also solidified her interest in emergency medicine while overseas, working as a certified EMT.

At HMS, her paths are coalescing. “There’s often a separation between public health and emergency medicine,” she says, “but they come together downstream, when people end up in the emergency department with something that could have been prevented. Better understanding the care people receive outside of the hospital will help us care for them when they end up in the ED. This ties in with my interest in legislative advocacy and politics, which are major factors that shape health.”

Misra believes emergency medicine physicians can be effective policy advocates because “they see so much of what is happening in the community and affecting people’s health,” she says. The ED is also a good place to reach patients without creating barriers. She cites Vot-ER, an organization founded by an HMS graduate that works to integrate voter education and registration into health care settings, as a perfect example of the kind of bridge that can be built during hospital visits. “Emergency departments can make things accessible, available, and easy,” she says. “I get excited thinking about that.”

Misra says that being an advocate is “just as important to me as being a clinician. I plan to continue to engage in public health research and legislative advocacy throughout my career.”

Elizabeth Gehrman is a Boston-based writer.

Images: John Soares