By Julie Galante
Emergency physician Dr. Cara Buchanan MPA 2025 is using policy and practice to bridge the health equity gap in justice-involved care.
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When Dr. Cara Buchanan MPA 2025 stepped into the chaos of the emergency room (ER) during the COVID-19 pandemic, she carried more than her stethoscope. She carried stories—of patients, of her own family, and of a system stretched to a breaking point.
Now as an attending emergency physician at Mass General Brigham in Boston, Buchanan stands at the crossroads of practice and policy—determined to bridge the two—to serve, reform, and honor the lives of those who receive her care.
Buchanan took on a Health Policy and Social Emergency Medicine Research Fellowship and applied to the Master in Public Administration (MPA) Program at Harvard Kennedy School. Her two years at HKS—not exclusively surrounded by other physicians—was a “profound shift.”
“One of the great strengths of this experience has been the exposure to different ways of thinking: economics, diplomacy, leadership, management,” she reflects.
Her path to medicine wasn’t clear cut. Unsure whether to follow in the footsteps of her neonatologist father, Buchanan studied human rights and Hispanic studies as an undergrad at Columbia University. Shaped by questions of justice and equity, her academic journey took a decisive turn when she served on Capitol Hill for the late Congressman John Lewis in the early days of the Affordable Care Act (ACA) rollout.
“Congressman Lewis, in his larger-than-life way, never made me feel like I had to choose between medicine and policy,” she recalls. “He told me, ‘You can be a doctor and come back to do policy. We need real stories, of real people—that’s why we do this work.’ He made me believe it was possible to live at the intersection of both worlds.”
Inspired by Lewis’s encouragement, her close-knit family, and the legacy of healthcare advocates like Congresswoman Barbara Jordan and Senator Ted Kennedy, she attended medical school at George Washington University School of Medicine and Health Sciences in Washington, D.C., with policy still within her sightline.
In many ways, this balance—the micro and macro, making intimate human connection and designing opportunities for systemic change—has defined Buchanan’s career.
“Practice and policy have to go hand in hand,” she says. “It’s what drew me to medicine. I had this overwhelming sense of wanting to engage with something big and meaningful but also wanted to work with individual people and make real change.”
Buchanan admits she thrives in chaotic environments. “That undifferentiated, uncertain space where you’re not sure what’s going on? For some reason, that’s where I feel calm, clear, and focused.”
“Practice and policy have to go hand in hand. It’s what drew me to medicine. I had this overwhelming sense of wanting to engage with something big and meaningful but also wanted to work with individual people and make real change.”
But there’s more than adrenaline and commotion in the emergency room.
“There’s deep humanity in the chaos,” she says. “Everyone is their raw, unfiltered self.” Even amid systemic flaws, she finds something sacred in the ER environment. “Despite inequality in the system as a whole, the emergency room itself is a place that everyone accesses the same way. Once you’re inside, that space belongs to everyone.”
Buchanan not only sees patients in the ER; she sees patterns.
“Emergency physicians become incredibly attuned to nuance—small, observable behaviors that can tell you a lot,” she says. “Emergency medicine is also about pattern recognition. The human experience has rhythms you begin to recognize.”
She saw a shift after the ACA was passed.
“More people had access to healthcare for the first time. Pre-existing conditions no longer excluded them from insurance. That shifted what came into the ER,” she says. But while access improved, deeper problems persisted. Opioid use and overdoses, violent crime, poverty, and housing insecurity still drove people to the ER.
For Buchanan, the emergency room is a lens into society’s challenges.
“If any of those systemic problems reaches a tipping point, the ER becomes the safety net,” she said. “I couldn’t ignore the broader implications. I kept thinking: there are better systems, better policies that could prevent so many of these visits.”
Her frontline experience in the Los Angeles County Medical Center’s ER—recently renamed Los Angeles General Medical Center—during the COVID-19 pandemic marked another turning point.
“Any healthcare provider in the ER during that period will struggle to express what it felt like,” she says. “It was the lived case study of everything we’re trying to fight against: health disparities, unequal access to care, systemic vulnerabilities. Suddenly, all of those cracks in the system were fully exposed.”
Amid the heartbreak of losing patients daily, Buchanan experienced a deep personal loss: her father—her biggest role model, who shaped her values of resilience and her deep connection to justice—passed away from COVID-19 in the early months of the pandemic.
“I was grieving as a daughter and trying to show up as a doctor,” she says. “It was profoundly difficult.”
The trauma she witnessed and experienced pushed her to bridge clinical insight with systemic reform.
“It made me ask: what do I need to do to better equip myself?” she says. “Every day in the ER is someone’s worst day, so the question became: How do I honor that? How do I carry the lives lost and the grief I’ve witnessed, and make those realities feel real to people outside those walls?”
“Every day in the ER is someone’s worst day, so the question became: How do I honor that? How do I carry the lives lost and the grief I’ve witnessed, and make those realities feel real to people outside those walls?”
She found her answers in community, mentorship, and reflection. Support from loved ones and HKS’s intellectual environment helped her rebuild from burnout.
“I came into this space with a unique lens, having lived through the pandemic as a frontline provider,” she says. “I carry that trauma with me every day.”
Buchanan says her HKS experience culminated in organizing a May 2024 Harvard Radcliffe Institute Seminar that focused on the health equity gap in justice-involved care. She co-led the seminar with Angelopoulos Professor of Public Policy Marcella Alsan and Alice Bukhman, director of clinical operations at the Brigham and Women’s Faulkner Emergency Department, and brought together some 15 leaders around the country—physicians, researchers, healthcare providers, policy analysts—to build consensus on bridging the health equity gap in justice involved care and mapping out future priorities and challenges.
Among the leaders was Sandra Susan Smith, the Daniel and Florence Guggenheim Professor of Criminal Justice, faculty director of the Program in Criminal Justice Policy and Management, and director of the Malcolm Wiener Center for Social Policy. Buchanan worked with Smith after the seminar to launch and moderate a six-part speaker series, The Diagnosis of Incarceration: The Health Impacts of Criminal System Involvement, to focus on equity in justice-involved healthcare.
“The series helped spark real conversations about what compassionate, patient-centered care could look like in those complex settings,” she says. “The connections and lessons are still very relevant. I hope to help implement some policy work, especially around emergency room protocols and policies in large safety-net hospitals,” she says, adding: “I want to keep showing up.”
And she does—like in her recent collaboration with Dr. Onyeka Otugo MPA 2021 on a new project, Nadv.RX. Together, they are developing a text-to-speech tool to simplify complicated ER discharge instructions and empower patients to manage their care regardless of their language proficiency or health literacy skills.
“I had no prior experience in entrepreneurship, but I’ve realized the path I’m carving out in justice-involved care is actually very entrepreneurial,” she notes.
But even with policy and innovation in focus, Buchanan remains anchored in the ER.
“There’s something incredible about the ER ecosystem—the people who thrive in chaos, who problem-solve on the fly, who use humor to make light of the darkness,” she says.
Throughout it all, her friends, family—her mom and sister especially—and her partner, also an emergency room physician, remained her steadfast compass.
“My family has always been supportive, even though the path was hard. But it was guided by this sense of purpose—of justice—and by mentors who reminded me that the micro tasks were part of a much bigger picture.”
As she prepares to graduate later this month, Buchanan holds a steady view of what lies ahead. Because hers is a story of carrying both the weight and the wonder of medicine, grief, justice, and hope—and finding a way to honor them all.
“Slowing down, reflecting, building that longevity,” she says. “You have to hold the heaviness and the light. That’s how you build something that lasts.”
Portraits by Natalie Montaner; inline image courtesy of Cara Buchanan
