Jada Bussey-Jones, MD (Host): Hello. This is Jada Bussy Jones, the past president of the Society of Journal Internal Medicine And the host of SGIs President's podcast. We engage S'S former presidents who are leaders across healthcare, public health policy, and academia. I. As we lead up to the organization's 50th anniversary, we hope to capture insights from our national thought leaders so that our organization, our members, and healthcare And the community broadly, are in a stronger position to grow.



Innovate and meet the challenges of our time. So to our listeners, thank you so much for joining us today. I'm delighted to talk with my friend and colleague, Dr. Laroi Hicks, who is the president for the Wilmington campus of Christiana Care, and is a past president, of course, for SGIM.



Dr. Hicks graduated from Howard University, which a BA with a bachelor's degree in 1991 and completed his MD at the Indiana University School of Medicine. He later completed a fellowship in general medicine and faculty development at Brigham and Women's Hospital and earned a master's of public health degree from Harvard School of Public.



Dr. Hicks exemplifies healthcare leadership. He has had roles ranging from chief of hospital medicine, division director, vice chair, chair, executive director, chief medical officer, And for all these efforts, he's been recognized with numerous clinical and research awards. Including the Charles J. Harrington Award for distinguished service for visionary leadership, and a mastership award from the bestowed by the American College of Physicians.



This is one of the highest honors in internal medicine. In addition to being nationally known as a clinical system leader for growth and high quality care, he's also known for his research and work and health equity. So Laroi, thank you so much for all of your years of work.



and thank you for agreeing to be here to chat with me today. I'm gonna start off with, I hope a very easy question, which is telling me a little bit about yourself, before you started. And This is. Illustrious career. I would love to hear a little bit about who you are, your background and really how you started on this leadership journey.



I'm curious about whether you had leadership in your vision or whether it was something that happened, but first tell me a little bit about yourself.



Leroi Hicks, MD, MPH, FACP: Oh, thank you Jada. First, it is such a pleasure to have the opportunity for you and I to always connect, which is great, and an opportunity to talk to our members here at SGIM. To be honest with you, I have always felt a need to do everything I can to make sure that people didn't end up, as I did at 20 years old.



And I, think I've mentioned the story a few times. it was my, the end of my junior year of college when I lost my father somewhat prematurely to end-stage heart disease. my father died about six weeks before I actually took my, MCATs. and it was, at that point I had always intended to be a doctor.



but it was at that point I really began to understand, the differential impact of, being black and growing up, without a lot of resources. What that meant to my family, the community I was a part of, and I felt a calling to serve and do all that I can to make sure that, other children didn't, experience that same loss that early on.



And that, I should do all that I can to alleviate the burden of inadequate healthcare, on the communities that were similar to mine. And so, I didn't intend on becoming a leader. my intentions were always to work as hard as I could to be an excellent physician because I thought that, the people that I want deserve deserve that.



and through that pretty consistent pursuit of being better. I was blessed to have a number of opportunities and each time I ended up really weighing whether or not it would lead me, continue to lead me toward my true north. And that's sort of how I ended up doing so many different things and ended up where I am now.



Jada Bussey-Jones, MD (Host): I really appreciate your story of personal loss and how it led you to thinking about, your career, both as a clinician, but also as a leader. And so, it sounds like you found that leadership has allowed you to kind of be even more effective, in those initial goals that you had.



So That is really fantastic. Thank you for sharing that. Can you talk a little bit about why general internal medicine as a career specifically, was that something that you also envisioned yourself as doing when you thought about being a doctor?



Leroi Hicks, MD, MPH, FACP: not initially. It's interesting. I, you suffer a bit from. Skepticism Jada or people that know me well would just say I'm confused. I like everything. And frankly, when I was first applying for school, I was being interviewed for MD PhD programs because I thought I was gonna be a basic scientist, who focused on.



organ rejection, solid organ rejections, and some disparities between blacks and whites in those rates. That was, probably throughout the early part of my college experience when I first got to medical school was my intent to actually be, become a pediatrician, of all things because they were the only doctors I knew.



And in our city, the only black physician I knew was a pediatrician. And so that's what I thought I would I became interested in just about every rotation I did throughout the. First half of my third year in medical school. but it was really my first attending on the inpatient service in internal medicine, that, piqued my interest the most.



And then I realized that, this man who spent time both on the ambulatory side and rounding with residents, Was perhaps the smartest attending I had a chance to work with. He seemingly knew a little bit about everything, And the diversity of his career. the respect I have for his knowledge base, as an internist really spoke to me.



so that's what led me to be a general internist. And the reason I stayed, primarily focused on general internal medicine and really never contemplated, a subspecialty, was because as I thought about all the ways that, I might contribute most to improving health across the population. And then more specifically, kind of raising the tide, maybe differentially for those who are disproportionately suffering.



Being a generalist made the most sense, Soon to be most aligned with my mission. so from the age of, say, 25 years old, it's all I've ever wanted to be.



Jada Bussey-Jones, MD (Host): That is so awesome. I think in some ways I have a very similar journey. In my high school yearbook, it said pediatrician. but unlike you, I did not have any models for. General internal medicine. and I've talked to obviously a lot of our past presidents, we trained in a time where, not only there was lack of exposure to general internal medicine, but it was kind of actively dissuaded.



I mean, I, all of my inpatient ward weeks were with cardiologists and neurologists and other things. And so, to your point about the smartest people. Or thought to not do general internal medicine. So, but fortunately when I trained, I was able to get some of that exposure and really appreciate your journey.



It's, informative. so that brings me, you picked a career in general medicine it sounds like, very early on. how did you find SGIM and why did you join, what's been sort of your relationship before the presidency? with the organization?



Leroi Hicks, MD, MPH, FACP: S JM has always been the place I felt most at home, right? As someone who, I don't know, had scholarly inclinations. I, think when I, quick story, when I went to medical school, right? I. went back to my home state because it was the most, affordable option for me, but I also, was concerned I wouldn't be able to pay for it, even the amount that was due.



I was a Pell Grant kid in college and, worked two jobs, to make my way through undergrad. You can't really do that in medical school. And so I became a National Service Corps scholar. And, during my residency, I think it was the second year or my first year as a resident, my PGY two year, I realized I was really interested in, leveraging an evidence base, in my practice as a trainee.



I, I, found that the. first opportunities I had really to teach interns. I got a great deal of enjoyment out of bringing the literature into practice and, really working with the trainees, the medical students at Harvard Medical School and, the residents. And, while I was doing that, I began to realize that there wasn't much.



Information or evidence about, how clinical practice. Influences disparity in outcome. I'm old enough that at that point much of the work that focused on racial and ethnic disparities was focused on biological mediators or proposed biological mediators and not practice differences. When I began doing a more and more investigation, I would say This is a, key lesson for the young internist.



I found that that gap was something that I was most interested in doing. And so I began to think, if I were to practice as initially planned in an urban, fairly qualified community health center. Which I knew would fulfill some of my zeal. I might be missing an opportunity to make a major contribution, targeting something that I was sure, based on my personal experiences, influence the outcomes from my community.



so at that time, unfortunately it doesn't exist, anymore. There was something called the NRSA or NSA option, to pay back. the National Service Corps obligation. And so I lucked up. There was no internet right? Or it was nascent at that time. as much as I can, as many mapper papers as I can, from the people that.



Tended to look at differences in care and how it might be related to outcomes, not necessarily racial disparities, but I knew they'd be thoughtful and I found a few mentors. one of them was in my own backyard at, Brigham and Women's Hospital in Boston. Another one, Dr. Neil Poe, was at Johns Hopkins University.



And so I emailed them, began to have discussions, and I think Jada. It was from those discussions, I decided that I really would benefit from research training. and I, in those initial conversations, first heard about the Society of General Internal Medicine. it was the only place when I would hear them and other leaders, in the field at the time.



Was the only place where they tended to be able to apply their trade and find that there were people with common interest. I began, to realize was I think a common pathway for many of us who got involved. at that time, the first SGIM meeting I attended happened to be in Boston, and it was during my first year fellowship.



and not only was I encouraged to see posters and oral presentations by, people that were like-minded, I also was fortunate in that there were a cadre of people. Around my same phase in the, career, who looked like me quite frankly as well. And then that was unique, really rare in Boston, So, It was nice to see it, in the organization.



Jada Bussey-Jones, MD (Host): Perfect. And it's a story that we keep hearing about mentorship leading you to the organization, but this idea of like-mindedness similar careers and even similar backgrounds that sort of kept you coming back. And, That is really helpful. I. Wanna ask you a question, as we approach the organization's 50th anniversary, it's been really interesting to get reflections from our past leaders, And so I wanna offer an opportunity for you to offer up any reflections or thoughts that you wanna share.



If you have any advice for the organization, either it's current or future leaders, as we're thinking about the next 50 years, what would that be?



Leroi Hicks, MD, MPH, FACP: I think my, initial response was that. It's time to, reexamine, And this has happened pretty recently over the last few years, but, I think the cycle needs to be accelerated, the return on investment for this generation, That is currently going through residency and fellowship. Right. So, Jada at one point, I hate generational labels, but for the sake of discussion, I'll say I'm Generation X, and I comprised probably 60%, about five or six years ago of the academic, workforce and my hospital.



And in my health system. my generation is becoming diminishingly smaller, appropriately so. as we bring in more fellows and more young, faculty members, internist in other disciplines, they're also in a time that, I think we face unprecedented challenges. Uh. We face them in healthcare broadly, we face them, very specifically as doctors, broadly and across disciplines And in the world of general internal medicine And in academic medicine.



We have very, very specific challenges that this generation is going to deal with, not just currently, but for years to come. and SGIM, we need to be, continue to be a home for those individuals that meets their needs. My needs have been met largely, right. I've had, I've been very, very fortunate.



I've had a lot of success and SJM has played a key part of that, but I want the person That is 25 years younger than me, Who is the excellent young scholar, internist. To reap the same benefits that I did from SGIM and I think we need them to inform us as to the best ways to achieve that goal.



so I would love to see us continue down this road, right, of assessing. what our members need at different stages of their careers, And for us to continue to develop programming as senior leaders in the organization, past presidents, council members, to continue to evolve along with the evolving needs of, the general internists, particularly in these challenging times.



Jada Bussey-Jones, MD (Host): I love that and I'm gonna just build on that question a little bit and sort of. Not just as an SGIM leader or past leader, but your role as sort of a health system leader. you mentioned several challenges and opportunities And so do you wanna build on or talk specifically about any, challenges or opportunities that there might be moving forward for, those of us in the healthcare space?



Leroi Hicks, MD, MPH, FACP: Oh, there are numerous ones. You know, it, it's a little, so we're gonna talk a little bit, Jada, about how much of a nerd I am. Okay. Not that there aren't many nerds within academic, general, general medicine, But when I was growing up, it wasn't cool to be a comic book fan.



I'm an enormous, comic book fan and have been in the superhero since like the early 1970s. Turns out my daughters, yeah, you've met my kids. My daughter's one's 20, one's 22. It's cool to be a nerd now. Apparently it wasn't when I was their age. the, early 2010s. There was a series of comic books by an author, named Jonathan Hickman And what he talked about in those series of comics.



The theme was The Avengers, which is the really premier superhero group. If you know anything about the comics, Jada, they had to grow bigger. they had to, gain new membership because what they faced were, unprecedented threats and challenges, that seemed to accelerate And then come from every direction. And that's how I feel right now about what we're facing.



Those of us who care about, increasing life expectancy and improving health-related quality of, life for the people that we serve, right? Our communities. I see not only unprecedented challenges now, but I fear. That the threats are just beginning. and it's coming from every direction, right? So, there right now are about 13 states, for instance, that have, considered legislation that prevents.



Faculty members from their, state funded institutions from, participating in activities with societies that are deemed, as politically motivated or counter to the current administration's executive orders. Think about what that means for. an organization like SGIM And the many young fellows, or trainees or faculty members at places like, university of Kentucky, or numerous other places that now are challenged in terms of their ability to get funding to do the very work That is part of our core mission or participate in our core mission.



That is not something That is easily going to go away. That's why we have to think about how to make ourselves available when their resources are constrained. There are, I think you and I both know many many SGIM members who have been part of the United States Preventative Task Force.



Many of them are our friends. we know them to be not only exceptional physicians, researchers, and scholars, but people that care, significantly and quite meaningfully about the populations we serve, right? They just wanna do the right thing. And we know that there are significant threats to the, ability of those, very, very smart people.



To take what they know, what they can discern and their judgements about what should be covered and not covered and paid for. there are legitimate threats to the body of the U-S-P-T-F and who sits on it, and who may sit on it in the future. I fear that, we've already seen this happen with, vaccinations, right?



And the advisory panel for vaccinations here in the us Our Secretary of Health and Human Services has, made some really significant changes to, the body that traditionally looks at the evidence-based and makes recommendations. And I'm fearful that will happen, not just when it comes to vaccines, which is already problematic, but across the board.



And all of these things, and we've not begun to talk about loss of, payer status for patient's who are on the margins, right? We're predicting in my home state in Delaware, 11,000 people will become uninsured just as a consequence of losing the a CA subsidies, and we've not even begun to think about what'll happen in 2027.



As people come off of Medicaid, I run a safety net campus, a hospital, and several clinics that serve a disproportionately Medicaid population. so I look forward to seeing now increases in patient's who have target organ damage from things that were preventable, right? With appropriate access to ambulatory care. It almost feels, as I am talking about this, like the challenges are not only immense, but overwhelming.



but This is where I go back to the analogy about the Avengers, We have to have superheroes And we need a larger army of them. We've gotta get bigger, we've gotta get more efficient, and we've gotta get stronger. So if SGIM, can find its place, right and developing. Many more.



Jada Busey Jones of the world, right? And Dr. Hicks is, And the list goes on and on and on of really, zealous, highly qualified, highly skilled, SGIM members. If we can grow, I think we have the potential to be a really major resistant force at a time where it's really needed.



Jada Bussey-Jones, MD (Host): It absolutely does. and you have really done a great job of talking about these big, hairy problems. That are coming from all directions, but still giving a message of hope and resilience and sort of thinking about the future. But I'm wondering, as we're thinking about these big, heavy problems and trying to kind of, move forward, I'm wondering what keeps you Well, you're clearly very busy as an individual leader and a clinician, and.



So I'd love to hear, about some of your hobbies, what you do for self-care. Is it still the Avengers and comic books and other things, but what do you do to stay well?



Leroi Hicks, MD, MPH, FACP: Yeah, a look around my office, which you can't quite see is, uh. Numerous, novelty items, statues, a bunch of stuff. My, I have an obsession with the black superhero, And so I have all of that kind of, so I read avidly still, and I don't read probably. the high quality fiction and nonfiction things that you read, Jada, I read comic books a lot.



Still that brings me joy. I'm a cinema file, And so I make sure to carve out at least three hours a week to watch a movie. I don't like dub movies. I like movies. And the original language with subtitles or I like works, right? And I have a particular affinity.



for, black cinema. And so I try to look at things, movies that are both new, And then revisit the ones that I enjoy from the past. I think the best use of my time is actually spent though with my family. I have been fortunate, to be married as of next month, April, at the time of this recording for, 25 years.



I, am fortunate that at any random time I can get a, video call from one of my two kids, and as they've transitioned into adulthood, they continue to want to talk to dad. Now it's about different stuff, but it repeatedly happens And that brings me joy and I think what.



Really keeps me charged. Right? Keeps my battery at a hundred percent, quite frankly, is that, there are two things. growing up my real life superhero, so I had comic books, but my real life superhero, in addition to my parents, my parents were, incredible and a model for me and my wife, but it was Muhammad Ali, former, multiple heavyweight champion of the world who faces own challenges.



what I loved about Muhammad Ali is that that man always sought to do what he thought was just, and he was never shy about speaking, what he viewed as the truth, even when it wasn't comfortable for people to hear it. Right. And he faced repercussions for that. I think I'm cut from that cloth.



And so I'm actually energized by all the challenges we face because if not me, then who, someone has to be there on the front lines to fight, And someone has to feel as if, they've been called and have the responsibility to lead the charge. So every day, when I get up, I feel, invigorated, quite frankly, not discouraged.



Because I, I know that my job, my mind and my skills are very much needed at a time. maybe like they've never been needed before. so it's relatively easy for me to stay energized, quite frankly, because there's always something that I'm going to need to do, And then when I need to focus on something else, I have loved ones and hobbies and habits to, allow me to have, a little bit of a break.



Jada Bussey-Jones, MD (Host): laroi. I wanna first thank you and, not only for your time today. A, but also as someone who I consider to be one of my very own superheroes as well, someone who's inspired me, and mentored and supported me over the course of my career. So I wanna say thank you for that.



Thank you for your time today. and offer one final opportunity for any last reflections as we wrap up our time together.



Leroi Hicks, MD, MPH, FACP: Yeah. I first is there's mutual admiration between the two of us. So I'm, I don't take lightly what you said, and I'm extraordinarily humbled by it, so thank you. as the first thing I would say, and think if there are any take-home points, I want all of our members, regardless of how long, they've been practicing medicine, And what stage they are in their career, to not be overly discouraged.



There is no question that, again, risk and challenges are abound, And the assaults on all that we know help improve the lives of human beings, seem to be coming from every direction. Yet we have within us an organized body. Of people who are uniquely talented. And so if we don't give up the fight, we can really, you know, this too shall pass.



And real question is in what shape is this world going to be when the change begins to occur? And I think we have to, remain not only hopeful, but determined to help make sure that things don't fall into too much disrepair. And that requires activism. It requires engagement, and it requires not giving up on doing those things that we know are the best things we can do for human health.



So that would be my parting shot.



Jada Bussey-Jones, MD (Host): Well, I wanna thank you again for your thoughtful reflections today. I wanna thank our audience for joining us And the s. J. M Staff, r Bogle, our executive producer, and our entire production team. Also, I wanna say thank you to our listeners. You have been listening to the SGIM President's Podcast.



If you like what you've heard, please rate us and leave a comment wherever you listen to podcasts as it helps other's to find us also. look for us on the SJM webpage sjm.org and follow us on x.