Bruce Ovbiagele, MD, MSc, MAS, MBA, MLS, FANA
Professor of Neurology and Associate Dean, University of California, San Francisco
Chief of Staff, San Francisco Veterans Affairs Health Care System
Editor-in-Chief, Journal of the American Heart Association
Q. Please tell me about your career path, and research.
A. Well, I've always had a fascination with the brain, and also always had a tremendous interest in and a passion for optimizing health for vulnerable and underserved populations. I'm originally from Nigeria, and so having witnessed instances of discrimination and stigmatization towards individuals with certain conditions like stroke and epilepsy and schizophrenia in Nigeria, I frequently dreamt about being a well-trained physician, scientist, and a public health leader, with the capability and hopefully the credibility to help make sustainable differences in outcomes for vulnerable individuals in Africa. Part of this was inspired by a gentleman by the name of Prof. Thomas Lambo in Nigeria who was the first Western trained psychiatrist in Africa. He was very famous for his work in ethnopsychiatry and psychiatric epidemiology, and indeed, he established the first psychiatry hospital in Nigeria, and ultimately, he rose to become the Deputy Director General of the World Health Organization. So, he was always a role model for me, and in his work, he illuminated a lot about the burden of mental health in Nigeria, which by that time was a taboo, because people were ignorant about what it was, many thought people with mental illness were demon-possessed, and he facilitated the evidence-based treatment of individuals with mental illness.
I left Nigeria and came to the United States – I wasn’t sure if I wanted to go into neurology or psychiatry or neurosurgery. I started out doing residency aiming to be boarded in both neurology and psychiatry. My rotations in neurology I loved so much, and I discovered that it I was more intrigued by psychopharmacology than psychotherapy. So, I ended up deciding to focus solely on a neurology, In terms of choice of neurology subspecialty, I recall that in my second year of neurology residency I sat down with my chair at the time at the University of California, Irvine, Mark Fisher and I asked him, I said, “I know I want to do academic neurology, but I am not sure in which area I could make the most difference,” and he asked, “well, what do you want to do?” I said, “well, I want to help vulnerable populations,” and he said, “there's no other disease entity in neurology that disproportionately affects vulnerable populations like stroke.” I said, “Okay. So, then I’ll go into stroke.” And so that's how I ended up going into vascular neurology. I did a fellowship at the University of California, Los Angeles, UCLA. I planned to do a two-year fellowship, during which I intended to get a Master of Public Health, then I was hoped to join the WHO, like my hero, Prof. Lambo, but towards the end of the first year of the fellowship, this opportunity came up to be considered for the directorship of the stroke program at a county hospital in Los Angeles affiliated with UCLA. I had worked at the hospital during my fellowship and seen disparities in stroke care and outcomes. During the fellowship, fellows would alternate between the main UCLA hospital, which primarily served a higher socioeconomic, well informed patient population, and the county hospital, which served a primarily low-income patient population. And so, when this opportunity came up, I realized, “Yes, I want to help Africa. Yes, I want to work in underserved countries around the world, but there are lots of underserved communities here in the US.” I ended up being offered that job. I was director of the stroke program for almost 10 years, and it was extremely gratifying to serve that predominantly Hispanic, mostly immigrant patient population, and I think, along with my colleagues, we were able to make a difference to stroke care there. After that role, I have been privileged to engage in various activities that involved clinical care, education, research, community service, and leadership of programs, departments, healthcare systems, journals, conferences, and campaigns, aimed at improving both neurological care and overall health for disparate populations including African Americans, rural US dwellers, US Southerners, US military veterans, and residents of low- and middle-income countries.
Q. What elements of diversity, equity, and inclusion are most important to you and your career?
A. Well, I think all the elements, because to me all the elements are interwoven, and build upon one another. Dr. Marian Wright Alderman said, “you can't be what you can't see,” as part of a documentary called Misrepresentation that screened at the Sundance Film Festival in 2011. So true. First, I think it's important that there be more welcoming symbolism and actual representation of underrepresented individuals within the ANA. Many times, underrepresented in medicine folks look at an organization, trying to decipher whether the organization will be a welcoming and nurturing environment for them. For instance, when I first came to the US, trying to decide where to apply to I asked myself “Where have they taken Nigerians, and are those Nigerians thriving there?” So, I think it's extremely important for national neurological organizations like the ANA and others to take the trouble to signal inclusiveness. This profiling initiative is a step in the right direction and deserves strong commendation. Highlighting Black academic neurologists, especially during Black History Month, will invite and inspire others.
Second, is the issue of visibility of underrepresented individuals in leadership. It’s helpful for people to infer that an organization is highly welcoming of them but seeing people like them in leadership speaks to a nurturing and respectful environment committed to inclusion and empowerment of underrepresented individuals. If you do a comprehensive Google search you will find out that there's been only one Black president of a major neurological organization, and that was Dr. Audrey Penn, in 1994, almost 30 years ago. Another observation readily apparent from a thorough Google search is that while US neurological organizations, like the ANA, American Academy of Neurology, and the Child Neurology Society, all have presidential terms that last two years, virtually all other medical specialty organizations including neurosurgery, psychiatry, neuroscience, and all main internal medicine subspecialties have presidential terms lasting for just one year. Perhaps not surprisingly, when you now look at the proportion of presidents of these latter organizations (many which are younger than the ANA and AAN) who have been either women or from underrepresented groups, these organizations have a much higher proportion of presidents who have been women or been underrepresented than the aforementioned US neurological organizations. Third, something should be said about the power of leaders regardless of their demographic characteristics reaching out personally to make underrepresented persons feel more welcome. I will never forget attending an AAN meeting very early in my career, walking around the conference venue feeling isolated and intimidated. Dr. Berch Griggs saw me walked up to me, introduced himself (of course I knew who he was), and struck up a conversation with me, which ended with him taking my contact information and subsequently inviting me to review for Neurology and recommending me for AAN committees. He still reaches out to check on me and offer his help!
Q. What's the best career advice you've received?
A. Will start with my father, who would always encourage my siblings and I to follow our passions, do thing things well, and not think about money. I still hear my father's voice in my head, “Don't worry. Do well and the money will come.” Not that I don't want or need more money, but my focus almost always is, whether the job aligns with my passions, and whether I think I can add value by performing it to the best of my abilities. Another piece of great advice for me was from Dr. Clay Johnston, who said, “Bruce, always seek to be a leader.” “Does not necessarily have to be within an admin role but seek situations where you can have an impact in nudging people or society towards making a positive difference.” So, I often reflect on that “who am I leading, how am I leading, and where am I leading”, which I think has led to a lot of wonderful opportunities for me. In academia, we often get extremely focused on individually delivering great clinical care, individually imparting great knowledge, and individually conducting high quality research, often because the incentives are aligned that way. However, I think it’s important to take a step back sometimes and examine how you leverage the talents and contributions of others to achieve a noble goal that’s greater than the sum of its parts.
Q. What does Black history month mean to you?
A. It represents a recurring opportunity to acknowledge the rich history and the pivotal contributions of Black Americans, despite tremendous and ongoing structural impediments. I think it's a time for both hearty celebration and deep reflection. Beyond just Black Americans, it’s also an avenue to identify with all members of society who have been historically disenfranchised or are currently marginalized, and contemplate what we all can individually do, to make things better.
Q. Who is an inspirational, an additional inspirational, Black historical figure that inspires you and why?
A. There are several, and I have already mentioned Professor Lambo, but I will pick just other one for now. Rosa Parks. I often marvel about how people arrive at high stakes courageous actions that come with sacrifice and have implications that go way beyond just them. That simple expression of righteous indignation and defiance, gave African Americans a new sense of pride and purpose, initiating a movement, and inspiring a generation. As she said, “You must never be fearful about what you are doing when it is right.” It was a phenomenal act of leadership and aligns with Clay’s career advice to me. However, it’s one thing to seek to lead and quite another to lead when the potential consequences might be dire for you, like in her situation. The more audacious the leadership goal, likely the greater the risk. In pursuing career goals, I often ask myself whether concerns about personal or professional risks to me, might be standing in the way of me being bolder or more ambitious.
Q. What can professional organizations like the ANA do to support the advancement of Black physician-researchers, and scientists?
A. First, the ANA is to be congratulated. In my humble opinion, it has come a long way in a very short time, towards being more welcoming and inclusive. We spoke about the elements of DEI, and it is increasingly embracing all those elements fully. However, in terms of further supporting advancement of Black physician-researchers and scientists, while the numbers are relatively few, I think there could be more recognition of meritorious Black physician-researchers and scientists, again with the goal of inspiring others like them. An early career colleague of mine presented an abstract at the ANA meeting in 2021 showing that virtually no Black physician-researcher or scientist had received a major award recognizing scientific work or achievement from the ANA in its history. Obviously, such recognition must be truly earned, but I do think there are Black physician-researchers and scientists out there worthy of such recognition. If you look at comparable organizations like the American Academy of Neurology or American Heart Association, one sees more public recognition by these organizations of the important scientific work being done by underrepresented folks in neurology and neuroscience. Perhaps greater outreach by ANA and its award committees, as well increased diversity on the selection committees might help.