The pediatrician as advocate: Rhea Boyd on making clinical work about community needs

Rhea Boyd is both a physician and a researcher. But she never wants to separate high-level academic questions from the direct needs of those around her.

When the pandemic began, Boyd — a pediatrician in the Bay Area — helped develop a national campaign for Black, Latinx, and Spanish-speaking communities to provide answers about Covid vaccines. She has worked with colleagues in the Academic Pediatric Association to develop a national child poverty curriculum, and also teaches a course for pediatrics residents at Stanford on structural inequality and health.

For Boyd, a pediatrician at Palo Alto Medical Foundation and University of California San Francisco Benioff Children’s Hospital Oakland, those efforts have been shaped by her own experience as a Black woman in the largely white medical world.

STAT spoke with Boyd, who was recently named a 2022 STATUS List honoree. This interview has been edited for clarity and brevity.

When did you decide that you wanted to be a doctor?

I’d say probably when I was four or five, pretty young. I remember my earliest conception of a doctor was actually of a pediatrician, because that’s the only doctor I knew. They seemed like people who help kids. And I remember at night before I would go to bed, my parents would pray with me. We would always pray for the people we know, then we would pray for people we don’t know.

So I would often pray for kids who needed help. And early on, I thought pediatricians are the type of people who would help if kids really needed someone. So that idea of a pediatrician as not just a doctor, but an advocate, solidified in my mind as a young person. I can’t actually remember wanting to be anything else.

How did this idea of a pediatrician as also someone who is an advocate grow or change for you as you went through pediatric training?

Because I had that idea early on, it was really helpful because even before I was in my formal pediatric training, the experiences that I put myself in to see if I wanted a life of service in this way always had me doing advocacy alongside clinical work.

One of my projects during residency training was in the tattoo removal clinic at our county hospital. The goal of the clinic isn’t just to remove unsightly tattoos. It’s actually a violence-intervention program for gang-affiliated young folks and young adults. (And potentially, although it wasn’t a huge part of our patient population, for commercially sexually exploited minors to remove their branding; to remove some of the markers of the lives that they lived or had been exploited into living.)

The program was run through the hospital, instead of being somewhere in the community that might not be as safe or might not be in certain territories. Questions aren’t asked about when people go to the doctor. It was covered completely by Medicaid state insurance. It’s a painful procedure that takes multiple visits, so the actual clinical procedure itself is a choice that young people have to make again and again — which is a challenging choice because it’s associated with pain — to leave a life that may have been all they knew. So it’s also this profound part of their behavior change. That experience helped me see how closely clinical work can be embedded in really important community advocacy.

You received your undergraduate degree in Africana studies and health from Notre Dame, attended medical school at Vanderbilt, then completed a pediatric residency at UCSF. And then a few years after all that, you earned a master’s in public health from Harvard. What was it that made you want to go back to school for that? 

I needed time, honestly, to read. I needed to join a full-time educational program so that I have more time to read. When you’re in active practice and you’re doing community advocacy, some days, it felt like I was working more than a full-time job. And so I thought, public health school is a place where they already understand the connections between history and our social world and health. And then the particular program I went to had an intense focus on leadership skills for health policy changes that affect minority communities and marginalized populations. So it also was a curriculum that was tailored to the same communities that I was trying to build expertise around serving.

How do those two parts of your background — your clinical experience and community work — inform each other? 

Sometimes, like the tattoo removal clinic, it’s really obvious and clear that what we’re doing clinically has critical importance to the advocacy work that’s necessary to help people in their lives outside our clinical space. But other times, it’s less obvious, to be frank. Sometimes I’m just looking at X-rays, or sewing up stitches, and the two worlds could seem very disparate. And for clinicians who might not understand why others care about politics and policy change — I can understand it in a way because they might live on the other side where all you’re doing is stitches all day.

Sometimes if you don’t ask more questions about the lives of the patients that you serve, you might miss injuries that are avoidable or social situations that aren’t healthy or safe. So I think there are times when it seems like my work dovetails and then there are times where it’s just: You have pneumonia and what’s going to fix it is antibiotics, not a community intervention, per se.

Much of your research is around, in the most general terms, the effects of racism on young people’s mental health and well-being. And you do a lot around police violence in particular. What drew you to that area of research?

All of my academic publishing and all of the teaching and studying that I do is deeply community-based, because I work in the community, I don’t work at a university anymore. It really shapes how I approach what might otherwise be an academic question that then I go to write about in an academic setting.

So, for example, around police violence: The city I live in, like many cities across the country, has had multiple incredibly prominent cases of police excessive use of force against communities of color, particularly Black and Latinx young men. And so my interest in that area first came just as somebody who lives in a community who has questions about how law enforcement is serving our community’s interests or putting our community members at risk. So first, I got involved in community advocacy groups who have long traditions of addressing police violence. Again, not as an academic medical interest, but as a community member.

And then from joining those spaces and learning more about their advocacy work, I was able to see where I could bring some of my clinical understanding to the space. And over the last five or 10 years, more folks recognize that there are some community needs that are not best served by the police, but are better served by other health care teams that are equipped with mental health experts and social workers. But early on, many of us across the country, myself included, were trying to better understand, how can we also be of help? How can I use the skills that I have in clinical medicine, understanding a bit about mental health, understanding a bit about injuries, to do violence prevention work?

In the early days of the pandemic, there was this recognition of how dire a need there is for stronger mental health care for kids and young adults. Kids were out of school, and then of course, in the summer of 2020, there was this national wave of protests happening around racist police violence. Do you feel like major change has come out of that recognition? Or are more changes needed?

I think it’s both. I think major change has come and more change is needed. Specifically around acknowledging the harms of police violence, we as a nation have progressed enormously over the past couple of years for it to be general knowledge that this is at least an issue.

And for folks who never thought it was an issue before to understand more about it and be moved to do something about it. I think that moment really mattered. It opened up funding and space for more folks like me to think about partnerships between clinical entities and community-based advocacy groups to make sure that we’re responding to community needs.

You’re currently on leave through the early summer, and that’s also involved a break from social media for you. How has that break from social media been? Will you return?

It’s been kind of hard, to be honest. I’ve been a little out of the loop. By taking a break to be more present at home, I have no idea what people are focused on, so it’ll take some time to get back into that. But then taking a break away has been great because part of how social media works is the news cycle is so rapid. What’s trending changes multiple times every day, and that type of frenetic energy is distracting in a way. It makes it harder to have one or two interests and carry them all the way through. It makes it harder to be somebody who’s working on a topic whose time seems to have passed, but it’s still an issue. So I think being away from it helps me have a little bit more perspective from a quieter place to say this is how I will address this issue, not in some rushed fashion to fit this rapid social media timeline.