"The VA is the largest health center in the country and one of the largest in the world," said Chang. "It is the only model of a national health care system that really exists in the U.S. public health care. The VA has probably the most sophisticated electronic medical system in the world." Using the VA's electronic medical record system as a base, Chang and her colleagues oversaw the development of an automated system that connects health care providers nationwide.
Politically pre-medicine
Chang gives credit to Amherst for giving her a strong foundation upon which she built the rest of her education and career. "The emphasis on writing and writing well, especially in the political science curriculum, has been very helpful for a lot of what I do now and have done, not only in clinical medicine but also in my work on local state national health issues," she said. "The ability to write and speak relatively clearly has been a great asset."
Chang fulfilled all of the pre-medical requirements at the College and was the only political science major in her class to apply to medical school. "A couple of us ended up writing a whole guide for pre-med students," said Chang. "I thought I had a great experience [at the College]. There was plenty of room to be active to do whatever you wanted and whatever you were interested in."
As part of the second class of first-year women at the College, she faced " a lot of tension and a lot of transition. The ratio [of men to women] was far from 50-50. It was an interesting time to be at Amherst. It made me a lot more politically astute."
Chang overcame this tension by taking a central role in the development of a women's center that served as a "haven and a physical place where we could talk about women's issues." The women's center was then located in what is now Grosvenor House.
"I guess the most striking thing about [Chang] would really be her ability to juggle multiple responsibilities because what's unfortunately happened to many women of our generation, especially when they have had children, is that it becomes almost impossible to juggle their career with all their other responsibilities," said Suzette Brooks Masters '81, a classmate and close friend of Chang's.
"There's been so many go-getter women who felt they could do anything in college, but then reality sets in," Masters continued. "[Chang] is an incredibly organized doer type. She's just really one of these incredibly powerful whirling dervishes in that she can really handle lots of things, [like] many balls in midair simultaneously. Not many people can do that."
After graduation, Chang immediately started school at the College of Physicians and Surgeons, Columbia University's Medical School. "[It was] very helpful to have gone to a small liberal arts school where you get a fair amount of support and attain a fair level of self-confidence before going to a large urban school like Columbia," said Chang. "[The College's] science courses are quite small [and] we didn't have such things as multiple choice exams. It was quite a transition. At the time [Columbia] had the largest amount of lecture hours at the week, so it was very different.
Epidemic proportions
Chang's experience in medical school fell on the cusp of a new trend in medicine of epidemic proportions. "When I was in medical school at Columbia, it was during our first year [in '82] that we began seeing cases of young men who were dying of unknown causes," said Chang. "My medical career started even before we knew what HIV and AIDS were. My training started before we saw any clinical manifestations of HIV. We were just entering what became a very strong epidemic."
After receiving her M.D., Chang went on to intern at the San Francisco General Hospital where she continued to observe and learn about HIV and AIDS for the next three years. "Up to 30 percent of the patients were dying of AIDS at any time … [it was] very intense training," she said.
From San Francisco she was granted a fellowship from the National Center for Health Services Research at the Universities of California at Berkeley and San Francisco, where she completed her Masters in Public Health (M.P.H) and then began her long history of work with the city of San Francisco.
She was hired as the chief administrator of San Francisco's Department of Public Health AIDS Office where she designed and oversaw programs that expanded the office's budget from $8 million to $32 million during her three years there.
Chang headed a team that strove to "create and grow the San Francisco model of HIV care," she said. "[We] really tried to institutionalize this model of care, which in essence is comprised in trying to maintain patience in the community for as long as possible so rather than trying to focus all of your care in the impatient hospital setting. We focused on support services to try to keep patients functional in the community as long as possible."
Quality and quantity
Chang says that throughout her career, her main areas of interest have been HIV/AIDS and improving the access of health care to lower-income patients. She focused on both of these issues during her time at San Francisco's Department of Public Health. "Right now we take it for granted, but at the time the whole expectation that patients should be a lot more active in deciding about their care was more of a new phenomenon. There are a lot of politics in patient advocacy. [That] really started with the AIDS activist community," she said.
"I was trained in an academic medical center and went from that to running a community based for allocating large amounts of funds," she continued. "It was an extremely political process [and] I think that having a stronger liberal arts education was actually very helpful in that setting."
Chang left her post in San Francisco in 1993 to serve as a special consultant to the Secretary of the U.S. Department of Health and Human Services where she worked to review national HIV prevention projects within the department. "At the time we thought we were going to have a health care reform so I was commuting back and forth from Washington D.C., but the reforms didn't happen," she said.
"[Chang] was a very engaged, civic-minded person, but she's not ideological in anyway. She's an incredible pragmatist," said Masters. "She's not the kind of civil servant that really idealizes government work and views it as a critical mission and downplays the private sector. She wanted to affect systems and how things are done more broadly and felt that the best way to do it was through the government."
Because of this aspiration, Chang resumed her work as a primary physician and also accepted a full-time faculty position at the University of California, San Francisco (UCSF), where she remained for four years. There she worked on research in the area of breast cancer and was awarded the American Cancer Society Cancer Control Career Development Award.
During her last two years at UCSF, the city of San Francisco approached Chang to develop and manage the city's version of Medicaid assistance. She accepted the position and successfully oversaw all medical aspects in the design and development of the San Francisco health plan.
In 1997, the Kaiser Family Foundation asked Chang to join their staff as the director of HIV/AIDS programs. "I stepped out of doing a lot of local health policies back into the national arena," said Chang. "I worked on larger health care financing issues and also wound up doing a lot of general raising of HIV awareness."
As part of the attempt to raise awareness at a national level, Chang worked as a medical consultant for Black Entertainment Television Teen Summit on HIV, an MTV documentary, a national Hispanic radio series on HIV, as well as for several spots on the television series "ER." In addition, she conceived and oversaw a variety of grant programs to improve quality and access to HIV care and HIV-related public education.
Chang began her current position at the VA in 1999 and remains committed to improving the quality of and access to health care nationwide. "Veterans in the country are generally of lower income and otherwise would have no access to quality medical-student care," she said.
In addition to the general focus on HIV and AIDS, Chang has also tackled hepatitis-C, "another large epidemic that we're going to see a lot of in the next decade," she said.
While she continues to practice clinical medicine in addition to her work with the VA, Chang still has time for life outside of her work. She is married to a professor at Stanford University Medical School, and is also the self-proclaimed "soccer mom" of two daughters, aged 10 and 7.