​

Dr. Jada Bussey-Jones (Host): Hello. This is Jada Bussey-Jones, the current President of the Society of Journal Internal Medicine and the host of SGIM's President's podcast. We engage SGIM's former presidents who are leaders across healthcare, public health, policy and academia. As we lead up to the organization's 50th anniversary, we hope to capture insights from our nation's thought leaders so that our organization, our members, and the public broadly are in a stronger position to grow, innovate, and meet the health challenges of our time.

To our listeners, thank you so much for joining us. Today, I am so delighted to talk to Dr. Marshall Chin. Dr. Chin has a longstanding career in improving healthcare and reducing inequities locally in Chicago and really across the nation. In his national efforts, he leads initiatives as Director of the Robert Wood Johnson Foundation's Finding Answers: Solving Disparities through Payment and Delivery System Reform Program, and as co-director of the Merck Foundation's Bridging the Gap: Reducing Disparities in Diabetes Care National Program.

He has several other leadership roles, including Associate Chief and Director of General Internal Medicine Research, Director of Chicago Center for Diabetes Translation Research, and Director of the McLean Center for Clinical Ethics. In addition to his clinical and research roles, Dr. Chin is a teacher and award-winning mentor committed to providing opportunities for trainees and learners across the spectrum.

He co-directs the Summer Program and Outcomes Research Training or SPORT where he supports mentees or countless learners, as they learn research methods. Dr. Chin has several accolades including being elected to the National Academy of Medicine in 2017. He is also the 2024 recipient of SGIM's highest honor, the Robert Glaser Award. Marshall, thank you so much for joining me today. I am just honored to be able to spend some time with you this afternoon. And as we get started, maybe I'll start with the start of your career, and your leadership journey. So often, I ask folks on the podcast, did you know you wanted to do leadership? How did both your career start and your journey in leadership start?

Dr. Mashall Chin: Well, thanks so much for inviting me to be on your podcast. It's a great idea having this podcast, Jada. I guess maybe to start, I come from an immigrant family where it's my grandparents' generation that came over from Southern China and both my parents grew up in Boston's Chinatown. And so, we would go into Chinatown every Saturday to see the extended family. And I became acutely aware of the bamboo ceiling of how there were clear limitations on what many of my aunts and uncles could do, basically because of their race and ethnicity. And so, that sort of stuck with me, that sense of injustice and the drive to want to make a difference, both in individuals' lives as well as trying to impact wider systems and policies.

I knew at a fairly early age that I wanted to be a doctor and I would enjoy individual clinical medicine. And I was exposed, again, early on to some wonderful role models who combined clinical medicine with health policy. As an undergrad at Harvard, I had some time with David Blumenthal and audited his course at Kennedy School on Health Policy and had a reading course on health policy with him and a historian named Harry Marks at the UCSF, where I was a med student. I was so fortunate to be exposed to the terrific General Internal Medicine Division there. Steve Schroeder was my mentor, division chief at that time, and a future president of SGIM, and there was an incredible group of junior faculty who then became later leaders in SGIM internationally, people like Eliseo Pérez‑Stable, Bernie Lo, Steve McPhee, Bobby Barron. Just some really wonderful folks, and they showed me that it was possible to do clinical work, to be a terrific teacher, and then to impact these wider policies, fellowship and then faculty time, and story goes on.

I do think that it's just so important, the people you contact as advisors, mentors, role models, which is really one of the great strengths of SGIM that many of my most valued friends and peers and advisors and mentors come from SGIM, and really a great source of support and inspiration.

Host: That's so awesome. And thanks for sharing this concept of bamboo ceiling. I don't know that I thought about it in that way, but also sort of not only your training, but also how you engage with leaders, not only in medicine, but in SGIM. And so, that may lead me to my next question, which is how did you get started in the organization specifically? I assume it may have been through those leaders, but I'd love to hear sort of how that got started. When did you first learn about or engage with SGIM?

Dr. Mashall Chin: Probably a typical story where first it was attending meetings, then submitting abstracts and presenting oral abstracts and posters. And when I got my first faculty job at the University of Chicago, I was new to the Midwest. And fairly early on, I applied to run for Midwest SGIM Council. Ran twice, was not elected both times. And I was just essentially getting involved in the organization that I just volunteered anyway to help out with the annual meeting and their activities. So actually, that was sort of like a good lesson for me of, if you really interested in something, just volunteer. People always are happy to have extra pair hands around. And so, that was really my entree.

I think eventually I was invited to be on probably like different committees or whatnot, whether it was an abstract review committee or, at some point, I did some work with the research committee. And like anything else, if you do a good job, then you're asked to do more things. And so yeah, maybe that's one of my pieces of advice for folks, that whatever you do, take it seriously. And if you do a good job, then more things will come your way.

Host: I love that. I really have found SGIM to be an organization where you can raise your hand, and do things within the organization and connect. So, that's been my experience as well. I want to ask a little bit about sort of the intersection of your role in SGIM, and then also your expertise and interest around health equity. I know that the organization and its members have really played an important role in advancing health equity. I feel like it's one of the foundational parts of the work of the organization. What do you think are some of the highlights of SGIM's efforts in this space?

Dr. Mashall Chin: Yeah. SGIM has been an incredible national leader in advancing health equity, really on all fronts. I like to say that advancing health equity is truly a team sport that you need to have everyone, clinicians, researchers, educators, people from the social sciences, people from a variety of different expertise. And SGIM is the great generalist organization. So, we have these disciplinary strengths. We have folks that have all these different skills. And then, a very mission-driven place that really do equity work, it has to be mission-driven. It's hard work. We have to be inspired to basically keep on pushing forward and carrying the torch here.

And I remember, as a young person going to the meeting, how that was really one of the dominant feelings that I really felt that this was such an incredibly positive organization, people that were inspiring. It's truly a mission-driven place. And it felt so good to be around people who had similar values and ideals really looking out for our patients, all of our patients, and especially the most marginalized.

And I think if you look at SGIM's impact, it's been both as a group that says equity's important to support all of the activities that happen both at the annual meeting and ongoing that provide a structure for both products, like the various position statements and policy statements regarding equity, as well as the forum for to convene people and for them to share. And I've learned so much from the various presentations and workshops along all the different spectrums, whether it's advocacy, whether it's how to be a better teacher about equity, whether it's the research. And so, it is really been really one of the premier meetings for those who are interested in advancing health equity.

Host: Marshall, I know that you're right. And I agree wholeheartedly. And as I was starting out in my own career and thinking about the meetings that I attended, that's where SGIM stood out, sort of that common theme around people focused on historically marginalized groups, health equity broadly in so many different areas.

And so, I really do think it's one of the foundational Identities of our organization. And with that in mind, I think that it can be particularly challenging for our members during this time when they may be concerned about national policy changes that might harm the patients for which they have cared for and provided so much effort in terms of science and clinical care and their academic careers. And so, I'm wondering, as a leader in this space, what-- if any advice-- do you have for our members as they're thinking about how to survive or thrive during these times?

Dr. Mashall Chin: First, to keep on doing the work. it'd be a big mistake if we all get frustrated and say, "Well, we're going to get paralyzed. We're just going to worry. We're not going to do the work. We're just going to ruminate, right? That's losing the battle. And so, there's just so much we can do on just continuing the work.

So, for example, like, like trainees, I tell trainees that one of the biggest things in advocacy they can do is finishing their training, becoming well-trained as a clinician, as a teacher, as a researcher or an equity expert. And so, there are different ways you can be an advocate. So basically, doing the work, doing the research, doing the teaching, doing the patient care, keep on doing that.

A second is to realize that we have righteousness on our side. And so, one of the challenges is that like the way that DEI is being defined nationally, it just is a broad swath that anything that has even a hint of the words in all are deemed as bad. And that's really not the case. And, as we know, like advancing health equity, equity defined as ensuring that everyone has a fair and just opportunity for health is really a core value that like when you pull the American public, two-thirds of the American public agree with that. And so, a lot of the things that we are doing really get back to good patient-centered care and doing what it takes to basically improve the health of the population and individualizing care. A good clinician individualizes care to the patient. A good policymaker individualizes the policies to the specific context. And that's really what we're doing, whether we're a teacher or clinician or a policy person. And so, continue the work. And so, we may have to change some of the words regarding funding with the various rules of the game right now. You can still continue the work because this is, again, work that the American public supports, which is just common sense and evidence-based for tailoring care.

And I think also that we need to think about what does it mean to be an advocate both in our professional lives as well as citizens. And part of this depends upon issues like where you are and like your career and in your overall life. And so, for example, some folks have a lot of family responsibilities, whether they're raising young kids or they're taking care of older parents and they may have more time later on and all, there are more and better times to be able to spend more time on this. Others will have more time now. When you're more junior, perhaps a more vulnerable position than when you're more senior. So, don't think you have to do it all at once. But regardless of whether you're a junior, senior, there's plenty of things you can do, whether it is continuing the work, whether it's teaching others, whether it's one-on-one or like an SGIM workshop, whether it's writing an op-ed, whether it's coalition work, so SGIM's wonderful for the opportunities to work on committees. There's power in organizations. A lot of power. So, that's a great way to get involved. Coalition work is very important, community-based works, if you go to some of the demonstrations. Whatever feels right to you, work within your organizations of keeping the equity flame alive.

So, there's plenty of things to be doing. Part of it's a matter of like your personal taste, your personal strengths, what feels right to you. And it may evolve over time. But the point is all hands on deck. Everyone should be doing something. This is sort of a fight for the basic values of our country, democracy, and fight against cruelty and a fight for our patients and communities.

Host: Thank you, Marshall. I think what I hear you saying is that these are the values of members of our organization. It has been for a while and that we shouldn't give up on that, because our environment changes that, if anything, we have to think about the ways that we'll engage in. Perhaps it's expanded, perhaps it's different, perhaps it changes over the course of our careers. But that we shouldn't give up on this really shared value and mission that is truly patient-centered that very few in the public, when they actually understand, would disagree with. So, thanks so much for that.

One of the reasons sort of selfishly that I have been doing these podcasts is because I'm just so thrilled to hear from leaders like you about their careers, their time as president early on. I'm towards the end of my tenure now, but I was really trying to figure out what to do as president and to get as much advice as I could. But I am going to ask you, especially since we are getting close to our half century mark, if you could offer any advice for SGIM, the organization or its current or future leaders, what might you offer? You sort of talked about folks who are interested in health equity, but really just broadly in SGIM, any words of advice?

Dr. Mashall Chin: I think it's important to look both inwardly as well as outwardly. Traditionally, SGIM has been very strong with the inward look, meaning how we are thinking about our members. And I think we do a great job of nurturing young folks, whether they're students, trainees, fellows, junior faculty, and help provide additional skills, a community, a sense of us that we're not alone. So, that's something we should continue doing, and it has been historically a great strength. With the external look, I think we have done some things, and so the health policy committee has really been outstanding throughout. A lot of the issues that we are interested in are ones that go beyond purely SGIM, where the coalition work becomes particularly important. Issues of generalism, the partnerships are critical with family medicine who well positioned for this. There are more opportunities now nationally, regardless of whether the change of administration.

There was recently the National Academies' Implementing High-Quality Primary Care Report came out a couple years ago. There's been the formation of a Primary Care committee, work with the National Academies, a lot of big organizations coming together where it's not just SGIM, as a sort of a lone voice here. And there's power in that type of coalition work and numbers. And that's something that I think that we are continuing to do and continuing to develop those connections and those strengths.

And because there are these opportunities that I and I think are better than they have been 10 years to actually have some meaningful reform on a policy level for primary care. A lot of the challenges that we face in our particular discipline have their roots in policies, whether it's payment policy, whether it is the structure of care that does not advantage primary care. So, the job has become more difficult over time. So critically, I think they have a force to have both an inward and outward look and to always maintain our sense of mission.

Host: I love that. And I agree that inwardly our sense of community and shared values is the reason that I joined and have been so committed over time. And especially, over the last year, we have continued to expand our connection with other organizations. You'll be happy to know we just signed on as a co-sponsor with the National Academy on their primary care work as well as new collaborations with Research!America and the like. But I think that those opportunities, we need to do more of that. So, thanks so much for that advice.

I would love to hear-- clearly, you have been doing so much great work over the course of your career-- what or who have been your sources of inspiration that have kind of driven you to your personal and collective success? What's inspired you?

Dr. Mashall Chin: I mentioned a number of like the professional influences. And so, I've been very fortunate from an early time to have a lot of great role models. A couple people I didn't mention came later in the career. Lee Goldman was my mentor during fellowship. And, boy, he was great regarding quality advice, the timeliness of feedback, being very direct, which is just great that you want to have direct feedback as opposed to a guessing game. And he had the highest morals, regarding fairness and the tone and the sense he set within the group regarding rigor and treating people the right way. So Lee, and you know, people sometimes are surprised because Lee is not known for doing equity research and he was a tremendous mentor for me.

Actually, my father perhaps that has been one of my greatest influences. He was not an academic, he was a mechanical engineer, you know, tough street kid grew up in Boston. And so, he grew up kind of hard scrabble. And so, he's really kind person and very matter of fact of the world can be a hard place. You just got to grit and, you know, work with things to try to improve things. And so, he had this great ability to get along with anyone. He was, again, very down to earth, very natural with people. So, he'd get around with anyone. And so, I really admired that about him and is a joy being a caring person and, yeah, pretty down to earth.

Host: I love that. And it's interesting, you know, your inspirations or source of inspiration, it's not just about the work or the science, right? It's like who they are, their fairness, their ability to engage and get along with people. So, thanks for sharing that.

Dr. Mashall Chin: You know, that's my mom too. I mean, my parents were of traditional generation. The man is the work person, and the mother is the caregiver. And she was wonderful also. They both passed away from the past five years. And regarding caring for people, being a great listener, always interested-- My parents were always interested, throughout my life and career, even on things where maybe it wasn't necessarily their world or things they would totally understand, they were always interested and cared. So, I really appreciate that.

Host: That's right. I very much relate to that as well. Because very few people in my family, other than my siblings have gone on to college. And so, there was not a lot of understanding about what it meant to be on call or other things, but so much support and so much interest. And so, that's really a beautiful thing. I'd love to hear with all the time that you obviously have to spend working, what do you do for self-care or what do you do outside of medicine and work?

Dr. Mashall Chin: Yeah. So, I'm from Boston. I'm a rabid Boston sports fan, so I spend a lot of time on following professional sports and probably could have a fairly intelligent conversation with fans of most any city about most of the professional sports, which actually is really good. That like is a great sort of like topic you could have with anyone in the country.

The thing that surprises people is that my wife and I, we started training and performing in improv and standup comedy about 10 years ago. Really fun and the skills translate to the GI jobs. So, actually, a group of 20 of us, we've been working with the first year medical students at University of Chicago. This past year, we had four hours to do improv and Theatre of the Oppressed Workshops in the health equity course around that. The most recent course my wife and I took, and we've been part of an improv team in the past, we took a musical improv class, which is not like jazz, it's musical improv, and get suggestion from the audience. And then, the group then enacts like a scene and a song from a musical that they make up on the scene.

And a couple weeks ago, I was actually in Second City, that I was a storyteller, they have a show called Study Hall where two or three storytellers tell a real serious story. So, I told a story about health equity actually based upon my fourth year ED rotation at San Francisco General Hospital. And then, the improv team then riffs off of that. So, I really enjoyed getting that glimpse into like the improv and standup world. I have a lot of respect for the folks who try to do that professionally, very hard area. Some really cool people. It's just exercising like a different part of my brain. It also puts me in situations that purposely are uncomfortably forced to me. So, musical improv was uncomfortable for me initially. I ended up having a blast and really loved it.

Host: That is so awesome and so unexpected, Marshall. I did not know that about you, and I did not expect that, but that's awesome. Thanks so much for sharing. And as we wrap up our time together this afternoon, I wanted just pause and give you a moment to see if you had any final thoughts or reflections that you want to share with with our audience.

Dr. Mashall Chin: Well, SGIM is a very special organization. It's one of my favorite, if not favorite organization. The people are wonderful, so mission-driven. And so, I would recommend to everyone, whether you're a junior or senior, especially if you're a little bit fearful, a little timid initially, and haven't had a lot of time in SGIM. Just jump in there and, again, remember like my story of like just volunteer. If you are going to provide good contribution to work, people are always happy to have helping hands. And I found that you always get more out of it than you contribute. I've learned so much. There's just such good people at SGIM. I just learned so many different skills and qualities and just watching people how they conduct themselves, how they lead, how they are team players. I've learned so much because there's just such high caliber people within organization. So, no matter how involved you are, get even more involved in SGIM. It's really worth it.

Host: Awesome. Thank you so much again for joining us today. I also want to thank the SGIM staff and Roz Bogle, who is our Executive Producer and the entire production team. Also, thank you to our listeners. You have been listen to SGIM's President's podcast. If you like what you've heard, please rate us and leave a comment where you listen to podcasts. It helps others to find us. Also, look for us on the SGIM website, sgim.org. And follow us on social media.