Dr. David Chang: Taking a Unique Route to Become an Unwavering Advocate for Health Equity
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Dr. David Chang is a clinical assistant professor, section chief of the community partnership program within the division of primary care and population health, and co-director of the community health scholarly concentration at Stanford University School of Medicine. He also serves as an assistant health officer at the San Mateo County Health Department. Dr. Chang is highly passionate about population health – the field of improving health outcomes in a community, rather than just in an individual. His interest in tackling healthcare issues arose partly from his own experiences interacting with the health system when he did not have insurance, and also from serving as a caregiver for both his mom and dad (at different stages of their lives) during his adolescence and after college. From these healthcare encounters, Dr. Chang realized how hard it is to stay healthy without insurance or others to help you navigate the system. In these experiences, Dr. Chang felt an innate desire to make a difference in the system.
Dr. Chang with his mom, dad, and sister as a child
After working for a few years post-college, Dr. Chang spent a month working in an orphanage in China. This experience spiked his interest in the medical field, as he realized that medicine gives concrete and versatile skills to help people in underserved settings. This motivated him to attend medical school at Tufts University and to complete an internal medicine residency at Johns Hopkins, which allowed him to gain concrete skills in treating diseases and relieving people of their pain and suffering.
Approaching the end of his residency, Dr. Chang felt burned out from clinical medicine. He felt frustrated and hopeless that his clinical work was not addressing the root causes of poor health. Therefore, he decided to pursue population health by taking on an almost completely administrative role of Health Director at the Virginia Department of Health in 2011, right after completing his residency. Dr. Chang was responsible for leading a department of 120 people, serving 10 counties across rural Virginia. Transitioning directly from resident physician to Health Director, Dr. Chang initially felt ill-equipped for his role. However, he quickly learned skills on the job, learning how to build community, run programs, and manage people. Once he built up his expertise, he leveraged the power and resources of the Virginia state government to uplift local communities.
After working as Health Director for six years, Dr. Chang decided to move back to the Bay Area of California, as he wanted to raise his kids in his hometown close to his friends and their families. He had been planning to work in public health for the rest of his career, but he struggled to find a job in public health after returning to California. Only by accident, he came across a job posting at Stanford after being back in the Bay Area for 18 months.
Having a strong emphasis on personal values, Dr. Chang wanted to make sure that the values of Stanford aligned with his before he took his new position there. Before arriving at Stanford, he talked at length with 10 different faculty members to understand Stanford’s values. To this day, he continues to listen to different perspectives from Stanford faculty to get a fuller picture of Stanford’s values.
Currently, Dr. Chang wears multiple hats – he teaches students and residents, does research, directs community health programs, and is a father of four kids. One may ask – how does he parse through the numerous personal and leadership decisions he has to make daily with all of these responsibilities? Dr. Chang’s response to this is that he has a well-developed personal value system, which includes him deeply caring about advancing health equity. He has an effective approach to filtering his decisions through his value system. For example, when an opportunity arises, Dr. Chang asks himself – will it help to improve community health or student programs? Every few years, Dr. Chang takes a retreat to spend time alone to review his values. Having a calibrated moral compass makes it much easier for him to make decisions.
Dr. Chang with his family
After completing medical school and residency, Dr. Chang learned the value of leveraging the power and resources of large health systems to do good in communities. His colleagues at Stanford had directly reached out to community organizations and asked how Stanford could help them. When he arrived at Stanford, Dr. Chang continued to expand the university’s work with community clinics. Instead of health fairs or donations, these community organizations needed help retaining long-term physicians to work in their clinics. Generally, these community health clinics have complex patients and lower pay for physicians. Therefore, Dr. Chang leads a program that places Stanford doctors at these community clinics, where Stanford pays for their time. Currently, they have placed 15 doctors at five different clinics!
In addition to retaining physicians, the community clinics have also asked Dr. Chang for Stanford’s help to recruit medical directors, develop performance and quality improvement projects, and establish telehealth and e-health consult programs. Plus, many medical and physician assistant students, who are interested in working in underserved communities, have also worked at the community clinic site for clinical clerkship rotations.
Dr. Chang personally works at the community clinic called Peninsula Healthcare Connection, located in Palo Alto, CA. Right next door to his clinic is the Opportunity Center owned by a non-profit called LifeMoves. Homeless individuals come regularly to this center to receive meals and other services such as job training. With his proximity to the clinic, Dr. Chang goes to the LifeMoves shelters once a month to see patients. He works very closely with the LifeMoves case managers to ensure those seeking services at the Opportunity Center are receiving the best medical care possible. He strongly believes in meeting patients wherever they are to improve their access to health care. To spread his passion for health equity, Dr. Chang frequently brings students along with him on his visits to the shelters.
Furthermore, Dr. Chang assists with the Stanford Housing Equity Project (SHEP), a student-led organization. SHEP delivers mental health first aid in local shelters, assists shelters with case management, and helps individuals with benefits enrollment. Dr. Chang emphasized how much passion students and faculty have for this organization. One of SHEP’s initiatives is providing financial incentives for substance users to attend counseling services and to provide negative urine drug tox screens. This initiative has seen great success, especially as an increased number of people have been seeking substance abuse treatment.
Dr. Chang facilitating a panel interview at a recent Stanford conference on housing justice
One roadblock that Dr. Chang occasionally faces is that people frequently are too focused on saying the right things and spending excessive time building a perfect strategy to address a problem. Instead, he believes that you should come up with practical solutions for needs that you see right in front of you. These solutions do not need to be perfect; they are effective as long as they are making a difference in the community.
In his final message for the reader, Dr. Chang wishes to share some wisdom. He believes people should be good observers of their ecosystem, and try to determine what is causing the issues they are seeing. Once you identify the cause, you should figure out how you can make a small difference in your community using the skills you have. Plus, you should not limit yourself to what you have seen others do already. Dr. Chang learned this lesson from his own experience – he broke away from the traditional path of doing clinical medicine after residency, and took on the challenge of working as a Health Director without previous directorship experience. Most importantly, ask questions! Do not be afraid to reach out to people and apply for things you are interested in. Most mentors are interested in working with others if there is an alignment in their interests and passions.