Like many of her physician colleagues, Dr. Manisha Sharma long embraced a dream to heal the world. But Sharma, now a prominent physician activist and health equity leader, could never have predicted this form of healing would manifest through health and medicine – at least, not initially.
“I never wanted to be a doctor,” Sharma recalls. “My first career was as a musician. I went to Berklee College of Music, and my way of trying to heal the world was really through music and dance,” she says.
So Sharma, as energetic as she is passionate, danced down that path in the performing arts, hoping to “gig and make it big” – much to the chagrin of her South Asian immigrant parents, who had always hoped she’d become a physician.
“I’m the first generation born in the United States, and I’m a girl. My mother was a doctor, the first woman to be educated in our family,” Sharma says. “So I think education was super-important, and my parents just didn’t see music as a way to achieve that.”
Still, Sharma remained steadfast and intentional in her music mission, never imagining she’d veer into the healthcare arena. But one day, when Sharma was in her early 20s, she was badly injured after being struck by a car at a crosswalk – and, suddenly, “I entered the space of healthcare as a patient,” she remembers.
Over multiple, difficult hip surgeries and recoveries, Sharma learned firsthand the pitfalls of the American healthcare system, especially as she struggled to walk again. But the life-altering event that lit a fire in her soul came when she was abruptly dropped by her insurance company, who cited the injuries from her accident as a “preexisting condition.”
“Here I was, a 20-something-year-old, trying to heal and at the same time fighting with this big, faceless insurance company that is basically telling me they’re not covering me because I have a preexisting condition, through no fault of my own,” Sharma recalls. “Well, as you can see, I’m very, very energetic – and I got mad,” she says.
Channeling anger into advocacy
Sharma recounts how, then living in Boston and charged into action, she became actively involved in organizations to learn more about how health systems worked. “And I learned about what it meant to be single-payer, and I became a single-payer advocate,” she says. “I started to meet patients like myself, standing in line arguing for bills, and realizing that this was a bigger story than just me.”
Sharma remembers how, waiting in an interminable hospital line, she was especially moved by an interaction with a Portuguese woman, a fellow patient, who was speaking broken English. “She was trying really hard to explain herself and why she has to pay this bill, and the lady behind the counter was yelling at her as if she was deaf, but she wasn’t,” Sharma explains. “I remember stopping the lady after – she was crying and showing me the bill – and so I actually went back to the counter with her and said to the lady, ‘Look, she’s basically asking you why is she getting this bill and how does she pay this bill?’”
It was at that moment, Sharma says, that she realized she was an advocate – and with her passion and perseverance, she could do so much more in that role. “I thought, well, the best way to become someone’s advocate was to be his or her doctor,” Sharma explains. “And that’s how I got into medicine – not because I loved medicine, but because I loved people. Then I was really clear about what I wanted to do, which was social justice medicine.”
Tearing down the red tape
In her 30s, Sharma enrolled at St. George’s University, a Caribbean medical school in Grenada with a student body that comprised mostly U.S. citizens. This was back in the early 2000s, she says, when then-presidential-candidates George W. Bush and John Kerry were campaigning for the 2004 general election. “It was really important to me to get the kids on campus to understand that they could do absentee voting,” Sharma notes. “They needed to be registered and they needed to absentee-vote. So I became an activist and an organizer for that.”
In partnership with the U.S. embassy, Sharma set up a grassroots registration booth and began registering fellow medical students to vote. “I just remember being ridiculed and being told that there’s no business for me to register people to vote, that medicine isn’t politics,” Sharma recalls. “But I stood strong; I was determined. I ran a whole registration-to-vote initiative with paper ballots, absentee ballots, the whole nine yards – because back then we didn’t have the internet to do a lot of those components.”
Overcoming copious challenges, Sharma’s civic-minded mission was ultimately successful – but the dogged doctor-in-training was only getting started. Later, during her residency at Montefiore Medical Center in New York City, Sharma embarked on another ambitious project, an effort to bring voter registrations to the clinic floor – where she faced even more uphill battle, a wayward path paved with thick, red tape.
“I submitted a proposal, then I was told that I had to get approval from the hospital to do it, so I put that through and they told me no, ” Sharma recounts. “But what was interesting was that they told me no because they said it was illegal – and I was like, that doesn’t make sense.”
Where others may have admitted defeat, Sharma remained indomitable. She consulted with lawyers from the American Civil Liberties Union (ACLU) and discovered the hospital did not, in fact, have a valid case to turn her down. “So I ended up creating a counter-argument to their ‘no’ through a legal standpoint and used the lawyers to help me,” Sharma explains. At that point, “the hospital had to say yes. The government relations department had to say yes,” she explains.
Sharma recalls vividly what happened next: she was summoned to the office of the hospital CEO, a consequence keenly redolent of being marched to the principal’s office in grade school. “I remember my residency program director calling me and saying, ‘Oh god, what did you do?’ And I thought, ‘Oh no, I’m going to be kicked out of residency!’”
But when Sharma entered the CEO’s office, the executive simply grinned and told her plainly, “Don’t worry, you’re not in trouble. I just wanted to meet the person who beat government relations.”
“That’s awesome, isn’t it?” Sharma thinks back, smiling. “In the music business, we always say that in a sea of no’s, you only need one yes, right? Every audition you go on, don’t take the rejection to heart. You go to the next door until somebody says yes.
“I really believe in that. And that’s the battle – you’ve got to really believe in what you’re doing,” she says.
Boldly battling forward
In the end, Sharma convened several clinicians and ran a successful voter registration drive at multiple health centers in the Bronx, New York. The project resulted in a peer-reviewed paper that was published in Annals of Family Medicine in 2014 – and “that paper really was the impetus for people to get bold about registering people to vote,” Sharma explains.
Ten years later, countless other, clinician-led initiatives have blossomed from Sharma’s original social medicine project, including Vot-ER and Civic Health Alliance, two nonprofits working to integrate civic engagement into healthcare. Currently living on the west coast, Sharma also serves as medical director for Blue Shield of California, where she focuses in the Medicaid space – and dreams of adding automatic voter registration to the Medicaid enrollment process, in all 55 U.S. states and territories.
“Honestly, it should be like the DMV. It’s an opt-out system, so if you’re getting your license, you’re already registering to vote,” Sharma points out. “That’s what I think Medicaid should be as well: a way to get people who are othered by the system, to have a voice at the table.”
For Sharma, a dreamer with big, bold ideas, these efforts are just the tip of the iceberg; she says that even outside her day job, she’s always planting seeds that she imagines could transform healthcare from a policy perspective, to “strike when the iron’s hot.”
But to fellow clinicians who may not share her outlier drive and determination, Sharma emphasizes there are still plenty of ways to join the movement, which start with simply acknowledging how civic engagement is critical to health – then spreading the word, belting out the powerful tune – throughout the U.S. healthcare arena.
“We see the bodily impact of bad and good policy, and bad and good system design, in our exam rooms – bad and good policy over food access, bad and good policy when it comes to where poor people live and how they live – all of the things that are social and structural drivers of health, we see the bodily manifestation,” Sharma emphasizes. “These things matter. You can’t have a healthy community without all community invested in health. So we all have to be a part of that component, and we also have to remember that health is in all policy.
“I think we have to stop looking at it like, ‘medicine is my business because I’m a doctor,’” Sharma continues. “Health is everyone’s business! So if doctors really believe that they don’t have to be in politics, honey, let me tell you: you’re already involved, whether you like it or not. It’s all connected,” she urges.
If you’re a healthcare leader looking to implement civic engagement into your organization’s policies and practices, start by downloading Civic Health Alliance’s Civic Health Compact at https://www.civichealthalliance.org/compact.
Comments