Welcome to Collective Conversations, a series of discussions aimed at highlighting people and groups working to improve health through better health care systems.
In this conversation, you'll hear from Dr. Anisha Ganguly as she shares about her path to becoming a Health Equity Fellow.
Joy Lee: Tell us what led you to join the Health Systems Pathway within the UW Internal Medicine Residency Program?
Anisha Ganguly: So, I joined the Health Systems Pathway, which is our curriculum piece developed for residents, partially as part of an effort to prepare for a career in healthcare leadership. A lot of people use the term ‘healthcare administration’, but Rick Goss, who is the Chief Medical Director at Harborview, he uses this term ‘healthcare leadership’ which I like a lot more because it makes you think about, not just the mundane bureaucratic aspects of running a health system, but also the sort of vision that it takes for transformation in the healthcare system. It invites you to think a little bigger about all these inequities that exist in our healthcare system and I think it is more empowering to think that change is possible and healthcare delivery can be better than it is now. So, that pathway is such a great foundation for thinking about how does healthcare payments work? What are the sort of the goals in healthcare administration? What’s the difference between health operations and clinic-level management? Those sort of nuances that, when you’re a medical student you’re thinking about like how do I get to be a doctor? How do I get to deliver patient care? And that is the most important thing – taking care of patients is what drives us all. But sometimes, you know, you’re limited with what you can do for an individual person. And what gives meaning to those individual interactions is like kind of those system-level changes like how are we impacting communities? How are we impacting state-level policies? How are we thinking about federal-level policies? So, it’s really exciting to think about those macro-systems along with the individual patient encounter.
JL: What has been your main focus or focuses while in this pathway?
AG: My interests are diverse but they all center around and targeting systemic racism both in the healthcare system. And that has become such a mainstream topic I think in the last couple of years, which is really exciting that finally a lot of equity researchers have been pulling attention for a long time is finally getting its moment. It’s really important to highlight that sort of work.
In terms of the scale of what I’m most passionate about: institutional advocacy is really important to me and also state-level policies is really important. I was thinking equitable delivery across states even up to the federal level. The patient populations I am most passionate about serving are those who are uninsured or underinsured. And increasing access to care to folks who feel like they can’t get the care that they need, whether that’s because of the color of their skin or because of their country of origin.
In terms of the specific projects I’ve been involved in here at the UW, I’m a resident member of a team focused on breast health equity. So, equity and breast cancer has been UW’s equity goal for the past two years, specifically focusing on increasing access to mammography for Black women in the Seattle area. As such a progressive city, it’s sometimes not as clear to a lot of average Seattleites how much inequity exists in our city. So, certain demographics for example, our Somali population in Seattle is such a historically rich community in Seattle, has very low mammography screening rates. And this group has been so engaged in trying to fill that gap for these patients and building trusts with communities so these women can get the appropriate equitable care that we all deserve. But a lot of that is such a complicated task to achieve. A lot of that is related to systems factor that is built into our healthcare system. And a lot of that comes down to building trust with the communities that we’re serving. So, that’s why I love our team. We have an interdisciplinary team comprised of breast oncologists, general medicine physicians like myself, and then our amazing cultural mediators, which I think is one of the most special resources that we have here at Harborview – they are so much more than interpreters; they really are true cultural liaisons that help bridge these gaps between the formal healthcare system and individual patients – and then amazing data analysts who are so mission-driven just like the rest of us. And we have a team of all women. It’s kind of amazing to have this robust research team of women who are serving women.
JL: Wow, that sounds so empowering and how incredible. We really appreciate you in telling us about the interdisciplinary team and everyone’s roles and really highlighting the culture mediators – I don’t think that a lot of people know about them and they’re always given the credit that they deserve.
AG: It’s really special. I don’t think a lot of hospitals have that. I’m new to the healthcare system as a resident. But I think it’s just this nuanced way to build rapport with patients and I think there is such an importance with that in research as well because of all the protection our patients deserve when we approach medical research with communities. Equity research is such a hot thing these days. But I think one of the most rewarding parts of that is when you’re doing these kind of big picture things – when you are in patient care, you get the instant gratification of impacting someone directly and working with the person that’s in front of you and you can kind of feel the more tangible effects of whatever medical care you are delivering. In research, there’s kind of like a delayed gratification, like you have to take some time for the fruits of your results to be shown, right? But I think with equity research, it’s so life-giving because you can call out these true imbalances and inequalities that all of us understand intuitively in everyday life. But it’s this special thing when I’m working on the project like this mammography project and I’ll be writing a paper and be like so energized by the fact that people want to know about this. People want to make the system work better for people who have been lost to the system. And you kind of get that instant gratification.
JL: It’s so true. Gosh, I just got all tingly as you were describing that. I think certainly there’s this energy that’s so palpable and tangible and sustainable – it makes you want to keep going.
AG: I love that. Yes, it certainly gives this magical feed-forward loop where I’ll take whatever seeds of justice in my research, it’ll feed forward into my patient care, and then I bring those ideas back to my research. There’s just this amazing synergy.
JL: I understand that after residency training, you are doing a two-year fellowship as a Health Equity Fellow. What is a health equity fellow and how is it similar or different from other perhaps more traditional research, advocacy, or policy fellowships?
AG: That’s a great question. It’s kind of a new concept. There are some institutions that are kind of setting up these smaller programs given the interest and understanding that equity cuts across multiple domains of healthcare engagement. So, my fellowship is going to be at Parkland Memorial Hospital, which is the county hospital in Dallas. It is a very large county hospital that serves a very large uninsured population, majority Spanish-speaking only population. And the fellowship is structured a little more loosely than traditional health services research fellowship. A lot of health services research for general internists is more rigid like research requirements and it’s setting you up to be like a full-time clinician researcher. For my fellowship, it’s a little more loosely defined for what they want their fellows to go on to do. So, there’s opportunities for fellows to graduate to come into healthcare leadership or hospital leadership. It’s more open to people interested in advocacy or health policy physicians. And that sort of training is built into my fellowship. So, there is a lot of protected research time to keep that door open for my research career. I’ll have 70% of my time protected for research and I’ll be embedded with a research team. So, there’s a lot of existing resources to support my research there. But there’ll also be a lot of curricular components with opportunities to advocate for the hospital system at the state policy level. So, my hospital will be in Dallas, but the state policy happens in Austin, so there are some opportunities for me to go and lobby with the policy team for the hospital, in Austin. And then, lots of mentorship opportunities with the hospital leadership who are involved with the fellowship. So, I think it’s a little more open than a lot of health services research fellowships, and that’s a good thing and is also maybe a little less structured than a lot of residents. You know I was grappling with the fact that this is probably the least amount of structure I’ve ever had in my life. You know when you go through 13 years of school – 4 years of college, 4 years of medical school, 3 years of residency, and then now the future is more open-ended than it’s ever been for me. So, we’ll see how things go but I’m excited that things are a little more unwritten than they have been in the past.
JL: Sounds like you will embrace the ambiguity but certainly this fellowship has so much wonderful intention behind it and thought put into the curriculum.
AG: Yeah, that’s right. I’m excited. There’s just a lot of open avenues from that place. I’m also thinking the sort of system you want to be embedded in is really important – I think that has been very defining for me here at UW Medicine and specifically with my time at Harborview, which I think is such a special institution for what they are able to do for an amazingly underserved population. Like my primary care patient panel at Harborview: I have just been reflecting on this as I’ve been handing them off to the next primary care doctors who are taking care of them. I’m like wow, these patients, Harborview is able to take care of these people that the odds are really stacked against. And I’m excited to take those ideas and model the care to other places. And I think at the end of the day, as long as you’re closest to the patients that drive you, you’re going to drive meaning in whatever you do.
JL: I can only imagine how exciting this time is right now, but also how almost difficult it is to have this transition. But certainly, I think the world is better off with folks like you being our champions out there.
AG: Well, there are many of those people. I was just so very energized meeting some brand new interns. I was like wow, my patients are in such good hands with the new interns coming on. It is the most bittersweet experience I’ve ever had in my life. You know, finishing residency is like this “Oh my gosh, achieved it!” It’s one of the hardest things I’ve ever had to do. At the same time, I’m so excited it’s over because you never have an opportunity to have those amazing memories and those intense experiences – I’m bonded to my co-residents forever.
JL: How do you see this fellowship contributing to your career goals – both in addressing systems of care or beyond?
AG: At this point, I think this fellowship gives me a good amount of protected research time to build my equity research portfolio and transition into an academic generalist position. Maybe not as like a full 90% researcher, 10% clinical. Maybe a little bit closer in the middle. I’m hoping it gives me space to really pick and choose more policy-driven projects and my dream is one day to be like one of those social justice physicians that gets called upon legislative bodies to lobby or testify about things. And I will never forget as an intern at UW Medicine grand rounds, Rochelle Walensky, who is our current CDC director, she gave our grand rounds three years ago. And I remember seeing and hearing her stories about testifying in Congress and the photos of her kind of standing up about HIV drug prices and stuff, and I was like I want that job! I want people to like cite my papers when they are writing laws and I want to be invited to talk about my patients’ experiences. And I’m not sure what form that will take yet. But people within the UW Medicine system, people like Nancy Connolly at Pioneer Square, she is running for state legislature because she is like – well, I know all about housing in Seattle and I know about income inequality. And she’s going for it. I think that’s amazing. I don’t know if I’m there yet, but let’s see where the future takes us. As physicians, I think we have more powerful voice than a lot of us realize. And it’s on us to do a little bit of advocacy and beyond. And you know patient care is the most important thing, but if you have the room to raise your voice on behalf of patients, you should be doing that.
JL: I think all of us can get behind you or stand with you. I love your vision. And I just can only say that we’ll all support you no matter what you’ll be doing next. We hope to also speak with you again because we want to see where you go and what happens next.
AG: I appreciate that. I will cherish the training I’ve gotten here at UW Medicine and Harborview and amazing mentors here. I think in Washington state, there’s always stuff to work on. But there are so many good ideas that I’ve gotten here and it’s taught me a little bit about what’s possible when we have a robust safety net. And I hope I can spread the good word – that’s my dream.
JL: Any words of wisdom for others interested in health systems, and pursuing experiences like a fellowship focused on health equity and research?
AG: I would say always follow the patients. Pay attention to which of the patients that you talked to at the end of the day with your family and your partner. And who are the patients that gets you worked up about what they are dealing with. And think about what are the small or big changes that this person would benefit from. And I think more is possible than we realize. There’s a lot of challenges of institutional inertia or governmental inertia. But I think during my time here, I’ve been amazed more often about what I can do rather than what I can’t do. And I think we all need to remember that. We can do it. We just have to set our mind to it and make the time for it.
JL: Thank you so much, Dr. Anisha Ganguly. Your reflections are wonderful and I think everyone listening will have been so glad that they listened in to this. And congratulations on your fellowship. And I think we’ll miss you a lot here in Seattle, and we’re hoping that we’ll see you and speak to you again.
AG: I appreciate the time. Thanks for having me to chat, Joy. And thanks to everyone listening about my time here at UW.