Career Q&A: Interview with Dr. Winston Wong
Dr. Winston Wong, a Trailblazer in Public Health Leadership | Dr. Wong has had roles in direct patient care, volunteering in community health initiatives, directing medical advisory committees, and much more. He has dedicated his career to breaking barriers in the healthcare system, addressing health disparities, and caring for underserved populations in the United States. Tune in for a video interview where he reflects on his career, the direction of public healthcare, and improving patient care practices.
IPHS: It’s great to meet with you Dr. Wong. We wanted to start by asking if you could just give a quick summary of your career. That would be great.
Dr. Winston Wong: Sure. And I’ll try to be brief because every year it’s getting a little bit harder, because you live a little bit longer, you work a little bit longer, you have more things to share. But I will say that my interest in community health and being committed to working in underserved communities, particularly immigrant non-English speaking Asian communities, was pretty much my mindset going back as an undergraduate at UC Berkeley. And one of the things I like to brag about, and I say that a bit facetiously, but I believe I was the first Ethnic Studies major at Berkeley that ever got admitted to medical school.
So I was not a Bioscience major as a pre-med. I was an Ethnic Studies major with an emphasis on looking at healthcare in minority communities as an area of curriculum study. So, it was really a mindset of not just being a physician for physician’s sake, but about what I could do if I was able to go to medical school in terms of serving underserved communities as a primary care physician. So fortunately, I did get in. I got into the joint medical program at UC Berkeley/UC San Francisco.
And much of my work and study was not just trying to simulate all the clinical skills that are necessary to be a doctor but also thinking about some of the broader sociological issues in terms of providing medicine and having some firsthand experience of understanding the issues that confronted a lot of underserved populations. So even when I was a medical student, I was doing some work at the community health center in Oakland Chinatown as well as working with a refugee clinic at San Francisco General Hospital, among other things. But fast forward to after I finished my residency in Seattle in family medicine, I did really want to come back to the Bay Area. And to my delight, I was taken on as the third family physician at Asian Health Services in Oakland Chinatown and had a lot of different experiences there, including being one of their leads in a major research project and then subsequently becoming the medical director there and also seeing some rapid increase in our capacity to serve patients during the time I was there. I was there for seven years and became the medical director.
And then an opportunity came up, which I hadn’t expected, to assume a role of being the so-called regional clinical coordinator, which is basically the chief health officer for Department of Health and Human Services of the federal government for Region 9, which is the Western United States and Hawaii and the Pacific, focused on primary care issues. So I was really excited about taking on that role. It was under the Clinton administration when I was a commission officer. It wasn’t a political appointment. But I did serve as a commission officer for ten years and saw a lot of how the government really works and was responsible for developing the quality of community health centers and federal programs that we had jurisdiction over. And I had a lot of exposure to think about international medicine relative to The Pacific Basin, including Micronesia, Guam, and other places.
So it was quite an education for me to know the inner workings of Washington DC and how the federal government works. And then again, I didn’t anticipate this, but after serving as commission officer for ten years – and I had anticipated actually having a full career in the federal government – I was asked to consider a job at Kaiser Permanente at the executive offices, which were based in Oakland, California. So fortunately for me, I didn’t have to leave the Bay Area. But they had a newly created position of Chief Clinical Director of Community Benefit, which was really exciting because it worked to improve population health while working with Kaiser Permanente, which provided grants based upon our nonprofit status and our commitment to investing in communities.
So I did that for 17 years, and I really learned a lot about philanthropy. I learned about big corporate structures and also about integrated delivery of care. I had a lot of exposure to Medicaid and Medicare programs and also the strategies that Kaiser Permanente is well-known for in terms of crafting approaches to improve overall population health with using data and big, large populations to legitimize and identify effective strategies for improving health. And I had a lot of fun in terms of learning about philanthropy and how we can give grants out and build partnerships and communities. And along that line, our journey towards how to address health equity and health justice and fortifying the safety net, improving the health of all, looking at aspects of place matters as far as social determinants of health are concerned.
And I did that up to July of 2020, so 17 years. And, at that point, because of COVID and everything, I left Kaiser Permanente and had a number of different opportunities to continue work around health equity, some of which were partly funded and some which were pro bono. And I continued to be involved in a lot of policy development, working with colleagues to develop strategies to make sure that health equity is in the middle of how we think about improving health in our country. I had a few appointments in major federal committees, including in CMMS, including at the Department of Health and Human Services, advising them on minority health and also having some kind of academic research opportunities at the National Academy of Medicine, previously known as the Institute of Medicine.
So there are a lot of things there. And then, as has been my passion as you can tell going back forty years, I thought about how I could contribute to elevating our understanding of issues around disparities and equity, particularly as faced by Asian American, Native Hawaiian, and Pacific Islander communities. So I’m sorry if that was a bit long, but as I said, it gets a little bit longer the longer you live.
IPHS: Thank you so much for that summary. We also wanted to talk about what you think the next steps are to improving public health within the next decade, including your thoughts on the intersection between public policy and health care.
Well, I think it’s amazing because things are happening very quickly, probably most dramatically as we saw the transition from one administration to another.
Emphasis, connotations, narrative, are all moving. And also, the nature of how medicine is being delivered relative to things like artificial intelligence, vertical integration of delivery systems, the survival of safety net clinics, the challenges of rural communities, etc. So, there’s so many things that are happening very quickly. But I do think that what we need to do right now is really focus on the fact that populations and communities are increasingly feeling alienated from our health care delivery system. I think we witnessed that with the social messaging that occurred after the murder of the United Health president and CEO, I think any anybody who has humanity would say that was a terrible tragedy, but you could see from the reaction that many folks kind of used as a vehicle to express their sense of alienation from getting health care from a system that ostensibly is the best in the world.
At the same time, we have communities that over the last ten years were provided increased access in terms of health care coverage. But, you know, with maybe 16,000,000 people having insurance now that didn’t have it before. But also recognizing that even with insurance, we knew this when this happened with the Affordable Care Act. Even with insurance and coverage, the issues around accessibility, getting primary care, having culturally competent and linguistically competent physicians and health care providers was still going to be a challenge. And I think our communities felt that particularly during the COVID pandemic.
So I think what we’re looking at is this confluence of social factors, with regards to the relationship that individuals and communities have to a healthcare delivery system, and how our healthcare delivery system and the leaders within public health and healthcare delivery systems have to take some accountability about, “How do we fashion as humane of a delivery system as we can with the science of understanding the intersection between social determinants and physiologic determinants of health?” In fact, we have slippage with regards to life expectancy over the last ten years, which is ironic. But there’s a lot of different reasons why. And it behooves us to be more sophisticated about bringing the science as well as the humanity and the commitment around looking at these issues in a way that’s much more systematized.
IPHS: Thank you so much. We also wanted to ask, what are some positive changes that you’ve witnessed in public health or medical training throughout the years?
You know, I’m actually quite worried, if you will, of our cadre of young physicians and other health care providers now. They arguably have more technology at their fingertips than ever before. But at the same time, their level of burnout and sense of connection between patients is probably more challenging now than it ever has been.
So even when I started practice, I started with paper and pen literally looking at a patient face to face and speaking to them in the language that they understood if I could speak their language. And there was always a sense of gratification in that inner interchange. And fully knowing that we had a lot of pressure in terms of trying to render them the kind of care that we felt they deserved. But fast forward now 35 years later with electronic health records and with the requirement to input various diagnostic codes for billing effects, to reauthorization requests, to being able to fit the formulary. These are changes that maybe had to happen with the centralization of health care delivery systems to make it more efficient, but at the same time, it’s put a lot of stress on, I think, physicians who really feel like they want to be able to connect to a person as much as a community, as much as a population, as much as this society to do the kind of gratifying work that they want to do.
I think there’s something special about being a nurse, physician assistant, nurse practitioner, and physician that cause people to do the profession, but we need to find ways that that is continued to be, a really important part of why people do this, because I don’t believe people do this for the question of making money, you know, bringing the bread home. It should be more than that. And we have some challenges here. There’s a lot of needs in the community and then a lot of practitioners not really knowing if they’re making a difference. How do you think we can improve patient physician interactions with the amount of technology that we have now? So what do you think are some next steps?
It’s really interesting because I’ve been talking to young physicians and it’s astounded me, because in some ways I get very discouraged and other times I think, “Hey. This is really pretty cool.” My example being, as I mentioned, I was using paper and pen. And you know, this is not that long ago. Right?
It’s like 1980s and 90s where, after the day of seeing 20 or so patients, you would write down on your paper notes your so called “encounter with your patient” and what kind of medical issues as well as social issues that you wanted to address in longhand in your unsightly writing, which, in the best of times, it meant a kind of a group accountability between the health care team, the family and the individual and the physician around “What’s the best course of treatment and support we can provide to that individual?” And then as I said, in the last ten years or so, I don’t know if that occurs very much because people need to put in the data into the computer. Now the good thing is I’m hearing that artificial intelligence is maybe making some forward progress in terms of freeing up physicians from entering all that data longhand through even a keyboard and that they can encapsulate this in kind of transcribed artificial intelligence-supported notes, which frees up maybe more time for physicians to be, more personally invested in their patient’s journey. And then for us to think more collectively about the overall health of our communities.
I do think too the good sign is, as much as I lament going back to the times that we maybe had more of our interpersonal encounter, that if we look back 50, 40 years ago physicians were somewhat confined to thinking about the patient in front of them as opposed to the data that’s at at our disposal now that enables us to understand whether a community’s health is actually improving. And whether collectively as a healthcare team or as hundreds or thousands of healthcare providers we can actually make a difference in improving the health of a given community. And so you know, we have that data and we don’t take much collective accountability for it. We talk about it, but most of our aims are not aligned with trying to improve community health. No.
IPHS: 100% I agree. It would be great if that allowed doctors to be more connected to the patients they’re seeing in front of them. So that’s awesome. Also, I think something else we wanted to ask was, which of your roles which of your past roles did you enjoy the most?
That’s a really good question because you know, it’s probably a cop-out for me to say I enjoyed each one for its own different reasons. But I think that’s probably the truth. I mean, part of the reason I have had a lot of different gigs, as I like to say, is as much as I really loved caring for my patients as a primary care provider for 6, 7 years at a community health center, there’s a burnout factor there.
And I mean, I liked doing that, and I liked it so much that I volunteered for the next fifteen years going back to the same clinic one day a week. But at the same time, something told me I didn’t want to do that for the rest of my life. And then being a federal person, having a lot of fun working at the elbows with people working together to implement a federal national policy, made me feel like I was doing something important. But then at the same time, you kinda feel like, with the bureaucracy are you really making a difference?
And then you go to a corporate thing like Kaiser Permanente. It’s got such a strong identity and reputation as being a great delivery system and I really saw all the magic that they can do in that regard, but then also realizing there’s a lot of aspects of corporate culture that still define that kind of work in that setting. And then working in the community just generally. Maybe I could say that [has been my favorite role]. I’ve had so many opportunities to work with people who are translators at different lines as well as researchers who are really focused on caring for the underserved and people who are, you know, government officials, public health directors.
And when I get to work with them, it’s a lot of fun because I think I learn a lot from those folks, empathize with them, and all those relationships have given me opportunities that I wouldn’t have had otherwise.
IPHS: Thank you. That was a great response. I agree that there is definitely so much to be learned from every single role you’re in, whether you’re in the beginning stages of your career or where you are now with so much experience. So, with all the experiences that you’ve had, what is some advice that you would give to someone who’s interested in a pathway like yours, whether it’s in medicine or public health or public policy?
Yeah. I’ve been asked that a few times, and I think I feel pretty confident in my answer now. I would say this. I think as people in the healthcare space, we need to be caring for patients with humility and be a vessel to capture their stories. Whether we decide to pursue excellence in a particular area of clinical medicine or public policy or public health, those stories inform and evolve within the settings in which we play. So, you know, my advice is to really feel foundationally anchored to the experiences of people that we care for. And when I use the term “care,” I mean that in the most heartfelt way, as opposed to just caring superficially, you know, in a hospital or clinical setting, but rather to care for people in terms of anguishing in their suffering and rejoicing in their victories and in their pursuit for happiness.
We care for people, and when we get into other disciplines – whether it’s social policy or federal policy or research – that’s the well in which people really can draw from as far as giving them the ethical and moral foundation in which they can do rewarding work.
IPHS: Awesome. That was a great response. I think the humanistic aspect of medicine gets lost on us especially with burnout and working long hours, but like you said, that is the foundation of our work. Next, we wanted to ask if there were any moments in your career that have really stuck with you or set you down a particular path?
Yeah. Well, you know, as I said earlier, the advice I give young\er physicians or providers is, start collecting your stories. Right? And be reflective.
So I have a number of stories. But I’ll just mention two because I know you want to keep it short. One is, I frequently give this vignette to medical students about how I cared for a patient who was not very formally educated, who was an elderly lady.
She was special to me because she reminded me of all the aspects of resiliency and love that she had for her extended family. And then when the time came when I had to take care of her in a pretty serious situation, she was probably more empathetic towards me than I was to her. And it made me think, you know, we’re pretty privileged. We’re so gifted. People teach us things in that setting and it makes me think about how much she gave me, as opposed to anything I gave her. So that’s one thing.
And then another lesson I had as a federal person was, once I had to evaluate a program by its capacity to provide mental health services to a Native Hawaiian population. And I go to the clinic and the clinic says, “Well, you want to see our mental health program. Right, Dr. Wong?” I said, “Yeah. I need to evaluate. I’m a federal guy, you know.” And so they brought me to a garden and they were showing me how they harvest the taro plants and, you know, bananas and things like that. And I said, “This is really nice. It’s nice. It’s a nice garden. But I’m here to evaluate your mental health program.” And then they kinda said, “This is our mental health program.” It’s not about sitting on a couch with a person looking at you and you telling them your problems. It’s about being in that place where people are doing something together that connects them to the land and the people. And for you to understand that, you need to be in that space, which taught me a lesson because we are so comfortable within the Western model, we fail to really see the actual aspects of of a culturally competent way of thinking about mental health as opposed to the, you know, a traditional, stereotypic mental health program. You see a therapist and you get a diagnosis, and someone comes in with a white coat and says, “We’ll listen to you for half an hour once you start this antidepressant,” you know, that kind of thing.
So those are maybe a couple of stories among probably a dozen that I have that remind me, you know, what’s the North Star we have? And I’m not an expert in predicting all the health care financial models in the next 10, 20 years. But at the same time, I don’t lack confidence that I know what is good and right in caring for people.
IPHS: Those are really beautiful stories. Thanks so much for sharing. We wanted to end off by asking, what’s a question that we didn’t ask that you wish we did? If there’s anything else that you want to share.
That’s really tough. Well, I guess, when did I start medicine? I was licensed in 1983 or ’84. So that’s about forty years now.
What would I want to see in forty years? Because I’ve lived at least forty years in that profession. And I really hope and wish that – actually for folks like you, and I don’t mean that to be patronizing because I see that you have values and your inquiry is one show what you seek in our healthcare system – I hope that in forty years, it becomes very natural for us to integrate all these streams of thinking, not only in terms of clinical science, but also around social science, humanity, you know, caring for people in a way that’s much more seamless, buttressed by some technology, but that the technology supports the central element and not the other way around.
I think the danger is that technology becomes such a beast, including the technology around intensifying capital and investment, that the people around it feels secondary to supporting the beast as opposed to the people who should be at the center. The systems should be supporting the people’s journey. And a lot of that has to do with empowerment of the providers within the system, as well as empowerment for the consumers or the people who are getting care or seeking care or just want a better health situation left to our own tendencies. I think everybody’s looking for an environment where they can feel safe and sound and healthy, for themselves and for their families. And that’s really how it should be built. But\ right now, it feels like we’re kind of far removed from that.
IPHS: Definitely. And I’m thinking about the Hippocratic Oath that every physician or health care provider takes, which centers the humans and going good for people with what we have. And I feel like that’s definitely something we hope will improve in the next forty years of care. But that’s all that we had for you. Thank you for all your insightful responses.