THREE FRIENDS are sitting by a swiftly flowing river enjoying themselves when they hear someone crying for help, caught in the current, trying not to drown. They swim out and rescue the person, pulling him back to shore. After a few minutes, they hear another cry for help, and again they all jump in. Then it happens again, and again, and again. The three are soaking wet, tired, and confused. One of them gets up and starts to walk away. “Where are you going?” the others ask in disbelief, imploring him to stay and help them rescue all these people. But the first one says he is going to walk upstream to understand why all these people are being thrown into the river in the first place.

As an emergency room doctor, Alister Martin MPP/MD 2015 often feels like one of the friends, jumping into the river, shift after shift, attending to gunshot wounds, heart attacks, strokes, and the many patients who come to the ER with any ailment because they simply have no alternative. But he has also wandered upstream, combining his clinical work with a sharply analytical and deeply humane interest in what turns people into patients and then launching effective and influential campaigns to instill change.

To date, just two years after completing his residency, Martin has built successful national campaigns to enlist doctors in the battle against the opioid epidemic and to use health care settings as a nexus for voter registration. He is part of a wider movement within medicine that believes that doctors should not be confined to the examination room but should also be part of broader public debates on issues that have obvious health care implications—such as gun violence, the criminal justice system, and economic inequality—and that they can be part of the solution. “We’re all sort of painting this mural together of what the future of health care looks like,” Martin says. “My role as an emergency room doctor doesn’t end at treating the emergencies; it extends to how to prevent them.”

Martin’s views and his ability to work at both the clinical and the policy levels have been influenced by his medical training, by his exposure to policy at the Kennedy School and in short stints in public service, and perhaps most of all by a difficult childhood and adolescence marked by many of the same difficulties he now dedicates himself to fixing.

We ask everyone about smoking. We ask about domestic violence. We should be asking folks if they’re registered to vote in the next election.

Alister Martin

MARTIN GREW UP IN A LOW-INCOME COMMUNITY in New Jersey. His mother—a biology teacher who had to work multiple jobs to keep the lights on—raised him by herself. His father (whose story would later have an unexpected impact on Martin) left when Martin was very young. His family’s experience with health care was similar to that of many of the patients he now sees: They were sometimes uninsured, sometimes without a primary care doctor, sometimes simply unable to get to a doctor’s office during the day.

“When your mom works until 8:00 p.m. every night, or when health insurance is more a luxury than something that you rely on and depend on,” Martin says, “if you have something that needs to be looked at, the answer is ‘We’re going to the emergency room.’ Because for low-income, vulnerable communities, it’s the place that’s always there for you.”

man in doctors coat looking into camera

When Martin was 11, his mother was diagnosed with cancer. It was caught late, and he thought he was going to lose her. He saw the doctors who treated and saved his mother as heroes. But his path to medicine was tortuous. He was a smart kid. But he just wasn’t able to see the future that studying could bring. Then, in his senior year in high school, he was expelled after he and a couple of friends got into a fight with a gang, resulting in severe injuries. He was physically broken and now couldn’t envision a path ahead. His mother tirelessly advocated for him, and when she was unable to find a school that would accept him, she took out a loan and sent him to a tennis academy in Florida famous for training Venus and Serena Williams after their move from Compton, California—an earlier summer job as a janitor at a country club had introduced him to tennis. It was there that his life changed. He earned his GED and was recruited to Rutgers to play Division I tennis and spent his first year holed up in the library (when not on the court), fearful of not being able to make it.

“I had this opportunity, this door that had creaked open,” Martin says, remembering what felt like a second chance. “If I applied myself, I could make something of myself, and I sprinted through that open door.” His hard work paid off, and he was accepted to Harvard Medical School. He excelled clinically and would eventually be selected as chief resident of his residency at Massachusetts General Hospital, where he now practices. But three years into his training—the year when medical students step out of their classrooms and into the wards—Martin began to chafe against the complex machinery of health economics and what he saw as fundamental inequities in the way health care was delivered. It was during that time of doubt that he applied to the Kennedy School, looking for the tools and resources to help him understand the deeper problems he was seeing.

The Kennedy School also represented something more personal. When he was 20, Martin met his father for the first time. The man was not what Martin had expected (his mother had shared very little with him): He was a diplomat from Belize and an alumnus of the Kennedy School, which he had attended as a Mason Fellow. Just before Christmas break during his first year at HKS, Martin received a message that his father was fighting his own battle with a late cancer diagnosis and did not have long to live. He traveled immediately to be by his side. That time together helped Martin understand his father and the choices he had made. “My going to be there for him in his final days was a reflection of my mother’s strength, of all the kindness, love, and compassion she had instilled in me. I came to understand my father, and by doing so, came to understand myself more clearly,” he says. Now his father’s Kennedy School degree hangs framed on Martin’s wall next to his own.

HKS expanded Martin’s understanding of the levers of change. A period working in the Vermont governor’s office gave him insight into how health policy was crafted as a dialogue between decision-makers and area experts, but it also showed him that only those who were politically involved could influence the process. But he never abandoned the idea of being a doctor, for the “bifocal vision” that being in the emergency room gave him as well as for the satisfaction of healing his patients.

If you want to solve problems, you have to be close, you have to feel them and know the impact and understand the stories.

Alister Martin MPP/MD 2015

“I believe firmly in the concept that Bryan Stevenson [MPP/JD 1985] calls proximal leadership,” Martin says. “If you want to solve problems, you have to be close, you have to feel them and know the impact and understand the stories. Once you understand the problem in as much detail as you can, and understand the nuance of it, you can begin to see areas of solution—because ultimately it’s the people with the problem who are the solution.”

DURING HIS FIRST OVERNIGHT SHIFT in an emergency room, Martin came face-to-face with a problem: a woman who had become addicted to opioids in just a few short weeks after a bad ankle fracture. She had become so dependent on the oxycodone she had been prescribed that she found a dealer. But the woman had decided to take a stand, and that night she came to the emergency room looking for help.

Martin, who had seen Vermont’s nationally famous opioid addiction programs close up, was devastated when he learned there was nothing that he or the department could do for the woman—they couldn’t connect her to a treatment program or prescribe medication to help her fight her addiction. In the end, she had to be discharged. At the height of the opioid epidemic, this seemed like madness.

Then Martin saw something he could do. An arcane rule required emergency room doctors to obtain a special waiver from the federal Drug Enforcement Agency to prescribe buprenorphine, a drug that helps treat addiction by blunting both cravings and the pain of withdrawal, but only one percent of ER physicians had that permission. Combining elements of behavioral science and organizing that he had learned at HKS, Martin began the Get Waivered campaign, first enlisting leadership in his department and then building participation until 95 percent of emergency room doctors at Mass General had received the certification. The program has expanded nationwide, including in partnership with states such as Texas and Nebraska.

David Brown, the chair of Mass General’s emergency medicine department, has supported Martin in his work and sees it as a vital component of the way the department and the hospital approach medicine. “Many of us can identify problems,” Brown says. “Some of us can suggest solutions. But very few of us can actually implement those solutions. And that makes him unique in my mind.”

lanyard with scannable QR code on the front.“I think he’s the ultimate example of multidisciplinary training,” says David King, a senior lecturer in public policy, who taught Martin and has remained close, advising him on his projects. “He’s obviously a very good doctor and has the personal qualities that one would hope for in a physician—very good bedside manner, listens deeply and analytically, and has an intuition about what the patient might need. He takes the time to do an analysis of what’s ailing the body—and also what is ailing the body politic. Alister sees the political system as the body politic, and he sees individuals as part of a social system and a health system. So it only makes sense that they’re connected.”

The body politic is precisely where Martin is now working through the VotER campaign, which has helped more than 48,000 people get ready to vote through voter registration or by helping them receive a mail-in ballot, and has created a vast network of more than 25,000 doctors dedicated to expanding their patients’ political participation. It was again an encounter with a patient that kicked off the initiative. This time the patient was a woman who had fled an abusive relationship in another state, had lived with a relative in Massachusetts for some months, but now found herself homeless with her two children. She came to the emergency room late, afraid that it was too cold for her children to spend another frigid night sleeping in their van.

Martin reached out to a social worker, who told him that Massachusetts is a “right to shelter” state for families, meaning that the woman and her children could be housed temporarily in a hotel or a motel, but she needed proof of residency. Given her unstable housing situation, the woman had nothing—not a check stub or a utility bill or a Massachusetts driver’s license. But there was something she could do: register to vote, as this would count as proof of residence in the state. A federal law passed in 1993 to increase voter participation encourages places such as motor vehicle registration offices and hospitals to register voters.

Martin returned and asked the woman if she wanted to register to vote. The woman, who was 27, said it was the first time she’d ever been asked. “I had chills up my back at the time,” Martin says. “I was like, ‘My God, how many people, how many patients have I seen like her that have not been registered?’ So I looked at the data: A Pew Research survey back in 2018 found that 60 percent of voting-age eligible citizens who were not registered to vote had never been asked. There’s this whole lost continent of people—50 million people—not registered to vote, many of whom have just never been invited into the process.”

Once again, Martin not only used his extensive support network at Mass General but also reached back to the Kennedy School for help. He worked with Miles Rapoport, a former Connecticut secretary of state and a senior fellow at the Ash Center for Democratic Governance and Innovation, who helped connect him with others, including philanthropies, in the democracy space. Aliya Bhatia MPP 2018 is the organization’s chief operating officer. Kathryn Peters MPP 2011, of Democracy Works and TurboVote, helped Martin navigate the practical challenges of registration. And ideas42, a Washington-based behavioral consulting group that counts numerous Kennedy School alumni among its ranks, helped VotER shape its strategy. That strategy, which relied on kiosks in hospital waiting rooms, had to be radically rethought when the pandemic hit. Now, in place of touchpads at centrally located kiosks, the 25,000 doctors across the country who have registered with the program wear distinctive lanyards and ID badges with QR codes designed to engage their patients and then direct patients to a website where they can register.

The approach is nonpartisan. Martin believes it’s a logical continuation of what doctors have been doing. “We ask everyone about smoking,” he says. “We ask about domestic violence. We should be asking folks if they’re registered to vote in the next election.”

The campaign is not only increasing registration, Martin says, but also changing the way doctors think about their role and “fundamentally changing the way that physicians are thinking about solving problems.” He is aware that some people are critical of doctors’ taking on this role, either because they feel that doctors should “stay in their lane” or because they think it’s too political. But he tackles that argument head-on. “I’m acknowledging that this whole thing is political,” he says, “because health care is political. What we’re avoiding is the partisan part of it.”

Banner portrait by Raychel Casey

Photo by Jonathan Wiggs/The Boston Globe via Getty Images

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