Ep 61: Question the Status Quo

[00:00:20] Kristi Ebong: Welcome. Today, I’ve got Dr. Nimisha Kalia with us, and I’m so excited to have you here. We go way back which I’ll get to in a minute, but thanks for logging in to her story. My name is Kristi Ebong. I’m with Define Ventures. We do early stage digital health investing in VC. And I’m actually also an advisory council member for Her Story and super excited about what we’re building and also to have Dr. Kalia here today with us. Mish, talk to me a little bit more about your background. We actually go way back to grad school. We did our MPH and MBA together. This is before public health was sexy, if we can dare say that now with COVID, that the mainstream is using all this public health terminology and everything. But give me a sense of what you’re working on, what got you to where you are today.

[00:01:11] Nimisha Kalia, M.D., MBA, MPH: Gosh, this has been a long journey, it feels like. I think the roots of it, or the foundation of it’s really my parents. And they moved here to the US when I was eight years old, and I have two younger siblings who also were born abroad and then came into the US. So I think the foundation of everything to me, no matter where I have gone and will continue to go in life, always goes back to kind of remembering where my roots were and how hard I watched them work coming to the country, not knowing much English, and then not having much money, and having three kids they were responsible for. So kind of puts it into perspective for me, right? No matter what you’re going through, it’s never going to be as hard as what my parents faced or what other people might face. So I think that’s the foundation of it. But yeah, I’ve been working in medicine for a long time, as you know. And public health

[00:01:58] Kristi Ebong: Absolutely. Yeah. And what got you interested in going into medicine?

[00:02:03] Nimisha Kalia, M.D., MBA, MPH: Kristi, I know you’ve met my family. They’re all a bunch of nerds, but my dad works for NASA. So I grew up around science and just loved it, like, learned about like drag forces and aircrafts early, early on. And so science is also always an interest of mine. But I knew I wanted to work with people individually and be able to help them individually. And medicine just had called me, like, I think at eight years old, I knew I wanted to be a physician. I knew that, if I went into medicine, I could move or live anywhere in the world and my skills would still be translatable or helpful to that population. That’s what really drew me into medicine and public health.

[00:02:42] Kristi Ebong: That’s so exciting. And I know that one of the things you and I have spoken about in the past is just how much your family life and family culture supported you even as a woman, being a little bit undaunted, I would say, in kind of charging ahead. With what you’ve accomplished, it’s been really impressive.

[00:03:00] Nimisha Kalia, M.D., MBA, MPH: Yeah, absolutely. I’m the oldest, as I said, and I didn’t grow up with traditional gender role conformities. My dad cooks, so I was with him in the kitchen, with my mom in the kitchen, and my mom worked in finance. So she taught us about taxes and stuff, and my dad would also teach us. And they never put limitations of, this is what you’re kind of expected to do. So I think the three of us grew up just kind of relying on one another, talking through it, and sharing ideas with one another, and having these parents that were just very, very supportive of anything we wanted to go into, very practical parents, like didn’t give us advice of, yes, go pursue this interest that you have, that you learned how to sketch now and become, but also very, very supportive of whatever we wanted to do.

[00:03:47] Kristi Ebong: I love that. I remember, in grad school at Hopkins, on the weekends, going to your folks to study and to get some really, really good cooking, and always feeling that this intellectual curiosity was pervasive in your family of origin, which I just found so incredible and also heartwarming because they’re warm, kind people and it makes a lot of sense how you’ve gotten that support to get to where you are now.

[00:04:13] Nimisha Kalia, M.D., MBA, MPH: It makes such a big difference. I think having the family that you have, or the family that you end up adopting of people that are around you that can just nurture your curiosity and not put limitations on you. I think anything that you want to do, you really can, especially if you have the people around you that that will continue to say, okay, yeah, you want to do this? Like, how can we help? What can I do to help? Do you need to talk through anything or I’ll help you look at programs that could get you to where you want to be. So yeah, absolutely. Makes such a big difference.

[00:04:42] Kristi Ebong: And then tell me a little bit more. You’ve chosen a bit of an unconventional specialty path. And going into, and I think you’ve done, if I recall correctly, some type of fellowship or work in both preventive medicine, as well as occupational medicine, which might not be as mainstream in terms of knowledge to the broader population. But, talk us through a little bit, that thought process. A, what is it that you work on and then, B, what made you think of it or what made you want to invest your career in that?

[00:05:13] Nimisha Kalia, M.D., MBA, MPH: Early on, again, I knew I wanted to go into medicine and I really liked public health. I didn’t necessarily know that what I was interested in was truly population health because I didn’t know that terminology when I was young. But growing up, I knew I wanted to work with a population and I knew I wanted to help them really to live their fullest life. So, physical wellbeing, mental wellbeing, like the full gamut of well being for individuals. So I thought I wanted to go into infectious disease. And then when I learned about the day-to-day, what my life would be like an infectious disease, I thought, you know what, that’s not exactly what I want. I don’t necessarily want to be working in a hospital setting in a practice setting. What I want to do is population health, and that’s why I chose Hopkins to come to for my MPH and my MBA. The MBA really tied it all in for me, because I think, if you want to be a healthcare leader, in order to get any of your ideas across, if you can also back it up with the financial aspect and the financial win-win for all parties involved, the more successful you’re going to be. So I was fortunate enough to get into the MPH MBA program and attend it with you Kristi, and then also did my occupational medicine fellowship at Hopkins. So after internal medicine, my fellowship was an occupational medicine and this field really looks at a specific worker population. So whether it’s with a company or a subset like firefighters, for example, so not a company, but a general population and says, what are the specific risk factors that these workers face that maybe no other ones do, and how can we best protect these workers? So again, the same principles that I knew I wanted to apply throughout my career early on were actually much more specific to occupational medicine. So right now I am the current Chief Medical Officer for GE. And so my patient population is essentially the around 195,000 employees of GE. And so, I take that with a lot of responsibility and want to make sure that we’re providing the absolute best resources we can to help our employees with physical wellbeing, as I said, mental wellbeing, financial wellbeing, and all the gamuts of their lives that we can help with. And COVID has definitely tested our capabilities, let me tell you, but yes, that’s kind of what occupational medicine is and what I do day to day.

[00:07:34] Kristi Ebong: That’s remarkable. I want to dive deeper into the oc med side of things in your current role, but I want to take a moment to acknowledge the infectious disease background that you have, because I don’t know if you remember this, but back in grad school, there was a photo contest that a lot of our clinical and public health colleagues submitted photos. And, for those listening, Misha, Dr. Kalia, submitted a photo of probably one of the most disgusting things I’ve seen in my life. It was a parasitic worm that was, how long, maybe a foot long?

[00:08:08] Nimisha Kalia, M.D., MBA, MPH: Yeah. A foot long. Yep.

[00:08:09] Kristi Ebong: That you had extracted from someone’s body.

[00:08:12] Nimisha Kalia, M.D., MBA, MPH: Correct. From their bottom. It was a child actually. So the mom came in saying that my little boy, he’s just been itching. He’s really, really uncomfortable. And again, one of the first things you checked for in underdeveloped nations is parasitic worms and, sure enough, did a physical exam and you could actually see the head of the worm. So, you have to very, very, very carefully now, I mean, took a pencil and very, very, very carefully extracted it. The worm was still alive. We captured it in a jar and we had the mom, she was crying of relief, holding the child and the worm. And that’s the picture that I submitted.

[00:08:50] Kristi Ebong: It’s something you cannot un-see. But no, we’re grateful for your clinical expertise on top of your professional statutre there. But I think I still have a picture of that worm actually, somewhere in my archives. It’s a good memory that Dr. Kalia shows up all professional and smooth. And then I say, well, I know when she pulled a massive room out of someone’s bottom. So, I love that story for the humanness of it. None of us are immune. But I want to dive back into the oc med perspectives because it was actually funny. When you and I were going to catch up and talk about and prep for this conversation, I caught you in the middle of the changing federal mandates around COVID vaccination. And, when you have 195,000 people and their families kind of dependent on the imperatives that are coming out and that you’re managing from a workplace perspective, I can only imagine that’s probably equal parts clinically challenging, politically challenging, professionally challenging. Talk to us a little bit more about the intersection for you of medicine and what your thought process is on, how do you lead in these uncertain times and kind of provide that leadership to almost 200,000 employees.

[00:10:05] Nimisha Kalia, M.D., MBA, MPH: You I think, when I was going through the interview process for this role, the CHRO of the company asked, I thought a really good question. He’s like, I’ve met lots of doctor physician leaders, and some of them really see themselves as business people. Some of them really see themselves as the policy folks, and then some of them really see themselves as clinicians. Which one would you say that you are? And I had to think about it. And I was like, I think I’m definitely still a clinician. At the end of the day, my roots go back to, I want to do the best that I can for my patient. And all of these extra little public health, the epi and biostats that we learned, and all the extra little skillsets, the business skill sets. Those are only to augment the best delivery of care for my patient. So, I keep that in mind all the time. The mandates change all the time and we have to focus. The clinical team and the medical team’s certainly very much focused on how is this going to impact our employees. And this time has been especially challenging because there’s been such a political overtone to the virus, the vaccines, the boosters, the implications, the side effects. So, all of that, managing that, I think the most effective or the feedback that I’ve received from employees, the most effective communication is not necessarily the formal communication that comes out like the Q&A with Dr. Kalia. It’s the emails that I get one-on-one or when an employee will ping me out of the blue and say, I have a question I really need to get answered, about, should I really get the vaccine, Doc, or like, I’m really scared about this. Those are the most impactful and I think that’s what I actually enjoy the most too. So, for me, it’s, still relatively easy because I know why I went into this and constantly remembering that helps.

[00:11:51] Kristi Ebong: I’m sure. And I’m sure these times help you to constantly remember that.

[00:11:54] Nimisha Kalia, M.D., MBA, MPH: Yes, they do.

[00:11:56] Kristi Ebong: I love that though. I love that principle of going back to what you know in times of uncertainty and what you know is caring for people, and caring for people clinically, and medically, and mentally. And I think that’s really powerful for all of us to remember, is go back to our own superpowers, and start with what we know in times of uncertainty.

[00:12:13] Nimisha Kalia, M.D., MBA, MPH: Yeah. I still have my personal statement for medical school. And I wrote that personal statement, I think I was the most optimistic I’d ever been in life. I wanted to change the world and I wanted to take care of communities. I go back to that because I think that’s kind of how I want to remain. It’s so easy to get jaded and it’s so easy to get exhausted and just feel, especially during this time, I go back to that quite a bit.

[00:12:38] Kristi Ebong: No, I love it. I mean, I think this has been a time of reverence and remembering while navigating so much of what is new. Because I remember, back when we first met, talking about, what if and when there’s a pandemic ?Or actually, was an epidemic and then, God forbid, a pandemic and it was theoretical, right? Or it was rooted on stuff that had happened centuries prior. And we talked through those things with the gravity of seriousness when it was something beyond the imagination, I think, of more the broad, general public. And so it’s been really interesting to see how those principles that you learn in a setting where you’re chin and just the one-on-one delivery of care. I’m grateful for the work that you’re doing.

[00:13:19] Nimisha Kalia, M.D., MBA, MPH: Oh, no, thanks. There’s so many facets. My brother and sister, for example, are some of the frontline healthcare workers, right? The firefighters, the EMT, those folks that are there on the frontline every single day, incredibly, incredibly brave. Yeah, and you’re right about how we talked about pandemics for awhile, we talked about epidemics for awhile, and still how relatively unprepared I think we were when it actually came to, and that’s what’s shocking to me because I get scared about what would happen if this were to happen again, because I can tell you most companies have a disaster management team or crisis management team that have laid out plans for these types of situations. And yet when we arrived here, none of those, we didn’t even look at those. It was just kind of like, just go, just go, we’ve got to figure this out as we’re going along. So it is interesting.

[00:14:10] Kristi Ebong: I want to go back and look back for a minute. 10 plus years ago when we met, we were not married. We didn’t have children. And I remember talking about it and I remember one of the things that you and I discussed before having families was, well, am I ready? Is my career in a place where I can do this and be set up to succeed? And that obviously has a lot of shades of gray. And I remember teasing you that you already had quite a few letters after your name and if you weren’t ready, none of us were. And now, you’ve started your family, you have a child, it’s so exciting. She’s gorgeous and so, so fun. Talk to me a bit about how that experience has impacted you professionally and how you navigate, A, your work, and your perspectives on navigating this professional journey as a woman.

[00:14:58] Nimisha Kalia, M.D., MBA, MPH: It changes you. Becoming a mother completely changes you. I think your perspective on life changes in terms of, I always thought, I mean, and I do, I love my career. I love working. But when you have this little two year old tugging at you and demanding attention, you cannot be sitting at your computer. You really start to question like, I do love my work, but my gosh, I love spending time with this little person. And they’re only going to be this age for so long. And they’re only going to go through these little milestones for so long. So you do start to question it. The best thing I think I’ve been able to do, and this has been hard, is ask for help and try to be really authentic with your colleagues and with even your managers in terms of where you are and what you need. That’s a challenge. It’s been really, really hard and I’m still developing it. But initially, I’ll tell you, for example, I was working in an academic center when I first had her and I remember feeling so guilty for taking six weeks. I had a C-section, so taking the full six weeks that my OB was telling me, no, you need to have six weeks to recover. And I just felt so, I’m never taking that length of time off. And then I even had colleagues that were calling me, and I won’t forget, this three weeks in. So my incision was still hurting, barely able to ambulate, but still in pain, and saying, you’re probably going to be judged for this. And I was like, what kind of profession is this that we’re being judged for just letting our bodies heal and recover? And so after that I was like, no, no, no, this is not going to-look-I know I work hard. I have to just at least try to plead my case. There’s a reason I’m taking six weeks. It’s not just to do nothing. It’s just that I have to recover in order to be able to function when I get back. So I remember having that conversation with my manager, the Chair of the department at the time. I thought maybe it would be taken in a negative light. That is a long amount of time. Dr. Kalia, blah, blah, blah. But instead it was a very supportive environment. First of all, he’s a man, so he’s like, I cannot personally say I know what you’re going through, but I can tell you I can provide help with resources during this time. So you let me know what you need. And we’ll make sure it’s there. So that was like one of the first times. And so I was pretty well into my career at that point. And that’s like the first time that I felt like I’m at the point where I physically can’t even get up. And that’s why I’m asking for help. I should have come to that point a long time ago and I didn’t. But I did. And I’m glad I did because it was received well, and it was received in a very supportive manner. And so now I feel much more open to being able to discuss, like, when she’s sick or when something else is happening in our families or in our lives, and just saying like, hey, this is what’s going on. So I found that, I know some people are probably really good at it. It’s been a learning experience for me and a real balancing act, I think.

[00:17:48] Kristi Ebong: I appreciate you sharing that so much. And I think what’s actually very interesting is this is a thread I’ve pulled on in other conversations as well. And it often comes down to a fear of asking for help. And then my next question is, where does that fear come from? Where does that, what is it, what are we afraid of if we ask for help? A, we’re afraid that someone might say no, and then we’re stuck in this really difficult situation. And B, we also, I think, have historically lacked women in leadership positions that can say no, no, this is normal. In fact, I know folks, my sister-in-law from Sweden being one, who would think six weeks off only is absolutely insane and you should have much more time. I think there’s really reasonable evidence out there, especially after a major surgery and caring for a newborn. But I think that what’s really interesting is if we pull on that thread of asking for help, and the worst case scenario is someone says no, or causes problems, then what do we do with that? Then we make decisions for ourselves of where we need to be to get what we need. I guess you could call it owning your power or knowing, like you said, you said you know you work hard, you know what you’ve brought to the table, and you deserve to have that support. So ,I am grateful for your story because I think it will be helpful to a lot of other women.

[00:19:05] Nimisha Kalia, M.D., MBA, MPH: No, I’m glad, I try to think about that now, especially the team members that I have that are undergoing fertility treatments, starting a family, thinking about starting a family, and just trying to be very cognizant of the support that they need. I think women, especially, need to be huge advocates for one another and normalizing the other part of life that cannot be ignored.

[00:19:29] Kristi Ebong: And men, I think the story you tell about your dad working for NASA, but also cooking at home and elevating you and your siblings professionally is it shows that there are different playbooks for how to support each other and for men to advocate for women in this context as well. And so I think it’s a really interesting story and I’m hoping that this next generation can benefit from that and that we don’t go into it saying, well, we had to do it. And so you should too.

[00:19:58] Nimisha Kalia, M.D., MBA, MPH: No, absolutely. In fact, I would say, one of the things that I know I’m going to be teaching my daughter is, question things. Don’t go with just the status quo. I think, for so long, many of us said, okay, well, me, for example, okay, well, I’m a physician. I went through medical school and residency, where you tough it out, like you worked 80 hours, you worked 100 hours. You tough it out, get a few hours of rest, and then you’d go back to work. And that’s it. So I think, what I’m going to be telling her, is question things, and don’t be afraid to ask, why is it this way and why can’t it be this way? And not be afraid to do that.

[00:20:39] Kristi Ebong: Absolutely. No, I’m so grateful for that. Talk to me a bit more about how your opportunities or challenges in the medical and clinical world, or even in the professional world, in terms of being in a C-suite leader at a major company, having 200,000 employee lives underneath you, how have your challenges maybe felt different because you’re a woman, or what difficult decisions have you had to make along the way?

[00:21:07] Nimisha Kalia, M.D., MBA, MPH: As we kind of talked about before, I think, like, inherently, I didn’t necessarily go into it thinking, oh, because I’m a woman, it’s going to be harder. I wasn’t raised that way and wasn’t raised to think that it’s going to be any different for me than it is for my brother. But I will tell you, there have been times specifically in my life and I know, in general, there are lots of other women that don’t feel that way, close friends of mine, even because they’ve had different experiences. One of the things that happened to me early on in my career, I remember, I would speak up and say something during a conversation. It was relatively ignored. And I was like, that’s okay, I’m junior faculty, no big deal. I get it. But then the same exact idea would be mentioned by a male colleague of mine. And this happened repeatedly. And then by the way, when he said it, it was like, that’s a great idea. I’m not going to use his name, but that’s a great idea. So I was like, okay, well that’s fine the first time, second time. And then it would be just kept happening repeatedly. I was like, you know what, why is this happening? I don’t get this whatsoever. First of all, medicine it’s ,changing a little bit, but it’s a very traditionalist kind of infrastructure. So there, there is some kind of that undertone, but I spoke to a couple of my female mentors about this experience because I was like, I don’t get it, am I not, like, I feel like I’m annunciating. I’m saying it clearly, succinctly. And they were like, it’s none of that. And they were like, listen, one of the things you’re just going to have to accept is you’re likely going to have to work like 10 times harder, especially in this field than your male counterparts and that’s just, just accept it. And I was like, okay, well, you know what, as long as I know what the playbook is, that’s fine. And so I did. I think I took it on as a challenge and just said, okay, you know what? I will. So what I’ll do is not just articulate my ideas. I’ll also come with evidence to support it and be able to, if anybody wants me to share it with them, I can share a deck with them of what I’ve done, background research. So I did. And finally, after some time, I think I cracked that little egg and was able to get some respect, was heard.

[00:23:10] Kristi Ebong: I love that. Part of the reason I’m smiling or laughing as you’re telling this story is because I remember calling you after giving birth to my first child. And I don’t know if you remember this, but I had some really rare complications from my epidural. And it took the top tier academic medical center here in San Francisco that had the best talent, is nationally ranked in so many specialties. It took them almost two weeks to figure out what had happened. And I described this to you in about one or two minutes and you said, oh, I think it’s this thing. And you were right. And that was just one of those funny moments where I remember thinking, yep, Misha is one of the most brilliant physicians that I’ve ever met, which I’ve known since I met you. And so it’s even more ironic that you would speak up and not be heard or not be taken seriously, particularly early in your career, but I’m sure still today.

[00:24:02] Nimisha Kalia, M.D., MBA, MPH: And I think a lot of women feel that way. And you know what, if that happens, like, work harder. To be very honest, sometimes that’s the world we live in. And so work harder. Polish up your skills so that you’re more articulate, so that you can perfect the data that you’re bringing to the table and be prepared for the meetings well in advance. Not that you shouldn’t be, but I think it may just elevate your skillset even more.

[00:24:26] Kristi Ebong: Is part of the reason you say to work harder because to try to fight the machine or fight the realities of what is all the time can just be exhausting or what’s the, I guess, what’s the trade off with, when do you speak up? When do you try to change the circumstances, or do you just know that those things take time and so focusing on yourself and what you can control is preferable?

[00:24:51] Nimisha Kalia, M.D., MBA, MPH: I think you take on the challenges that you know are worth taking on. So it’s not going to be every single thing, but they’re going to be two or three, probably, major issues or major discussions that are happening that you know are going to have a large impact to whatever, the decisions that are being made in the company or to the patient population. And so when you take on those challenges, that’s what I put my effort and focus on and say, okay, I’m not going to take on every single thing. For the most part, these are just day-to-day decisions that aren’t going to impact much. But these two or three things, I’m very passionate about. So I do want my opinion to at least be heard because I think there’s a lot I have data to support it. And those are the things you focus on. Again, I think it only makes you better as a leader to do that amount of background work anyways to show up.

[00:25:40] Kristi Ebong: So if I were to sum it correctly, you’re saying that the world is the way it is. And so if we can accept that, but choose our battles and how we incrementally work to change it, and not deplete ourselves along the way, that then we can be more powerful versions of ourselves while also making an impact.

[00:25:57] Nimisha Kalia, M.D., MBA, MPH: 100%. And be your authentic self. I think that’s one thing I’ve learned very recently, right? Be your authentic self. Don’t be afraid to speak up and say, hey, I’m really struggling right now because of this. This is what’s going on. And so, we may not meet this deadline, but you know, I have a plan. We can get a couple of other folks to pitch in and then we’ll be fine. I think those are the things that women are, at least in my circle, are very, very hesitant to speak up on. Many times, I think it also stems from, many of them know that they’ve had to work 10 times harder or a lot harder to get to where they are. They’ve had to deal with a lot, maybe put off a lot, balance a lot, to get to where they are. And so they see that as a threat to their identity if that role is taken away or if that’s taken away. It’s really like an identity threat. I think that’s why they’re afraid to speak up. But, moving forward, we have to think that if we don’t speak up, the next generation is going to go through the exact same thing and it’s our responsibility to try and make it easier for them by speaking up, by normalizing these kinds of conversations.

[00:27:05] Kristi Ebong: I love that. What’s interesting about taking that responsibility seriously and normalizing these conversations is that I feel like it’s easier to do the further along I get in my career. Like I’ve actually earned my keep a little more. And so that means something, I think it’s difficult when you’re in your twenties when you’re in your early thirties if you’re coming from any underrepresented background in a mainstream industry, to speak up because the costs are high and you don’t necessarily have a substantive background, Rolodex, set of experiences to fall back on if that’s questioned or not appreciated per se. So it’s something I think about a lot as we progress throughout our careers is, what’s that tolerance level for advocacy and for being outspoken while also focusing on what we call here at Define, “GSD”, and just making things happen. And so I appreciate your candor about that, and I completely agree in terms of our responsibility.

[00:28:03] Nimisha Kalia, M.D., MBA, MPH: Yeah. I’m now a mentor, which is like one of the best roles I have of an organization called Biomedical Science Careers program at Harvard. And they specifically encourage underrepresented minorities to get involved early in their career. So even middle schoolers can get involved, and high schoolers, and lots of college students, and medical students. So, when I have people in my mentorship group that kind of speak up, that I can hear, they want to say something, so I’ll encourage them, like you look like you want to say something, so go ahead, and they’ll speak up and say, I don’t know what we’re talking about is actually applicable in my community. In the Native American community, this is how it is. Or in the Latin community, this is how it is. Or, in my town where I come from, this is how it is. And I encourage that. That is exactly what we need. We need you to speak up. Please do, because we design these clinical trials with a very kind of narrow lens of how we know what we know. And we’re not as inclusive as we need to be. We’re not taking every perspective into account and we should be because then we know that the medications that we’re testing are actually going to be applicable to all the different populations that we want to serve. So I love that I’m seeing that a little bit more and I just encourage it as every time I do.

[00:29:16] Kristi Ebong: Yeah, I think you’re right. There’s a really healthy appetite now more than ever, which is just, it’s heartwarming and then it encourages more people. So there’s almost this whole momentum movement, if you will.

[00:29:26] Nimisha Kalia, M.D., MBA, MPH: Yes, it’s like positive feedback.

[00:29:28] Kristi Ebong: Exactly. Yeah. It’s a positive feedback loop. I want to look back a little bit on advice you’ve been given along the way. What is some of the worst advice or what is one of the worst pieces of advice that you’ve been given? And did you follow it? Did you not follow it? Talk us through that.

[00:29:46] Nimisha Kalia, M.D., MBA, MPH: Again, I think in medicine, especially, you’re kind of taught to follow the status quo a lot. And so I was kind of told, just kind of follow along. Don’t ask too many questions was kind of the exact… you just kind of do as you’re told and go along. And I did follow that for a long time. And then you get to a point where you’re like, this is just not working for me. So here are the two options that I have. Either I leave the profession all together because that’s the point where I’m at, or I just say, okay, well, what have I got to lose? Let me just be open about what’s really going on and see where that gets me because I’m at that point. We shouldn’t have to get to that point to say something. But I think that was the worst piece of advice. I think we should be encouraging, at every level, folks to question why the system is the way it is and whether it can be improved. What’s stopping it from being improved? So, yeah.

[00:30:38] Kristi Ebong: Absolutely. We’re grateful for your leadership on that. So Misha, if you wrote your story, what would you title it and why?

[00:30:48] Nimisha Kalia, M.D., MBA, MPH: Okay. I think I know. So one of my colleagues actually got me a shirt, kristi knows I’m 5’2, a shirt that says “small, but mighty”. And she got it from me. I love it. I wear it all the time. But I think I would title it “Small, but Mighty”, and not just because I’m tiny, but I think also I’ve learned that it’s the small thoughts and actions, and then the actions that become your habits, the habits that become your character, and your work ethic, and your destiny. It’s the small day-to-day thoughts that lead to what you eventually are able to have in life and experience in life. So it’s the small, but the mighty impact that it can have, the small thoughts, the small actions, the small habits that people may think are meaningless, but they’re really not. They add up to a lot and you can create incredible effects.

[00:31:42] Kristi Ebong: I think you’re living and emblematic of that for sure. So just to tie off, I know we’re coming up on time, but looking back at your career in medicine and population health, and now having almost 200,000 employees under you in your purview that you’re responsible for during a global pandemic, what would you, looking back, tell a younger version of yourself?

[00:32:05] Nimisha Kalia, M.D., MBA, MPH: I think I would tell myself to question things more, even more. I didn’t have the professional limitations placed on me, but I accepted a lot of things like, well, this is just the way it is. And I think that’s one thing that I, if I could go back, I’d say, you don’t have to get to a certain stage in life to say, when I get here, I’ll be able to make a difference. You can actually make a difference all along the way, as long as you’re speaking up and providing insights. So that’s what I would probably be telling myself. I will tell my mini me that.

[00:32:35] Kristi Ebong: And she’ll benefit from that. Definitely. I’m sure she’ll also welcome it. Anything else that we should tie off on or that you want to add for the group?

[00:32:45] Nimisha Kalia, M.D., MBA, MPH: No, I’m just so grateful for you inviting me to come. This has been such a pleasure. And if it’s helpful to anyone at all, like all the things that I’ve learned throughout my life, I hope that it is. And I hope that people are more empowered to speak up and empowered to really understand how much their voice matters and how much their opinions and perspectives matter. So yeah. Thank you.

[00:33:08] Kristi Ebong: Great, Dr. Kalia, thank you. so much for joining us today.

[00:33:12] Nimisha Kalia, M.D., MBA, MPH: Thank you.