Taking the long view

This story was published in the spring 2023 issue of 12th & Marshall. You can find the current and past issues online.

For some aspiring physicians, the path to medicine begins with an inspiring mentor. A challenging science class. Maybe a youthful curiosity.

For Shari Barkin, M.D., it started by falling down stairs.

She grew up – the youngest of four and the daughter of a physician and a nurse – in a home “steeped in medicine around the dining room table.” But she had a different future in mind.

As a freshman at Duke University and a talented dancer, Barkin had choreographed a major production that earned her an invitation to New York City for a prestigious performing arts camp working with Broadway professionals. It was there that she fell and, not long after, woke up in the middle of the night, unable to walk. Weeks of hospitalization and months of recovery followed. The experience, she says, helped her recognize “you can’t depend on one part of your body for your career.”

It also exposed her to the best – and worst – of medicine. To the physicians and medical students who crowded into her hospital room, “I was a specimen,” she says. They spoke about her, not to her. They examined her without asking permission. When she demanded they acknowledge her, she was labeled “a difficult patient.”

Yet she also remembers a nurse who attended her late at night. “He would pay attention to the little things,” Barkin says, like making sure she had cold water at her bedside.

Now chair of the Department of Pediatrics and physician-in-chief for Children’s Hospital of Richmond at VCU, Barkin learned important lessons in patient care from those impersonal physicians.

“I will not talk about somebody, I will talk to somebody,” she says. “I will not engage unless I have permission to engage. I will see the person in front of me, not the symptom.” And from her favorite nurse she learned, of equal importance, that “no act is too small if it can help improve somebody’s quality of life.”

Building systems that advance health equity

Barkin joined VCU from Vanderbilt University in August 2022, in the midst of construction on the new Children’s Tower. The major project to expand inpatient and emergency care helped draw her to the MCV Campus.

“From my perspective, CHoR and the Department of Pediatrics are at an inflection point,” she says. “Not only have we opened this beautiful new space, but it symbolizes what we are promising to do for children in Richmond and the region and beyond.”

At this moment of expanding mission and resources, Barkin brings deep clinical, research and leadership experience in children’s health, with a longtime interest in addressing health disparities and challenging public health issues like obesity. In addition to her M.D., she holds a master’s in health sciences, and throughout her career she has emphasized the importance of translating research into outcomes.

“She has a strong belief that any research that is developed needs to go back to the community, to benefit the community,” says Velma McBride Murry, Ph.D., a university distinguished professor and the Lois Autrey Betts Endowed Chair of health policy and human and organizational development at Vanderbilt University, who worked closely with Barkin. “She is constantly thinking about how providers can use information to create population health change, to increase patient engagement, to increase access to services.”

During her fellowship at UCLA, Barkin’s work focused on youth violence prevention. She didn’t think small; her first big, $2 million grant-funded study involved 5,000 families, 200 providers and 100 pediatrics practices across the U.S. and Canada.

“The goal is to use the gifts we are given to make the biggest difference possible,” Barkin says.

In the early 2000s, Barkin’s research shifted to youth obesity prevention and health disparities reduction. Since then, much of her work has sought to determine how to build systems that advance health and health equity.

“I look at the interaction of epigenetics, behavior, built environment and social environment, and how they interact over time as children are developing,” she says. A goal in her new role is to “understand the comprehensive nature of social determinants of health and how they influence health outcomes.”

Research in her field has recognized, for example, that obesity prevention for children requires intervening before risks develop, which means working not just with the child but the whole family, Barkin explains. With this approach, “You get a two-generation impact. You improve the outcome for the child by preventing chronic disease, and you intervene with parents to treat chronic diseases.”

Not surprisingly, nutrition is an important aspect of that intervention. Healthy food, Barkin says, “is both preventive for chronic disease and treatment for many chronic conditions.”

Elected to the National Academy of Medicine in 2021, Barkin is now researching how targeted nutrition might improve health outcomes, as part of a multicenter NIH-funded study called Nutrition for Precision Health. Along with the opening of the Children’s Tower in April, Barkin and team will launch a Family Resource Center with “food as medicine” at the center.

Leadership as collaboration

If these are ambitious goals, Barkin is someone whose leadership can make them a reality, says Karen Hendricks-Muñoz, M.D., M.P.H., professor and the William Tate Graham, M.D., Endowed Chair in the Division of Neonatal Medicine, deputy director of the VCU Center on Health Disparities and prior interim chair of the Department of Pediatrics.

“She is committed to having the best for children and their families,” Hendricks-Muñoz says. “In her actions you can see that she really means it. It’s not just verbiage. She makes things happen.”

Barkin jumped into action soon after arriving on the MCV Campus, appointing Hendricks-Muñoz to an inaugural role as vice chair for faculty development and diversity, equity and inclusion, and creating a DEI council of faculty and staff to support that work. Barkin sees that step as foundational to the broader goal of equity and inclusiveness both within the department and CHoR. Reducing health disparities depends in part on developing a diverse workforce with the cultural competencies necessary to create trust and connection with patients and their families.

Murry saw this principle at Vanderbilt when Barkin hired Spanish-speaking research team members to assist with an obesity prevention research trial in the Latino-American community.

“I watched her really share that leadership power with research staff who had greater access to and were much more trusted by the community,” Murry says. “She helped create a research environment that would encourage families to participate.”

For Barkin, that collaborative, inclusive approach is intrinsic to leadership. “Leadership doesn’t exist in isolation,” she says. “It comes with partnership.”

“She is a real doer, but a collaborator at the same time,” Hendricks-Muñoz confirms. “She brings her best every day, and she makes you want to bring your best every day, too.

Where curious people come together

Barkin sees an academic environment as an ideal setting for collaborative work. “A critical part of being in medicine is staying open and constantly learning,” she says. “Academics is where curious people come to make a difference.”

She also loves that academic medicine provides an opportunity to work with medical students. She meets individually with every student considering a career in pediatrics and brings students, residents, and fellows alongside her to work on research projects and gain experience.

“I have had many important mentors in my career,” she notes, “so it’s about paying it forward.”

At CHoR and in the Department of Pediatrics, Barkin plans to build off existing strengths. From mental health to emerging diseases to acute illness and chronic conditions, she wants to “highlight team science and how we bring multidisciplinary perspectives to how we handle the issues of today.

“Looking across the life course longitudinally, we can connect things from early childhood all the way through adolescence and adulthood,” Barkin says.

And from her own experience as a young patient, she continues to recognize the importance of advocating for others – and helping them advocate for themselves.

Barkin’s vision, Hendricks-Muñoz believes, will make a difference. “She has an incredibly dynamic, positive outlook in her focus on all children, on equity, on quality, on advancing support for families.

“In the next five to 10 years she’s going to make really important inroads for child health here in Virginia and beyond.”