Chi-Cheng Huang, MD, FACP, SHM, Executive Medical Director of General Medicine and Hospital Medicine Shared Services Wake Forest Baptist Health System

You earned your medical degree at Harvard Medical School and completed your residency training at the Harvard Combined Internal Medicine/Pediatric Program. What initially sparked your interest in pursuing a career as a physician, and how did you decide to specialize in your field?

My parents immigrated from Taiwan, and we resided in Columbia, South Carolina and College Station, Texas during my childhood. Growing up in an immigrant family, I bore witness to the unwavering dedication of my parents to their children, as they shouldered multiple jobs to support our daily lives and provide us with the best opportunities in education and upward mobility as a lower middle-class family. This formative experience profoundly ingrained in me the conviction that I contribute to the communal tapestry, extending assistance to those less fortunate than me, and aspiring to emerge as a constructive member of society locally and globally. Consequently, during my early years, two distinct occupational callings crystallized in my mind: the path of a physician or that of a foreign diplomat.

As a junior at Texas A&M University, I spent a week with an NGO and visited a refugee camp in the former Yugoslavia run by the United Nations High Commissioner for Refugees (UNHCR). I had a poignant and emotionally difficult encounter with a child whose father was conscripted into the Yugoslavian War. “Tatiana” left an indelible mark on how I see the world. Witnessing the involuntary conscription of numerous individuals into the throes of war and human conflicts proved to be a transformative juncture. Consequently, my aspirations of becoming a foreign diplomat and potential involvement in war and conflicts were relinquished. Instead, I resolved to pursue the medical profession, envisioning a trajectory wherein care would be dispensed irrespective of one’s background, status, or geographic location.

My trajectory towards a medical career unfolded with a resolute objective: to provide care that transcends socio-cultural boundaries. I appreciated the holistic approach in the field of medicine, guided by the principles of inclusivity and the pursuit of the greater well-being of diverse individuals.

Throughout your extensive career, you’ve worked in various hospital settings. Could you share your thoughts and perspectives on different types of hospitals such as Academic Medical Centers, Community Hospitals and Critical Access Hospitals (CAH)?

First and foremost, I wish to underscore the paramount significance of Critical Access Hospitals (CAH) and rural health communities. Having worked in Critical Access Hospitals situated on an island, amid mountainous terrain, and in various rural locales across the United States, I contend that the absence of these institutions will precipitate more substantial population health and healthcare challenges in the United States. The data revealing higher mortality and morbidity rates in rural areas accentuates the compelling demand for Critical Access Hospitals and more primary care clinicians and public health services nationwide. Furthermore, I also would like to emphasize the pivotal role played by Academic Medical Centers. These institutions serve as crucibles for medical innovation through rigorous research and development endeavors. Equally important is their role in shaping the next generation of healthcare professionals, who will assume the mantle of responsibility for future medical services. The Association of American Medical Colleges (AAMC) has projected a significant deficit in healthcare personnel in the United States by 2024, a shortage that will be exacerbated by an 11% surge in the population aged over 65 by 2034. A proactive approach to educating the succeeding generation of healthcare professionals, physicians, physician assistants, nurse practitioners, nurses, paramedics, and EMTs, is imperative to avert substantial problems in the United States healthcare system.

In addition, community hospitals stand as vital entities, responding to the needs of their communities that are often neglected and do not get the resources that they need. The preference for proximity to home is evident among patients and families in rural towns, provided exemplary care is assured. However, the quest for exemplary care necessitates a form of ‘innovation.’ I posit that innovation holds the key to resolving myriad healthcare issues in the United States. A transformative area that beckons innovation is collaboration among healthcare service providers, spanning physicians, nurse practitioners, and physician assistants. This synergy is crucial in meeting community and patient needs. A foundational innovation in this realm is the advent of virtual medicine platforms, hospital(ist) at home, virtual hospital, and virtual consultation.

For instance, at the Atrium Wake Forest Health System – Advocate Health System where I am affiliated, innovation takes the form of a substantial incorporation of virtual health and telemedicine into community hospital settings. Virtual hospitals enable practitioners to remotely oversee patients at multiple locations, mitigating clinician shortages. Initiatives such as “Hospitalist at Home” hark back to the concept of house calls, where paramedics visit patients at their residences post-discharge or when isolation necessitates attention.

As the Executive Medical Director of General Medicine and Hospital Medicine Shared Services and as the Section Chief of Hospital Medicine at Atrium Wake Forest Baptist Health System, what are your primary responsibilities, and how do you envision advancing healthcare in these roles?

Over the past three years, our institutional landscape has undergone strategic integration. Commencing as Wake Forest Health System, we transitioned into Atrium Wake, and subsequently engaged in a broader integration with Atrium Charlotte in North Carolina and Atrium Floyd-Atrium Navicent in Georgia and Alabama. Currently, our purview extends to approximately 22 hospitals, and our hospital medicine section manages an average daily caseload of around 2,500 patients.

Operating across three states presents a complex yet advantageous scenario. Firstly, leveraging virtual telehealth enables us to extend care to rural health and critical access sites with limited clinician resources. Secondly, our expansive organizational footprint facilitates impactful research initiatives, exploring potential differences in Learning Health System interventions. Thirdly, the sheer size of our system allows for seamless patient transfers to academic centers, fostering immediate access to specialized surgical or medical interventions when urgently needed. This extensive scope dismantles barriers that often impede health systems of lesser size.

Lastly, our position as an academic medical center (AMC) allows our Advocate Health System a synergy to work in collaborative fashion and move quicker with innovation. We serve as a crucible to provide specialized platforms for the education of advanced practitioner students, including physician assistants and nurse practitioners, alongside medical students, interns, and residents. This comprehensive educational approach caters to diverse aspirations within our cohort. Whether these individuals wish to remain in their communities, rural, urban, or community health settings, we have tailored our teaching programs to accommodate and alleviate potential tensions. This approach not only imparts practical knowledge but also equips the next generation of healthcare professionals with the requisite background to navigate their diverse practice environments.

You founded and operated the Bolivian Street Children Project/Kaya Children International. Can you share some insights into how you began this project and how it addresses the needs of the children it serves?

My experience in the former Yugoslavia country in 1992 very briefly at a refugee camp was a pivotal experience for me to decide on medicine as a career and more importantly as a small way that I can make change in our world. Upon the culmination of my four-year medical education, I opted for a one-year sabbatical, a sort of ‘fifth year,’ to take the next step in the arc service to others that are less fortunate than me. During this period, I proactively reached out to approximately fifty organizations, seeking opportunities for a medical student. Among the responses, three organizations captured my attention: one in Kenya, another in Taiwan, and the last in Bolivia.

Despite my Taiwanese heritage, I was driven by its focus on addressing the healthcare needs of vulnerable children and children of the streets coupled with my proficiency in Spanish. Upon my arrival in Bolivia, specifically in La Paz and El Alto, the pressing need for healthcare intervention among street children was evident and their need for food and shelter was overwhelming. The first 12 months in 1997 were marked by uncertainty, as my understanding of the challenges faced by these children on the streets was limited and we were staffed as a number of 1 to the care that these children needed.

Starting with my efforts with daily walks at night through the streets, I sought to know the children residing in sewers, abandoned houses, abandoned warehouses, underneath bridges and on the streets. What began as simple interactions, such as playing soccer and addressing their basic medical needs, evolved into a greater mission as the staggering realities of their plight unfolded. The mortality rate among these street babies was alarmingly high, with a shocking 30% succumbing to conditions exacerbated by malnutrition, dehydration, and the harsh living conditions at altitudes reaching up to 10,000 feet. Tragically, some children had perished from exposure during frigid nights, forcing them to navigate the streets in darkness to stay warm while seeking shelter during the day to sleep.

After the first year in 1997-1998, we recognized the imperative to eventually establish a non-profit organization dedicated solely to addressing the myriad needs of these vulnerable children. Through this initiative and other goals, we successfully constructed three homes, a drop-in center, and a facility designed to alleviate the health challenges faced by these children. Our journey is documented in the book titled “When Invisible Children Sing,” published in English, Mandarin, and German in 2011. This poignant narrative encapsulates our endeavors during our first year on the streets, providing a comprehensive account of our efforts in caring for and understanding the plight of these marginalized children.

Are there any ways for our readers to support your activities or non-profit organizations?

There are a few great organizations deserving of readers’ support. One such entity is Project Suma (https://www.projectsuma.org/). Project Suma provides care to women trapped in the sex industry, along with their offspring. During our tenure in Bolivia, we work collaboratively with this organization. Regrettably, a disheartening consequence of many children on the streets is that they get trapped into prostitution during their teenage years.

There are numerous health inequity problems in the United States that indicate the importance of social determinants of health. Please provide your thoughts on any significant issues that you believe are crucial for improving population health in the US.

In addressing the critical issue of health inequities in the United States, particularly from an Asian American perspective, it becomes evident that the social determinants of health play a pivotal role in shaping the landscape of population well-being. A nuanced exploration of various facets reveals significant challenges and opportunities for improvement.

One prominent health inequity issue is the lack of culturally competent healthcare. Asian Americans, encompassing diverse ethnic backgrounds and languages, often encounter barriers in accessing healthcare services tailored to their unique needs. Enhancing cultural competency among healthcare professionals and increasing language accessibility can bridge this gap. Moreover, promoting diversity in the healthcare workforce and within healthcare leadership’s C suite can contribute to a more inclusive and understanding environment for patients.

Mental health within the Asian American community is another pressing concern. Stigmas surrounding mental health conditions persist, hindering individuals from seeking necessary support. Culturally sensitive mental health awareness campaigns and accessible resources can help destigmatize mental health discussions and encourage seeking assistance when needed. Recognizing the diverse cultural factors influencing mental health perceptions is crucial in crafting effective interventions.

Additionally, socioeconomic factors significantly contribute to health disparities. Many Asian American communities face difficulties related to income inequality, limited access to education, and employment disparities. Addressing these social determinants necessitates targeted policies that focus on economic empowerment, educational opportunities, and employment equity. By fostering economic stability and social mobility, the foundation for improved population health is strengthened.

Language barriers present another obstacle to accessing quality healthcare for many Asian Americans. Limited proficiency in English can lead to misunderstandings, misdiagnoses, and inadequate healthcare. Implementing language assistance programs, providing language-concordant healthcare services, and promoting language diversity in health communications can enhance healthcare accessibility and quality for linguistically diverse communities.

Furthermore, the model minority stereotype often obscures the unique health headaches faced by certain Asian American subgroups, AAPI, South Asian and Asian groups. Recognizing and addressing the heterogeneity within the Asian population is crucial for targeted health interventions. Tailoring public health initiatives to account for specific cultural, linguistic, and socioeconomic factors within different Asian communities will contribute to more effective outcomes.

In conclusion, tackling health inequities in the United States demands a comprehensive understanding of the social determinants of health. From a nuanced Asian American and Asian perspective, addressing issues such as cultural competence, mental health stigma, socioeconomic disparities, language barriers, and subgroup-specific health challenges can pave the way for a more equitable and inclusive healthcare landscape. By prioritizing these areas, we can work towards a healthier, more resilient nation that embraces the diversity inherent in its population.

You’ve received numerous awards for your community service, teaching, and leadership. Which of these awards holds the greatest significance for you, and why?

One of my most treasured accolades is the Taiwanese Humanitarian Award, an honor bestowed upon me nearly a decade ago. This distinction holds profound significance for me, as it reflects the culmination of familial values instilled by my upbringing. My parents, through numerous sacrifices, paved the way for my opportunities, and this award symbolizes a reciprocation of their efforts.

The acknowledgment from my own ethnic community amplifies the weight of this honor. It serves as a testament not merely to my commitment to community service but also as an expression of gratitude to my parents. Their sacrifices facilitated my trajectory towards the opportunity towards making a difference in other less fortunate than me.

However, my commitment extends beyond the confines of the Taiwanese community. Embracing a colorblind ethos, my philanthropic endeavors are dedicated to the betterment of others at large. In essence, our genetic makeup underscores our shared humanity, with a staggering 99% similarity in DNA among us. Thus, irrespective of cultural, ethnic, religious, or sexual orientation distinctions, we are fundamentally kin.

Reflecting on my circumstances, I find myself contemplating the capriciousness of fate. The providence that led to my birth in the United States, a land of relative peace and prosperity, contrasts starkly with the plight of those born in regions marred by conflict, such as the Middle East, Central America, South America, Africa, and Eastern Europe. Grappling with the arbitrariness of such fortunes, I acknowledge the magnitude of my responsibility in light of the advantages bestowed upon me.

In embracing the ethos of “much given, much expected,” I recognize the weightiness of my obligations. The sacrifices of my parents and the fortuity of my birthplace amplify my sense of duty to contribute meaningfully to society. Consequently, the Taiwanese Humanitarian Award not only represents a personal achievement but also underscores the imperative to fulfill my role to try to make a positive impact on a local, national, and global scale.

Have you any advice for young people considering a future in healthcare generally, or in medicine in particular?

Engaging in any pursuit demands an intrinsic love for the career and that is imperative: If the passion is absent, the pursuit is best left untouched. Personally, my passion lies in serving people, delivering exemplary care to my patients, and an unwavering commitment that persists even after several decades in the field of medicine. One of my mentors, Paul Farmer, saying was “I am happiest when I am with patients.”

I am content and joyful when I can make a difference in others. I continue to have that fervent desire or fire to mitigate the suffering of others, whether it is the realm of healthcare, medicine, business, engineering, law, or the culinary arts, the underlying principle remains that one must possess an enduring love for her or his chosen path, a quality that allows us to sustain ourselves over a lifetime.

While an inherent passion augments one’s journey, it’s recognized that not everyone finds that passion in his professional pursuits. My one piece of advice to the younger generation is that effort and hard work is not necessarily genetic. Irrespective of the chosen field, diligence becomes the linchpin for success. Commitment, showing up, and a tenacious work ethic are indispensable.

The unequivocal mantra is clear: love what you do, embody passion, work assiduously, and, above all, consistently show up and work hard.

How would you articulate to young readers that healthcare can indeed be a profession they come to cherish?

In my formative years, my aspirations leaned towards becoming an athlete, a pursuit limited by my height and a lack of innate genetic advantages. As I often counsel my own children, early exposure to a broad spectrum of experiences is pivotal. I deliberately avoid exclusively immersing them in the realm of medicine; rather, my wife and I expose them to diverse domains encompassing liberal arts, business, science, and the arts. This multifaceted exposure allows them to discern their inclinations and preferences.

Encouraging youngsters to explore diverse fields is paramount. Exposure to various disciplines, facilitated by mentors and observational learning, enables them to evaluate their proclivities. Whether aspiring to delve into any domain, immersing oneself in that environment is imperative to ascertain genuine interest. Skills and passions, once identified, can be cultivated through intentional exposure.

In essence, cultivating a profound appreciation for the healthcare profession necessitates a deliberate and exploratory approach during one’s formative years. Through exposure, mentorship, and an understanding of personal passions, young individuals can discern the path that resonates with their passions and aspirations.

January 8, 2024

Chi-Cheng Hung, MD, FACP, SHM

• Executive Medical Director of General Medicine and Hospital Medicine shared service Wake Forest Baptist Health System

Dr. Chi Huang earned an undergraduate degree in biology from Texas A&M University and graduated cum laude in 1998 from Harvard Medical School. He is an assistant professor in pediatrics, medical director of inpatient pediatrics, director of the pediatric global health initiative, and internal medicine hospitalist attending at Boston Medical Center, Boston University School of Medicine. He has spent the last 15 years advocating for the lives of street children in developing countries; was influential in cofounding Casa Bernabe, a home for Bolivian street children, in 2001; and is the founder of Kaya Children International, a 501(c)(3) nonprofit. Dr. Huang has received numerous awards and recognition for his work. He and his wife, Kristin, have three daughters.