Over its 23 year history, the Commonwealth Fund Fellowship, along with California Endowment Scholars program and Joseph Henry Oral Health Fellowship, has a proven track record of creating physician/other health professional leaders; the Alumni Spotlight interviews showcase the expertise and dedication to care for vulnerable populations as a testament of that success. Interviews have been edited for length and clarity.
Joshua Budhu (CFF '22)
Attending Neuro-oncologist, Memorial Sloan Kettering Cancer Center; Assistant Professor of Neurology, Weill Cornell Medical College, New York, NY
Q. Could you describe your current role and your journey to that role?
A. I'm a neuro-oncologist at Memorial Sloan Kettering Cancer Center in New York. I see patients who have brain tumors or brain metastasis about two days a week, and the rest of the time, I'm a health disparities researcher. I work in interventions focused on health equity, especially for oncology and neurology patients. The Department created this hybrid role for me because they were invested in addressing health equity in neuro-oncology. The field itself is very scientifically heavy because we're always trying to find new cancer treatments. But they also realize that in trying to find these new treatments, we need to make sure that they're equitable to all different communities.
The way I got to this role is that I did an away rotation at Memorial Sloan Kettering Cancer Center when I was a medical student, and I became enamored with neuro-oncology and treating patients who have brain tumors, realizing how much impact we can have and how much we still need to do in terms of research and figuring out new treatments. I also did an away rotation at Mass. General Hospital and ended up doing my training there for residency and fellowship.
As part of my neuro-oncology fellowship, I was still trying to figure out how to incorporate health equity into my career. In neuro-oncology, our clinical trials are really robust, but they're not actually accessible to everyone. So, if you’re Black, Hispanic, American Indian, or Asian, you're much less likely to be enrolled in a clinical trial—which actually can be considered, for the clinical trials in our field, the best treatment that we can give you. We've also found data showing that socioeconomic status and race are actually a predictor for whether you will make it to your treatments, and overall quality-of-life and life expectancy.
I was seeing all this and trying to figure out what I could do about it, and that's when I decided to apply for the Commonwealth Fund Fellowship. And it was transformative for me. I was in the Fellowship when Sloan Kettering and I had discussions and they were very interested in the work that I was doing with MassHealth.
In this role, I can see patients and then do research on health equity, but then eventually go to the policy realm, as well. If we're saying that this intervention helps patients, can we get insurance companies to cover this? Or can we work with local, state, and federal government to put these into law? It’s a really fulfilling role that was created for me. It's been a great experience, and I’m really excited for the next few years and the things we have cooking.
Q: Can you tell us about your career goals? How have those goals shifted over time?
A. They've definitely shifted quite a bit. Initially, I thought I would become a primary care provider, like a pediatrician or family medicine physician, and go back to my home community in Queens, New York—because, growing up, I had seen the disparities in terms of treatment and I really wanted to get back to the community.
But as I fell in love with neurology and the brain, and I was training at different institutions, I realized I also wanted to make an impact not just on the direct community level, but on the systems level. Because I saw so many different places in which you can improve the health care system—how hospitals run, how insurance payments are doled out, how pharmaceutical pricing works. As I started to have a voice and actually started to have a platform, I figured out that I can hopefully start changing some of this.
So, from my initial thinking that I was going to be a primary care provider, I became a specialist. But then on top of that, I incorporated more of the research and policy side in terms of health disparities and working towards health equity. Where I see myself going, at least for the next few years, is developing sustainable research programs with the community that address health equity. Looking at community-based participatory research and figuring out what we can do on the health care side, working with an intervention and then proving that it works.
For example, how can we increase clinical trial diversity or make sure that underserved communities have access to different biomarker and genetic testing that can potentially be lifesaving? Hopefully preventing some cancers, but also, if you do have a cancer, getting access to new and advanced treatment. We're working with administers, legislators, and trying to figure out: now that we have a successful intervention, how do we make it feasible? How do we make coverage options for this? Do we need to pass a law?
Q: How do your personal narrative and past experiences influence your career progression?
A. Initially, I never thought I was going to be a physician. I was thinking about different careers. Economics or Finance or what not. But at the end of my sophomore year in college, my brother passed away. He died in police custody, in handcuffs, in the hospital from a preventable medical condition. He died from a deep vein thrombosis, a blood clot, that had gotten to his lungs. And that was the direct result of him being handcuffed and sedated and laying in a bed for six days straight. It was a what we call an iatrogenic death, in that, if he didn't come into the hospital, he wouldn't have died.
And that changed my entire view on health care. It changed my entire view on how the world works. Initially, we were all just so angry at the incident and we thought it was just a chance encounter. He was in the wrong place at the wrong time. He got picked up by the police and then brought to that hospital; we thought if that hadn’t happened, he would still be alive. He would still be healthy. But as I looked back at things, I saw all the social determinants of health play out in his life. His insurance status—he was on Medicaid. The overall issues that led up to him being in police custody—he was using alcohol and cocaine. He actually was driving drunk when he got stopped by the police. And this is in the context of him losing his job. He had to move back to my parents’. He became depressed. He became overweight. And the community in which we lived in Queens, New York, wasn't the best in terms of services being offered. We lived in a food desert. All of those things combined. His immigrant status—he was born in Guyana. All of that came together, and I thought, you know, things had not been going well for him for the past few years before his death. And if it wasn't that incident, then the probability was that something else would have happened in the future, and he wouldn't have been able to live the optimal, long, and healthy life that we all wanted him to have. That really made me think about social determinants of health and how opportunities are divided in our country and in our world.
That really influenced me. His death propelled me to go into medicine, because I figured that if I was on the inside, I could help change the system or advocate for my community. I could advocate for my family. And then when I got more knowledgeable about social determinants of health, I realized that health care wasn't just seeing a patient and diagnosing something and treating it. It was looking at the bigger picture: What's their employment status? Do they have enough money to pay for medications or treatment? Do they have access to food? Transportation? Housing? So that deeply personal, lived experience has shaped my entire worldview, shaped my view of health care, and has led me to this career and this path. And it's going to keep continuing to shape how I see things. Because the work that I do right now, which is a combination of research advocacy, patient care, and teaching, is all based on how I think I can be most effective in achieving health equity in our community.
Q. How has the Commonwealth Fund Fellowship impacted your career?
A. The Fellowship was transformative for me. I was at the end of my clinical training, and I was still deciding what I wanted to do. I was trying to figure out where could I incorporate health equity. And the Fellowship gave me those skills. It made me realize what I could do in terms of combining my clinical knowledge and research skills, and then looking at the overall policy picture—how do you really impact change and utilize different stakeholders? I wouldn't have been here without the Fellowship, simply put. And even now—the opportunities, experiences, and alumni network—it continues to play a big part in my life. If you are having doubts about whether the Commonwealth Fellowship is the right thing to do, I would say unequivocally it was the best decision I've ever made for my career.
