Physician leadership is a priority for ACEP Immediate Past President Aisha T. Terry, MD, MPH, FACEP. She’s approaching the issue from all sides. As she builds a programmatic approach within ACEP to identify and cultivate leaders, she is strengthening the “pipeline” and creating opportunities for newer physicians to thrive. In this spotlight. Dr. Terry interviews CVS Health’s Vice President and Chief Health Equity Officer Joneigh S. Khaldun, MD, MPH, FACEP.

The Leadership Spotlight highlights examples of emergency physicians using their foundation in emergency medicine to lead, teach, and inspire the next generation. Whether inside the hospital or beyond, the foundation laid by deep experience in the specialty is versatile, unique, and invaluable.

DR. TERRY: You’ve done so many things in terms of your career, and your current position is such a massive undertaking and impactful role. Was it always your intention to lead in this type of capacity? You’ve had certainly local leadership and state leadership and government related leadership roles in terms of advocacy and health policy. Did you anticipate being where you are today?

DR. KHALDUN: As a child, I knew I wanted to be a doctor because I saw my parents, who are from the east side of Detroit, deal with health issues in my family’s community. There were things that I saw as preventable, and I just had this fire in me where I wanted to fix it. I wanted to make my community healthier. Being a physician was the way to fix health, because as doctors, that’s what we do. I quickly figured out in my medical training path, certainly in medical school, that I wanted to make this a significant part of my career.

Through all my roles, whether it was at the Office of Health Reform at HHS or Chief Medical Officer in Baltimore or Director Detroit Health Department or leading Medicaid Public Health for the State of Michigan—and now at CVS—the common thread is that I really want to make changes in the health care system at scale. Public health is a good way to do that. But I still practice emergency medicine at Henry Ford in Detroit and have practiced throughout all my other roles. I love the practice of emergency medicine, especially urban emergency medicine, and I love working with medical students and residents because it keeps me grounded.

DR. TERRY: Most of your work has been through government, local, state and federal. How is your current role different?

DR. KHALDUN: There are some things that you learn, at least that I’ve learned in my career, which is when you get into leadership roles, the important thing is not your technical knowledge. The important things are often how you inspire and lead teams, how you address problems, how you determine what’s urgent, what’s not urgent, what’s important, what’s not important. It’s also how you build a team, how you manage a budget, how you work through change. In my roles, I’ve done that and then some. Those are similar things that I do at CVS Health. That’s what leadership is.

Yes, I’m in a company that is publicly traded now, right. It is a little different; how you engage is a little different. It’s also a company with 300,000 colleagues and businesses within the company. Things move very fast, so it’s fun. My ER doc self loves different things.

DR. TERRY: Did you seek out these roles, or were you sought after for the roles you’ve had?

DR. KHALDUN: What I’ve always sought out is an opportunity to be helpful. I sought out, of course, the fellowship at George Washington University because I had this itch where I wanted to get more training and understanding of health policy, and how I could be helpful for my career. I serendipitously was asked to be in those roles in in the city of Baltimore, city of Detroit, for the state of Michigan. But throughout my career I’ve taken chances and leaps. I’ve taken jobs where there was no job description where I wasn’t quite sure exactly what I was going to be doing, but I knew the true north of this seems to be an opportunity where I can potentially do some good and work with great people. And it is not lost on me that, as a Black woman from Detroit, I was behind the scenes doing operations but also trying to lead the masses of people. What it meant for there to be a woman of color in that role, and working on operations but also working behind the scenes on policies and decisions that were being made. I feel like I made an impact, and it matters that there’s diversity in the room when policies are being made.

DR. TERRY: You’ve spent your entire career trying to push the needle, certainly in your role in Michigan during the pandemic and pushing for positive change when it comes to health inequities. In the pandemic, there was amplification around how certain communities were impacted compared to others. Do you think we’re making progress when it comes to closing the gaps?

DR. KHALDUN: I think that progress is not linear. Do I believe that as a country we are in a better place than we were 100 years ago or 50 years ago? Absolutely. There’s no question. Think about my 97-year-old grandmother, who just passed away recently, may she rest in peace. She was orphaned at 6, lost both of her parents and was raised by her 11 siblings. She talked to me a lot about picking cotton. She never got past 6th grade, and you know, she came to Detroit for a better life with one of her older siblings, and she walked miles to clean other people’s homes and take care of their children while she had her own children at home. That’s the opportunity that she had, and she managed. I forgot how much it was, but somebody gave her and my grandfather a small amount of money to buy their house in an all-white neighborhood in Detroit. She made a life for herself there, and I’m benefiting from her hard work. My life will never be as challenging as hers was.

Have we made progress? Absolutely. But like I said, progress is not linear. If you look back through history, there have always been ebbs and flows. This work of health equity, the core work of it, is not new. It has been around for decades. Now it’s called different things, right? I think progress has been made. I think the challenge is to get beyond, as a society, the rhetoric and speeches. How do we get to the point where you embed that health equity lens into how you make decisions, how you look at data, how your policies impact people who might have been left behind. But I’m optimistic that there are many people, a lot of expertise, a lot of folks who want to do this work well. We just have to kind of stay the course and do the work.

DR. TERRY: There are people, some of whom are colleagues, suggest that health equity and focusing on things like social determinants of health are not in our lane as physicians – that we should just focus on the Science of medicine, the pathophysiology – taking care of patients in that way and leave the rest up the social workers or community activists. What would your response be to that?

Dr. KHALDUN: Everyone has their own reason for why they went into medicine or emergency medicine. I don’t pretend to speak for everyone. But I know I certainly went into medicine because I wanted to help people be healthier. We know that most things that make people unhealthy have nothing to do with what we do inside the walls of an emergency department. And we also know that for many of our patients, especially as emergency physicians, we are the only touch point. And there are all kinds of reasons for that. It’s not ideal, but it’s a fact. For many of our patients, the health care system has failed them.

I would love for everybody to have a primary care physician they can call anytime and get in whatever time, after hours and weekends, that they want. That’s unfortunately not what our system is set up for. I do believe that we have a duty to care for the entire patient. You can’t write a prescription, knowing that it’s not going to be successful because the patient doesn’t have a roof over their head and can’t store their insulin, whatever the case may be. I don’t think everybody has to want to lead. But you have to at least have the awareness and competency to understand that there are other things going on in people’s lives. You should at least be open to thinking things through and asking yourself how you can make people’s lives better.

DR. TERRY: You’ve done so much from the bedside to the boardroom to the C-Suite. What would you say to your younger self? What advice would you give 18-year-old Joneigh Khaldun?

DR. KHALDUN: I think my piece of advice would be, “Don’t worry about it. Keep being you, and you’ll be able to have the impact that you want to have.” I’m very grateful that I didn’t really tell myself that I had to do this job or I’m going to do this job. I never had it planned out. But I always had this burning fire to want to have an impact at scale. I used to feel anxious if I wasn’t having an impact every day. I’d ask myself, “What are you doing with your life?” I’m much more comfortable now. I’d tell my younger self to just be more comfortable in what you’re doing.

DR. TERRY: Any other advice that you might give to a younger person who is interested in this work, this work of systems change and health policy and advocacy, perhaps through the lens of health equity? Somebody who wants to be like you?

DR. KHALDUN: The first piece of advice is to be true to yourself. I would also say to seek opportunities where there is clearly a need, whether it’s from a population health perspective or just somebody needing somebody to show up and lead when no one else really has the capacity to do it. Find out where you can add value and fill the gaps. And don’t forget how important your connections are. First and foremost, show up and do a good job.

DR. TERRY: This has been a joy for me, learning more about you and talking with somebody truly passionate about this work and somebody who understands the importance of it. This gives me hope and inspires me. Thank you for everything you’re doing and thank you for your time.

Dr. Terry is immediate past president of the American College of Emergency Physicians.