Dr. Rishi Manchanda was in high school when he learned about the social determinants of health—that the community and environment can impact an individual’s health outcomes—and it was then that he decided to dedicate his life to serving the underserved.
Rishi pursued medicine after working in communities in inner city Boston and working in rural India for one year focusing on community development and health. He received a National Health Service Corps scholarship to earn his MD degree in 2003 from Tufts University, where he also received an MPH degree. He completed his service obligation at Venice Family Clinic in Venice Beach, CA, and St. John’s Well Child and Family Center in Compton, CA. At St. Johns, Rishi became the first director of social medicine, where he provided a full scope of primary care services and treated primarily African American and Latino patients from low-income working families.
Currently, Rishi serves as lead physician at a veterans’ clinic which is part of the Greater Los Angeles Healthcare System. The clinic was created to serve veterans experiencing homelessness—many of whom were accustomed to seeking care at emergency departments. Rishi’s patients face complex social issues, including mental health and substance abuse disorders and homelessness. The clinic acts as a touchstone of a comprehensive care management intervention, an “ambulatory intensive caring unit,” says Rishi. He is proud of this clinic and what they have accomplished. When Tom Bodenheimer, head of the Center for Excellence in Primary Care at the University of California San Francisco (UCSF) recently visited the clinic, he called it the “highest quality and most compassionate care” that he had ever seen.
Rishi is the author of the book “The Upstream Doctors: Medical Innovators Track Sickness to its Source”, and is very passionate about looking at the upstream drivers of negative health outcomes and health disparities in underserved populations. “Regardless of where we live and who we are; health is shaped by where we live, work, play, etc. Lack of health care services and housing can also impact health. As a clinician, I can say unequivocally that housing is health.”
Reflecting on when he started his career as a NHSC clinician, Rishi wishes he knew then what the most important upstream social determinants of health were in his community and how to address them. He urges current NHSC clinicians to understand what the “upstream approach” is and take advantage of online trainings.
Rishi says being a NHSC clinician has had a profound impact on his life. “I'm constantly moved by the special privilege that my patients grant my care team and me when they share their lives with us. That bond is powerful,” says Rishi. “It has helped me see the dignity, frustration, resiliency, and sometimes despair that my patients experience as they face inequities and personal challenges. That privileged bond and sense of solidarity have made me a better clinician.”
When asked what has been the most rewarding part of his service, Rishi does not hesitate. “The moment when a patient switches from despair to hopefulness is the greatest part of my service. The reward comes from knowing that my colleagues and I provide a system and an approach to care that help make moments like that happen.”