Roy H. Hamilton MD, MS, FANA
Professor in the Departments of Neurology, Physical Medicine and Rehabilitation, and Psychiatry
University of Pennsylvania
Q. Please tell me about your career path, and research.
A. Well, I've always known that I was interested in some aspect of brain science, certainly by the time I was high school and in college. I was an undergraduate major in psychology at Harvard, and then went to Harvard Medical School, and for a time to MIT. For me, the critical career decision was which kind of brain scientist I would be, whether I should go into a PhD program in cognitive neuroscience or to medical school. Well, like many other people who go to medical school, I wanted to pick a field in which I would make practical and palpable differences in people's lives, so I chose to become a physician. From day one of medical school I knew I was interested in either psychiatry or neurology. I guess you might argue that as a behavioral neurologist I split the difference. And it was also in medical school that I met a very influential research mentor who introduced me to noninvasive neuromodulation as an investigational approach in behavioral neurology. I got involved in magnetic brain stimulation and electrical brain stimulation, using both as tools to interrogate structure-function relationships in the brain as they pertain to human cognition. In other words, my work involves non-invasively “poking” different areas of the brain to figure out which parts of the brain are good for what. But we also try and import any insights we glean from using noninvasive brain stimulation into patient populations with neurologic disease. That interest has sustained me for the better part of two decades. I came to PENN for residency, and that institution also has served me in good stead for two decades, where I stayed on initially as a fellow in behavioral neurology, then as an assistant professor, and then made my way up through the through the academic ranks. I should mention that, in parallel with my scientific and clinical interests, I've always had an interest in diversity, equity, inclusion. I've been involved in a variety of different projects and positions related to DEI in medicine, and more recently in the in the field of neurology and academic neurology more specifically.
Q. What elements of diversity, equity, and inclusion are most important to you and your career?
A. I think the framing of this question is interesting, because you didn't ask me which of these values is the most important, you asked me which elements are most important to me and my career. I would say that inclusion has always been an important component of my career and how I try to work with others. That’s not to say that diversity and equity are unimportant—they both very important—but since you ask me which are most important in my career, I’ll choose the theme of inclusion and run with it for now. The reason I picked inclusion is that, throughout my career, I have often found myself in spaces where I was one of the only person who looked like me or had my background. For example, when I started my residency program…I hesitate to say that I was the only person from a minoritized racial group because I might accidentally forgetting someone, but I believe I was. I found myself in similar situations as a new faculty member, and throughout my journey to becoming a tenured professor. Add to this feeling of differentness the fact that I am to the first person in my family to pursue medicine or to pursue a professional career. In light of all these factors that can make one feel out of place, one of the things that has been vitally important to my success has been the presence of individuals who went out of their way to help me understand the path that has to be taken to develop an academic career, showing me all the potholes and pitfalls along the way. That, to me, speaks to inclusiveness. You see, throughout my career I’ve benefitted from those people who looked at me and thought to themselves “you may come from a very different background than I do, but you clearly deserve a seat at this table, and a voice.” I think a big part of what I try to bring to the environments in which I do my work, whether it's my research or my administrative work, is to make the path a easier for people who are not as far along the path as I am. My goal is not simply to make academic environments more diverse, but to make sure that when an environment is diverse, every person in it feels that they have a seat at the table. In fact, they shouldn’t just have a seat at the table, they should own the chair and feel fully empowered to have a voice. That mindset of inclusion has been critical to my own career development, and it is what I try to practice when dealing with others.
Q. What's the best career advice you've received?
A. I'm not sure that I can tell you the best career advice I've received. But I can tell you the advice I’ve followed most often. I’ll share two sayings. I've learned through Google that the way I learned them may not be exactly right. Be that as it may, they both come from my father. Before I say anything else, let me say that my father—who passed a number of years ago—was whip-smart, but did not have opportunities that I’ve had. He worked incredibly hard to create those opportunities for me. He’d used to say “You can't fly with the eagles if you're running with the turkeys.” The meaning of that saying—maybe it's self-evident—is that if you want to do really well, you need to surround yourself with excellence. Excellence begets itself. That has always been helpful for me in two ways. First of all, surrounding yourself with great people is a very practical strategy if you're trying to get great things done. But also, remembering that this is my intentional strategy helps me deal with imposter syndrome. I often find myself in a situations where I feel like, “Gosh! Everyone around me so accomplished, and they’ll all doing so great! Who am I that I am sitting in this space?” Then I reflect back on my own father's words, and I think to myself, well this is how you get to be great. After all, you can't fly with the eagles if you're running with turkeys, so my job is to find the eagles and fly with them. The second thing my father used to tell me was that it is “better to be a little smart and a lot hard working, then a lot smart and a little hard working.” I hope no one takes offense at this because neurology is full of some very, very smart people. His point was that to be talented is not enough in itself. In fact, it isn’t really anything to be proud of if you have natural gifts but you haven't done anything with them. Real progress comes from taking whatever gifts you've been given and doing the best you can with them. I repeat those two sayings to my kids and to myself all the time.
Q. What does Black History Month mean to you?
A. I think Black History Month is an important recognition of an integral part of this country's history. It pays homage to the many Black individuals who have fought for a more diverse and equitable society, persons who have been icons of our culture, and pioneers of all sorts. So on the one hand, I view it as valuable a step in the right direction. On the other hand, I can't say that I’m entirely satisfied with the concept of Black History Month because the idea of it carries the subtle implication that the rest of the year isn't about Black history. But think about how integrally woven the history and experience of African Americans and Black people is to the history of this country, how much of what has happened in this nation critically involves questions and challenges involving persons of color and Black individuals specifically. Think of how many pride accomplishments in this country reflect Black excellence. Viewed through that lens, it seems unfair to cordon off just one month of the year, and the shortest month - let's just put that out there - that is devoted to African American history. Our shared American history includes the rich and powerful story of Black people year-round.
Q. Who is an inspirational black historical figure that inspires you, and why?
A. Early on in my life, I was inspired by a lot of the same icons that inspire a lot of us. As a kid who knew he wanted to go into science, I especially loved George Washington Carver. I loved Frederick Douglass too when I was young. I still do. But someone I learned about more recently who inspired me is Dr. Solomon Carter Fuller. He was a Liberian-born turn-of-the-century neurologist-psychiatrist. This is back in the days when those two specialties were essentially one field. In the years since, psychiatry seems to have laid claim to Dr. Fuller, but I want to reclaim him for neurology. Dr. Fuller was a contemporary and peer of Alois Alzheimer and reported a critical early case series of persons who harbored the clinical and pathological hallmarks of the disease that Alzheimer had originally reported, which now bears his name. This case series was pivotal for establishing Alzheimer’s disease as a condition with consistent clinical findings and a common neuropathological basis. He was also the person who translated early work related to Alzheimer's disease into English, which enabled English speaking physicians and scientists to become aware of and start studying this condition. He held a faculty position at Boston University, but insofar as he was Black, he faced considerable obstacles in his ability to rise through the ranks of academia. The reason why I am inspired by Dr. Fuller is that, as a behavioral neurologist, I think my subspeciality has not historically had a special appeal to persons from marginalized backgrounds. One reason for this may be that the field doesn’t celebrate role models and early leaders in the field who come from those backgrounds. I think there's some truth to the saying that you need to see it if you want to be it. It's really exciting to discover that there was a Black person who was right there in the earliest days of discovery of our most common neurodegenerative disease.
Q. What can professional organizations like the ANA do to support the advancement of black physician researchers and scientists?
A. First of all, as I was just saying, you can't be it if you don't see it. So good job, you're supporting the advancement of Black physicians right now by highlighting that there are Black neurologists who have navigated their careers successfully. I think that neurology has had a bit of an image issue compared to some of its peer fields. It has been shown that, at least up until a few years ago (I haven't checked the numbers recently), individuals who are from minoritized populations were even more underrepresented in neurology than they were in the field of medicine generally. I think part of the problem has to do with how neurology frames it itself as a specialty and what it portrays as being mission-critical to itself as a field. Neurology hasn't historically depicted itself as a field that views advancing health equity and the needs of marginalized minorities and underserved populations as a core mission. That is unfortunate, since many of our most common and most burdensome neurologic disorders are heavily over-represented in minoritized populations. Let me hasten to add that there are certainly a number of people within neurology who have committed their careers to this this kind of work, so I’m not saying that that the work doesn't exist in our field. But let me put it this way: when a person goes to medical school, and they say “my interest is in being in a specialty that serves marginalized communities, that's why I’m choosing to go into_________.” How likely is it that the that that sentence ends with the word “neurology”? Perhaps less so in the past than now, but I still think that it is more likely than not that that sentence will end with a different medical subspecialty. This image problem impacts our field’s ability to attract a diverse workforce. There's no shortage of data that shows that individuals who come from marginalized and minoritized backgrounds have a have a higher level of interest in work that ends up giving back to those communities. If neurology portrays itself as a field that isn't especially invested in those communities, we can't be too surprised if minoritized individuals look elsewhere to develop their careers. In recent years, the ANA has worked to change its level of emphasis on health equity in neurology and on communities that are historically underserved. I think that this shift in focus is going to be really important for moving the needle on racial and ethnic diversity in the ANA and in neurology. Of course, we also need to continue to develop pipeline programs and other initiatives that increase access to neurology for persons from minoritized populations. But for these kinds of programs to work, we need to make the specialty we’re increasing access to more attractive to the people for whom we’re trying to increase access.