Toni Richards-Rowley AB '93
I graduated from Harvard in 1993, and I am a general pediatrician and practice right outside of Philadelphia in one of the Children’s Hospital of Philadelphia primary care centers. I’m a full time pediatrician by day, and I also wear a bunch of other hats. I’m very involved in the Pennsylvania Chapter of the American Academy of Pediatrics, and I also do a lot of work for the National Academy of Pediatrics. For example, I’m on the Committee on Federal Government Affairs, where I focus on advocacy at the federal government level. I also just started a term as an executive committee member for the section on minority health, equity, and inclusion.
When did you become interested in medicine, and how has your training at Harvard prepared you for this?
I’ve known since the age of four that I wanted to be a pediatrician. Because I had that knowledge, I wanted to study something at Harvard that I would never get an opportunity to study again. I was a sociology pre-med concentrator, and I focused on race and ethnic relations at Harvard. I was already studying the social determinants of health then, before it became more commonly studied as it is today, and particularly I was interested in poverty and health inequities. For example, the infant mortality rate and maternal death rate are especially high in African American babies compared to white babies. The sociology background has helped me ground my advocacy efforts now later on in my career.
At the time of the start of this field, what was it like to be studying the social determinants of health?
At the time, I was definitely part of a small set of voices trying to bring a focus on these issues in the general medical community. We were arguing that these inequities exist, and we have to tackle them and deal with them. I remember, going into my OB-GYN rotation, I was torn between OB-GYN and pediatrics. I recall some attendings and residents in the OB-GYN clinic talking about ‘crack babies’ and moms coming in addicted to crack, with similar derogatory words being used generally, too. After hearing this, I decided to do my lecture for that rotation on educating them about substance use and how addiction is not a personal failing, but part of the inequities that people face living in certain situations.
That’s incredibly brave of you to stand up and take that position, to speak up so that their future patients can hopefully have a better chance of receiving better quality care in the future. What led you to general pediatrics, then, instead of specializing?
I was tempted along the way to go into neonatology or adolescent medicine, but I ultimately chose general peds for the formation of relationships with families across time. I owned my own practice for almost eighteen years, and I took care of children from birth until age 18. Some patients who I had seen as adolescents also brought their own children then to see me because of these long-term relationships. It meant so much to me, to be one of the most trusted people in their lives outside of the family unit.
I always tell my newborn parents that this is a partnership. My role as your child’s pediatrician is to be a guide. It’s also helped having four kids of my own, as I use a lot of my successes and failures as a parent in my day-to-day practice with my families.
When all’s said and done, it’s going to be those relationships and making a difference in the individual lives that will always stay with me.
What are some of the challenges, then, that you have faced being a general pediatrician?
Just because kids are little, it doesn’t mean they’re not worth a lot.
Our society puts a lot of value on specialized medical fields. Take anesthesiology, for example, where you’ll make five times more than a primary care pediatrician easily.
For us, what describes our role is a T-shirt that says “Vaccines cause adults.” Our job is very hard — we deal with newborns in one room, depressed teens in another, and an autistic kid in the next. We have to pivot constantly, but our work is not valued—not paid—at the rate of an anesthesiologist who is trying to keep you alive while surgeons operate on you. That work, of course, is extraordinarily important, but I have to argue that we also do important work — we make sure somebody goes from birth to eighteen.
The way that medicine is valued these days, in addition to paying attention to service and quality care, it should pay a premium to pediatricians — we have a knowledge base that deals with such complex cases, even for giving medications to kids. For example, we have to calculate dosages based on weight in kilograms, while it is easier to give certain tablets to adults. We have a lot more things to think about.
It’s similar with teachers, too, as they are the worst paid profession out there — even though they spend eight hours a day with our children, and they are educating our next generation. In a country that prides itself on taking care of its most vulnerable, we need to make sure pediatricians and teachers are properly paid, not just celebrities or basketball players and the like. We do all this because we love what we do.
I completely agree — as general pediatricians, you are the first line of defense, but you are also the unsung heroes of medicine!
Indeed. In fact, people are giving us a challenging time about wearing a mask right now, too — even though there are these skyrocketing cases of flu, RSV, and COVID-19 in kids.
Going right off of that point, what has your experience been with pediatric vaccine hesitancy and COVID-19?
Going back 20, 25 years ago, I had a lot of parents asking questions about the MMR vaccine as it was supposedly linked to autism. Parents wanted to split it up into individual components or have a different schedule, so when I first started, I really tried to talk to parents and reassure them. Then, there were also parents who started to say that they didn’t want any vaccines for their kids at all — and, again, I would think back to the T-shirt, “Vaccines make adults.” There’s a reason behind why we give vaccines and the trust in my medical opinion, saying that this will be something that is going to protect your child. For me, their questions showed their was a bit of doubt in our partnership together — doubt in a partnership that I need to have with you in order to help your child become a thriving adult.
As a result, I made the conscious decision in my own practice then not to accept parents who did not vaccinate for the routine required vaccines — with the exception of the flu and HPV (which I would poke and prod them about every single year, believe me).
Actually, when COVID-19 was on the rise, we had parents clamoring to ask when it would be available for their kids. I even enrolled my own two younger children in a Moderna trial because I really wanted them to be protected—and they did end up getting it in the trial.
The hesitancy comes from a lot of misinformation in cyberspace, along with a decline in trust in the relationship with and the knowledge base of physicians in general. I understand that there are valid reasons for not blindly trusting your doctor. As a black woman in medicine, I understand you always have to ask questions—but for something as fundamental as vaccines that keep kids alive? There’s a reason why we don’t see live chicken pox or polio today. We’ve done a good job as pediatricians in caring for children, vaccinating them and eradicating a lot of these diseases.
How do you draw from your clinical experiences in your advocacy work?
In the world of advocacy, I can draw from a lot of my personal stories in the clinic for talking to members of the legislature, for example. I used to live in Florida, and I attended the Advocacy Conference for the Academy of Pediatrics as a general pediatrician, specifically focused on gun safety and lobbying Congress on gun safety.
Six months prior to this, I had a young lady, someone who I had seen for years in my practice, come into the clinic. She was about to graduate out of my practice because she was 18 and going off to college, but when she was here for her college physical, she was distraught. Turns out, she had lost her boyfriend to an accidental gun accident. He was hanging out with friends, one of the friends’ fathers had a gun, and they were playing with it. He put it to his head and shot his brains out, never thinking that it was loaded. They were planning to marry, and he was just going to go off into the military. Their lives ended at that moment. There were so many different ways this could have been prevented — it could have been locked away, it could have been unloaded, etc.
I used that story to talk to somebody who was Republican and not as interested in gun control. I noted that I understand where he is coming from, but I think we can still find common ground to support gun lock boxes, to change laws so that guns can have a certain fingerprint to be able to fire. Gun violence is now the number one killer of certain populations in the US, and if we don’t deal with it, we’re losing all those kids who I was saving with vaccines earlier.
Those day-to-day interaction stories with my patients help push along and make real lots of policies that people talk about, ultimately.
In addition to policy advocacy, you mentioned you serve on an inclusion committee. How do you promote recruitment and retention in these positions?
My motto is, if you can’t see it, you can’t be it. I was privileged — both my parents were physicians, and my mom’s father was a physician. They did not go to medical school in this country, but in Jamaica instead. Growing up, then, I saw a black female (my mom) who was a physician.
It was not until I was older that I began to realize all the obstacles my mom had to go through in the early seventies to be in medicine. For myself, going to medical school, I was very well aware that fellow medical students would think that I did not belong there, and residency can also be a traumatic time for a person of color because of the systemic racism in society. Knowing this, when I got a position in my medical school and residency programs, I started interviewing applicants for medical school and interns. When I was a clinical fellow in adolescent medicine, I was also a member of the Internal Selection Committee, and I was very purposeful. People of color need to interview people of color applicants because if you can see it, you can be it. They know that there’s somebody out there who looks just like them, and they can ask about our experiences.
It’s tough, but you can look for a support system and find your allies.
Interestingly enough, I was at a national convention recently where I met a woman who said she left medicine as an African American woman pediatrician. To describe her choice, she used the metaphor of a small story — one about a young boy who has a goldfish who just died. He goes with his mom to the store to get another goldfish, but he sees a clown fish and wants that instead. He asks his mom, but his mom says they can’t get it because it needs salt water, and they only have a fresh water tank. Then, the little boy decided to take the goldfish instead.
What happens at the institutional level with initiatives like diversion, inclusion, and belonging is that they bring in so many “clown fish” or “Nemo’s” into fresh water tanks, and the fresh water tank is literally and figuratively going to kill them unless the environment changes to become more supportive.
Here I was, trying really hard to get more residents of color into programs, but there was nothing happening at the top to really make it supportive of these people when they do get here. As a result, many of them might leave because they don’t see that it is worth it to stay here. For example, they face so many microaggressions — from being asked if they are part of the cleaning crew to being treated as if they were a nurse. There’s a lot of work that needs to be done, and it needs to be done by people who are at a position where they can afford to do this because they are in a more senior position or have had more life experience.
For me, if there’s not a seat at the table, I’m going to pull up my folding chair and sit there myself.
What words of advice do you have for our students and community members interested in advocacy themselves? What can we do?
Your voice is powerful, and it’s powerful in numbers. Find your passion—for me, it’s health inequities, mental health issues, juvenile justice, and gun control. Once you find those initiatives on a societal level, go and make change happen. Especially for those of you who are younger, you grew up with social media and don’t stay silent. You are able to make change, so never underestimate the power of your own voice.
Even in the darkest times, there’s always a rainbow. When things get really tough, just keep putting one foot in front of the other. Sometimes, you don’t realize something that you might have planned and was a great disappointment will actually be a good thing.
Toni Richards-Rowley, MD
AB 1993 | Sociology
Compiled and Interviewed by Felicia Ho