Interview with Renee Renee Hsia, MD, MSc; UCSF (elected 2019); December 10, 2024, by vido conference.
Interviewed by Jennifer Yu, MD, PhD (elected 2018); Member, ASCI Physician-Scientist Engagement Committee.
Note: The text has been edited for readability by ASCI staff.
Dr. Jennifer Yu: Good morning and welcome to the ASCI Perspectives. I am Jennifer Yu from the Cleveland Clinic, and my guest today is Dr. Renee Hsia, the recipient of the Marion W. Ropes Award. This award recognizes a mid-career woman physician-scientist for outstanding achievements in academic medicine. Dr. Hsia is a professor in the Department of Emergency Medicine in the Philip R. Lee Institute for Health Policy Studies at the University of California, San Francisco. She was the first woman physician-scientist in emergency medicine at UCSF, and she has paved the way for other clinicians and other clinician-scientists in her field.
Her research has highlighted how structural changes in our health-care system have led to inequities in health-care access and utilization. Her work spans multiple disciplines, including health-care economics, health policy, and clinical investigation. Her work has shed light on how market-driven imbalances in the supply and demand of emergency care impact mortality and exacerbate underlying inequities. Dr. Hsia’s academic contributions are remarkable. She has published over 190 articles, and her work has reached the public through media, including in the New York Times, Reuters, and USA Today. Dr. Hsia has received a number of awards for her research, including the Harold S. Luft Award
for mentoring in health services and health policy research. She was inducted into the ASCI in 2019 and National Academy of Medicine in 2021.
Dr. Hsia, welcome, and thank you for taking time to speak with us today.
Dr. Renee Hsia: Thank you so much, Dr. Yu, for hosting me. I’ve really been looking forward to this time with you.
JY: Thank you. You were the first woman physician-scientist in your department in emergency medicine, a department with few research scientists. Can you please share with us your path to becoming a physician-scientist?
RH: Sure. When I started medicine, I had never thought about becoming a research scientist. To me, emergency medicine was a way to kind of be very hands-on. I really liked talking with patients. I love being in the middle of everything. When I started at UCSF, there were opportunities for career development, and I thought I would take advantage of those. And then I became more aware, as I was practicing and as an early faculty, aware of the many issues that we struggle with in the United States health-care system. Previously, I’d been doing a lot of global health work, and when I became trained in research and methods, I saw that there were a lot of systemic issues that really required and needed answering here in the United States.
And so that’s how I began. I was a resident. Before UCSF, I was a resident at Stanford, and I had the opportunity to train with Laurence Baker, who’s a health economist at Stanford. And he really was the first entree into this world, where he let me have access to data, work with his team, and I became trained in health services research from him, being my first mentor. So that was the beginning of it.
JY: Thank you. And UCSF is affiliated with many different hospitals, and you chose to work at the county hospital. Can you tell us more?
RH: I love working at SF General. It is just a joy to be there. The reason I’m here, and I think the reason a lot of us work here, is because we are really committed to the mission of this hospital. And this is the hospital where we serve the majority of patients who are traditionally underserved. So, racial, ethnic minorities or minoritized communities or low-income. It’s a place where I feel like we’re able to give dignity to people who don’t normally receive it. It’s an honor to be here. I wouldn’t say that it’s always easy. I think it’s very challenging to work at this environment. It’s a struggle, to be able to provide good care when there are not as many resources available. But it’s the reason why I’m here is, the reason why many people choose to be here is because it allows us to practice in a place where normally we would not be able to maybe intersect with people in our daily lives in other ways.
JY: And disparities in health care are widening, and you’ve identified many structural and cultural barriers to health care for the marginalized, for the uninsured, which you see in your practice. So what are some of these critical barriers and how can we go about addressing them in our institutions?
RH: I think one of the things that I’ve been learning as I’ve been doing this research is that we have a lot of structural inequities that are embedded in our system. And that is not the result of one individual deciding to have bias towards another person. And it’s not going to be cured by having physicians, for example, do more CME or do more training necessarily on unconscious bias. That definitely exists. Implicit bias definitely exists, but the root of a lot of our inequities is really structural. And that’s what a lot of my work has been focusing on is, when you look at a graph saying, “What is the wait time of emergency department patients?” and White patients have shorter waits than Black patients. That’s not because an emergency physician is going out and saying, “Oh, I’ll see you and I won’t see you.” It’s because there are more hospitals that are located in areas that are affluent than not affluent, because the financial structure of the health-care system is that hospitals are incentivized to provide care where there’s “good” payer mix, where there’s commercial payer mix, where there’s strong Medicare reimbursement. And they choose to have service in in those areas, and they choose to close in other areas.
And I think one of the things that we can do is become more aware. I think in our practice a lot of times, we just feel like, oh, we’re just working in this environment and we feel like, oh, you know, kind of going out of that is exhausting or may be too much to think about, because there’s the insurance industry, there’s these health-care, huge hospital systems, and what can we do? But I do think that there is more momentum and more awareness to recognize that the fact that hospitals act like economic entities, that’s a result of the way that we’ve chosen to structure our health-care system because we have chosen to have private financing and we’ve chosen to have private delivery. And there’s other ways that we can think about organizing this.
And so I think that it’s a privilege and it’s a responsibility to speak out on these issues and become aware of them, because that’s really the root of a lot of the inequities that we face.
JY: Great. And can you talk about how perhaps telemedicine or artificial intelligence might be able to bring some of the expertise out to these underserved areas or underserved populations?
RH: Yeah, that’s a great question. And I think that of course, after the pandemic, there’s been an explosion of these technologies. But even before that, when we think about stroke care, for example, we’ve had telestroke, mobile telestroke units, and these kind of ways that we can bring technology into areas that are less resourced, whether that’s because of rurality or because of other reasons that, when hospitals, for example, they may not necessarily need, a neuro-interventionist to just give TPA. They just need the image to get transferred; they need someone to read it, and then they have the IV, they have the TPA to give.
So, what are the ways that we can make this more accessible? And also, again, I’ll just go back to what I mentioned before: The financial structure has to be in place that there is incentive for bigger hospital systems to help out these other hospital systems as well. Because if that doesn’t exist, then it’s just going to be an act of charity, which is not predictable, which is not a sustainable way to provide services to all populations.
JY: Right. And how? How do you think we might be able to implement these changes as a society?
RH: Well, I think that’s the million-dollar question. When we think about restructuring our health-care system, a lot of the things that we’ve been doing have been maybe Band-Aid approaches that accepts what we have and says, “Well, let’s try to fix these things on the end.” But we really haven’t been able to address the more fundamental issues.
But I think there really is more awareness that our health-care dysfunction, when we look at the malalignment of incentives, when we think about insurance and health-care systems, what I mentioned earlier, if we really want this to change, we really have to understand that it’s a bipartisan issue, that it’s not that there’s only certain states that have good health-care. No, like everyone is experiencing this, and there’s unpredictability, there’s fear of financial catastrophe, when you receive health-care services. And I think, now that there’s more awareness, there hopefully will be more political momentum to maybe make change.
JY: Right. Thank you. So there’s a lot of hope for the future.
RH: Maybe not in our lifetime, maybe in our children’s lifetime. I don’t know, but I hope so.
JY: And hopefully, speaking with the younger generations, we can also mobilize more energy and improve health-care and inequities.
RH: I do see that energy and awareness in our residents. I think people are interested in these issues. They feel the injustice, and I think that they recognize, that – It’s just like Cornel West, when he was saying that justice is a public display of love. This is the way that you love well is by changing these systems. And so, I know that’s a strange word to think about in academia. But I think all of us who are in academia, we do things because we want to improve the lives of others, and it comes from love. And so, there’s just different ways that it manifests itself. And research is one of them.
JY: For sure. And thank you for serving as a role model for all of the physician-scientists, all the people aspiring to be researchers and to change health care for all of our patients. So thank you.
RH: Thank you so much, Dr. Yu.
JY: Oh, you’re welcome. And for our early-career colleagues who will be seeing this interview, do you have any words of wisdom for them? Things that you’ve learned during your career journey?
RH: Yeah, I would say that the two things that I would share would be first to find other people who have talents and strengths and interests that are different from yours but are complementary, but that can be part of your team. And that’s been the key way that I’ve been able to do work that I feel like is rigorous and that is joyful and that is just a privilege to be a part of is to work with teams with – There’s so many people who have just so many areas of knowledge to contribute. And when you’re able to identify that and encourage that, that is really a wonderful thing to be part of.
And I think the second thing would be to recognize and accept, and not just accept but also embrace, the reality of human finitude. And I would say that, recognizing my own limitations, whether that’s time or needing sleep or whatever it is, but recognizing that I have finitude and not just accepting it, but embracing it and saying, okay, that we are not created to be machines. I think, in my younger years, people would say, “Oh, Renee, you’re such a machine.” And I would so proud of that. I would take it like a compliment. And that’s what we think in medicine. You don’t need to sleep, you don’t need to eat. You can just keep working hard. I think that it’s great to work hard, but I do think that there’s a way that – Sometimes I know that I’ve struggled with equating my work with my success or my work with, or my external success as my value. And I think that that’s dangerous. And I think that’s something that sometimes in academia or in America is a very cultural thing that we kind of identify ourselves with our external accomplishments. But to recognize that, we are finite, that we’re human. I think that there is a lot of benefit of recognizing those limitations. So that’s something that I would say.
JY: Right. Thank you. Absolutely. There’s such an important need to recognize what we can accomplish and to seek out others who can complement us and go together. We can go together and go much farther together as a team.
RH: Absolutely. Yeah.
JY: Thank you. Well, Dr. Hsia, thank you so much for taking time to speak with us today and sharing your journey, sharing your words of wisdom, and of hope for a better tomorrow.
RH: Thank you so much for your time, Dr. Yu, and I really been privileged to be part of ASCI and all of that it’s doing, so thank you.
