Jada Bussey-Jones, MD (Host): Hello, This is Jada Bussey-Jones, the immediate past president of the Society of General Internal Medicine and the host of SGIM's President's podcast, where 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 health and society 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'm very excited to talk with Dr. Nicole Lurie. Dr. Lurie is the Executive Director for Preparedness and Response at the Coalition for Epidemic Preparedness Innovations or CEPI, and the Director of CEPI US. She is also a senior lecturer at Harvard Medical School and a Professor of Medicine at George Washington University School of Medicine. She served an eight-year term as assistant secretary for preparedness and response at the US Department of Health and Human Services from 2009 to 2017. In that role, she led the HHS response to numerous public health emergencies, ranging from infectious disease to natural and manmade disasters, and is responsible for many innovations and emergency preparedness and response that are ongoing to today.

Dr. Lurie has a long history in health policy and health services research leading seminal work on access and quality of care, mental health and health equity. Prior to federal service, she was the Paul O'Neill Professor of Policy Analysis at Rand, where she started and led the Public Health Preparedness Program and Rand Center for Population Health and Health Disparities.

She is the recipient of numerous awards, recognizing her wonderful work over the years, including the Association for Health Services Research's Investigator Award, University of Pennsylvania's Distinguished Graduate Award, the American Federation for Medical Research. Nelly Westerman Prize for Research Ethics. And she is a recipient of the mastership of the American College of Physicians.

She is also a member of the National Academy of Medicine. So with that fantastic introduction, I want to say thank you, Nikki, for being here with us today. But also, thank you for your career in leadership and impact as that bio sort of tells the story. So, I want to start though, before you became Dr. Lurie, to really sort of ask you to share a little bit with the audience about how it all started. If you could just tell me a little bit about you and your background, before you sort of got on this professional journey.

Nicole Lurie, MD, MSPH: Well, before I got on this professional journey, I want to think, in some sense, it started in high school. I was a pretty rebellious kid—I won't surprise you, and I pretty much refused to go to high school my last two years. I was fortunate to get adopted by a pediatrician at the University of Connecticut who was working on meningitis vaccine in the county hospital. And she has started noticing that all these kids who came in with seizures, who she thought had meningitis didn't have meningitis at all, they had lead poisoning. And so, I became her research assistant. And as a high school kid, I trumped around the projects in Hartford, collecting blood from kids on their kitchen table, collecting urine specimens and paint chips, and mapping out lead in Hartford. She took me with her when she testified in the state capitol to get lead out of gasoline and, in retrospect, was an amazing role model, both as a woman physician and somebody who really figured out how to be a doctor for their community and how to make actionable the clinical problems that they saw. That's how it all started.

Host: Oh my God, I did not anticipate that answer. I'm learning so much about people during these sessions. But the fact that you've basically rebelled not going to high school is not what I expected to hear. But this really formative experience that you had with another woman physician leader with an impact, I think, it makes sense, I will just say that. Unexpected, but it completely makes sense. So, thank you so much for sharing that with me. I was wondering maybe based on that experience, but did you sort of aspire to leadership yourself? How did you think about where you wanted to go on your journey? Was leadership a part of it from the beginning?

Nicole Lurie, MD, MSPH: I think what I would say is wanting to create social change was always a part of it. I did not equate leadership with creating social change for the longest period of time. Maybe that was the rebellious streak in me, I don't know, but that was not part of my journey. I was always very driven by a theme of social justice and wanted career change. And the paths that I took and the various twists and turns were driven by that. They were not driven by any aspiration to be a leader or in a leadership position. It just turns out that you can do them better from—often, not always—but often from those positions.

Host: I gotcha. So, more of a means to an end to accomplish the change that you wanted to accomplish. So, that makes sense. So, how about if we take a step back and tell me about—so, there's social change and injustice and things like that, but how did you decide on career in medicine and specifically general internal medicine?

Nicole Lurie, MD, MSPH: So, I ended up in a career in medicine in part because I had put together my own major in college, on sort of the healthcare system and always viewed health policy reform as an instrument in social change. And a mentor in college basically said to me, "Nikki, you can't do this unless you go to medical school." And he really twisted my arm. I had no intention of doing it. The first year and a half of medical school is absolute torture. And when I started seeing patients, I fell in love with medicine and I've never looked back. And I decided to do general internal medicine because it was the path that let me take the most holistic approach to patient care and to blend, I think, patient care with all the social issues that I really cared about.

Host: I completely understand that. And it does make sense that someone who rebelled against high school might not want to spend hours in a classroom in medical school. But, as you described, once you get to patient care, then the ability to drive some of that change, it can really make a difference.

Nicole Lurie, MD, MSPH: I'll say, it wasn't until I started working on vaccine development when I was in government that I finally fell in love with science.

Host: Ah, okay. Okay. So, how did you get from general internal medicine to your role in government and vaccine work and things like that?

Nicole Lurie, MD, MSPH: So, that's a pretty long and winding path. But after I finished my fellowship, I did the Clinical Scholars program after residency at UCLA. And then, I moved to Minnesota. It was the best intersection of a two-career move at the time. And it's worth noting because it's so relevant to my life in SGIM that when I got to Minnesota, I accepted a position at the county hospital in a place where there was no general medicine. At the mothership hospital, the medicine chair didn't believe in general medicine. There were no general internists. There were no doctors who did health services research. But the chair at the county hospital understood what I was about, created a great opportunity for me, but the deal was I would never be eligible for tenure. it actually turned out that was a blessing in disguise, because I never really worried about publishing papers in the least publishable unit and all that stuff. It just turned out I had a lot to do and say. And so, the rest of it took care of itself.

About five years into this role, splitting my time between general medicine at the county hospital, which is also a teaching hospital and a health services research unit, which at the time was all male health economists. I came to this realization really over a single patient encounter that my patients weren't going to get better unless my community got better. And then, I needed to understand what it took to be a doctor for my community.

At that point, I ditched a ton of the work I'd been working on, mostly in the health economic space and really set out to talk to people in the community and listen to the community and came to understand what a set of needs were that, that I thought I could impact. It ultimately required me switching departments and the school of public health, because the health services people didn't quite understand what I was about. But I found some folks in the epidemiology department that were really willing to help me with imperfect science and imperfect studies, but also creating social experiments on social change.

And I started to get to the point where I was out of tools in my toolbox, and I needed to do something else. When John Eisenberg, also our former SGIM President and a hero of mine called me up and he'd been a friend and mentor ever since I was in college and told me that Dave Satcher, then Surgeon General and Assistant Secretary for Health was looking for a principal deputy, and would I be interested, And so, the long and short of that was I picked up my family, and we moved to Washington. I worked with David for two and a half years, kicking off the Health Disparities initiative, working on healthy people, doing a whole bunch of other stuff. And that was my first foray into government. And then, that election was an election that was decided by the Supreme Court. And so, I ended up leaving abruptly going back to Minnesota. That was not a great fit. And we went back, particularly for my husband.

At that point, I was offered into that chair at Rand. And we moved back to Washington. I got to Rand just after 9/11 and the anthrax stuff And the folks at Rand said to me, "So while you're getting going, we need somebody to do an assessment of the public health preparedness of every county in California and figure out how much it will cost to fill those gaps. Can you do that?" I'm a general internist. What do I know? You know? So, I'm happy to give it a try and found a collaborator and I got into this and I realized. That there are no methods or metrics or measures or anything, and basically started with a colleague to develop this field.

I came very rapidly to see this as a field that linked my interest in what was happening to my patients, to what was happening to my community, to understanding what it meant to be a doctor for my community. And most of the people who got into trouble in different disasters, we're people who are poor and uninsured or underserved. And so, it turned out to be a good fit. So when President Obama was running for office. I worked a lot on the campaign, and then was asked to serve in this role in government.

Host: How fascinating. Thank you so much for sharing that winding journey that you've made through your career. It's wonderful and entertaining almost sort of the twists and turns. But clearly impactful. You did mention SGIM along the way a couple of times. And so, I'd like to maybe center on SGIM and your experience with the organization a bit. You clearly have worked and led in a lot of different organizations, so I want to hear a little bit about, how you came to SGIM and maybe how this organization is different from others.

Nicole Lurie, MD, MSPH: So, SGIM I think was being birthed when I was a resident in a primary care residency, and then when I was a clinical scholar. And it was during that time that I went to my very first SGIM meeting and actually ended up giving a plenary presentation on the research I had done as a clinical scholar, which appallingly was about what happened to people who got cut off of Medicaid. This was 1984. We are learning all these lessons all over again, which is pretty horrific in its own right.

But when I moved to Minnesota, there was no general medicine. I knew nobody, and I had to depend on a network of general internists. Some from where I trained at UCLA, but very rapidly a network of people that I had met through SGIM. And so, I found myself connected to people all over the country, people who were very willing to answer questions, to be a mentor, to do other things. And when it came time to find people to fulfill different roles in SGIM, there was nobody from the Midwest. So, I had a lot of opportunities to get involved in and contribute to SGIM.

There were parts of the experience of going to annual SGIM meetings and connecting with these people that were very impactful. One was there was a longstanding task force. I think it was called On the Patient-Doctor Relationship or On Patient Communication. And it was through that task force that I really learned how to be a doctor, probably, that I learned how to be a leader, that I learned a set of communication skills and learned a set of ways to understand myself and be comfortable with myself. I joke and say the most impactful workshop that I ever went to at SGIM was a three-hour workshop on how to say no effectively.

Host: Okay.

Nicole Lurie, MD, MSPH: So, how to set limits and how to do this in a way that didn't tick people off. And so, it's relevant, because when I was asked to run for President of SGIM, I had a lot of ambivalence about it. And so I said—and I think it was to Steve Finn, but I can't remember who asked me—I said, you know, I have this arrangement with my kids—and this was true—then anytime I am asked to take on a commitment outside of my regular work-life, I go home and I discuss it with my kids. And I have to justify to them why I'm going to do this.

And so, I went home and I sat at the dinner table with my kids. And I explained to them that I was asked to run to be president of the organization, and that this was what it would mean in terms of my time commitment and my time away from home. And my middle son, Noah, looked at me and he said, "Mom, the times that you are the happiest is when you come back from SGIM. And if it is giving you so much that you need to give back, of course, you should do this.

Host: Oh wow. That's amazing.

Nicole Lurie, MD, MSPH: And then, he said, "And besides, Elnora makes the best spaghetti."

Host: Oh my goodness. That's a great story.

Nicole Lurie, MD, MSPH: But I mean, I think it really speaks volumes to what SGIM meant to me and what it still means to me to this day. It has just given me so much and so enriched my life and given me mentorship and a network of friends and family and opportunities that I never would've had otherwise.

Host: That's

Awesome. And so, maybe I can ask, as we're heading into the organization's 50th anniversary, which is pretty remarkable, are there any memories or reflections or thoughts or even advice for the next generation of SGIM leaders or members, based on your experiences with the organization?

Nicole Lurie, MD, MSPH: Sure. So, one of my very fun memories was giving my presidential address, which of course is anxiety-producing for any president to get ready. And I ended up structuring my address around the children's book, the Big Orange Spot. And my son, Noah, who had asked me, who convinced me to run for president, came and he read the book to the audience as I then interpreted what it was that we saw.

And it was, I think, a way for me to both convey an important message, but to demonstrate a kind of leadership that blends one's personal and professional life. And I really appreciated the opportunity to role model that kind of thing for members of SGIM. I got a lot of feedback about that from men and women alike, which was really nice. And that's a memory that I will always cherish.

I think almost every president of SGIM has seen one kind of turmoil or another, or one kind of challenge or another. And I think the organization has continued to evolve in some really exciting and important ways over time. I think the sort of advice that I might give now is the same kind of advice or struggle with that I give to people right now who are really challenged by the current environment that we're in, which is we cannot recreate the past. We cannot, nor should we put Humpty Dumpty together again. That just doesn't work. And this Humpty Dumpty's not going to go back together again. And so, I think we have to embrace new ideas, new solutions. I think we need to get younger people involved in the organization. But I think we can do that and have to do that being true to a set of core values, which are about what primary care is about and what taking care of our community is about. And I think if we're true to those values, I think the rest can follow.

There are a lot of pressures not to be true to those values, to compromise on ideals. That I don't think we can do. But I also feel pretty strongly that the kinds of people who are members of SGIM joined for a reason. That also had to do with core values that they hold dear. So, it will hold us all to account.

Host: I love that. And so, what you're saying is being consistent with our values and priorities. But at the same time, leveraging even crises or things that may be perceived as negative as opportunities to continue to grow and improve. And I think the organization and a lot of the leaders have done just that in their careers and in the organization as well. So, thanks for that. I think that's a really insightful way to frame it. And it's sort of in a more positive framework from my perspective.

Nicole Lurie, MD, MSPH: And I'd say a couple of other things. And all this disaster work I do, I always say, "Never let a crisis, never let a disaster go to waste." You can never make up for lost time, and there's a ton of opportunity and chaos. And so, jump into that opportunity. I think I learned from going to Minnesota at the time, there was opportunity in the fact that there was nothing there. There was opportunity in political turmoil and chaos that I could take advantage of to help create what turned into Minnesota care. There was an opportunity in a lot of crisis that you can use to create something better. And that, I think, is the defining challenge of our time right now.

Host: I love that. And framing these crises is opportunity. And more than anyone, you can speak to that, I mean, these large disasters being able to change policies and practices in ways that you've done. So, thanks for sharing that and doing that in the past. So, I wonder if we might take the last few moments or few questions of our time together and just maybe think about, share with the audience what brings you joy and inspiration, because there have been so many things that have been difficult over time. So like to kind of find out what is keeping people focused? Do you have hobbies or things that you do for self care, things that bring you inspiration or joy?

Nicole Lurie, MD, MSPH: Sure. First of all, and I'm very fortunate to still be doing work both clinically and policy-wise, that's very meaningful. And I get a huge amount of joy out of the success and seeing the impact on people's lives, whether it's on a global level or an individual patient level or on a family level. I now have six grandkids, which is mind-blowing to me. They give me an amazing amount of joy.

And then in terms of my day to day life particularly, I spend a fair amount of time on self-care. I tell people the more stressed I get, the more exercise I need. So until this past year, I ran and I get a lot of exercise. I run, I swim, I do a regular yoga practice a couple days a week. Those things give me a lot of balance and peace. I have on and off in my life been a potter. And I'm back at the wheel now that I'm no longer in government. And for me, I joke and I say, you know, I can't center a piece of clay unless I center myself. And, so it's an opportunity to center myself and to be creative and to do this just for me.

Host: I love that. Okay, Nikki. So, we are wrapping up here, but I want to give you one last opportunity to offer any final comments, or last thoughts as we wrap up our time together.

Nicole Lurie, MD, MSPH: SGIM is a special place. I think it helps you be the kind of doctor and the kind of person that you want to be professionally and, frankly, personally. And I very much hope that the society continues to find the balance to help people grow in both of those ways. It is, and just remains very special.

Host: Thank you again, Nikki, for your time today. And thank you for your inspirational career and all that you've done over the many years. I want to thank our audience again for joining us today as well as the SGIM staff and our production team. 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 others to find us. Also, look for us on the SGIM website, sgim.org, and follow us on X.