This interview is part of the series, Pathways to Practice: Stories from Underserved in Medicine, which features current residents, fellows, and recent graduates sharing their personal journeys – from formative experiences before medical school to the realities of being in their residency and/or fellowship programs. Each story highlights the moments, mentors, and motivations that led them to choose graduate medical education (GME) programs focused on medically underserved areas. Through these reflections, interviewees explore how their backgrounds and clinical education and training shaped their commitment to providing high-quality health care for all and influenced the paths they plan to pursue in practice.
Denise Powell, MD completed her pediatrics residency at the University of California San Francisco (UCSF), where she trained on the Pediatric Leaders Advancing Health Equity Track. She is now in her fourth year as a board-certified pediatrician practicing in rural Mississippi through the Mississippi Rural Physicians Scholarship Program. Dr. Powell plans to keep working in and for communities like the ones that raised her, while contributing to policy conversations around workforce development, access to care, and child health equity.
ACGME: Tell us about your journey and how it led you to where you are today, including about your medical school and residency or fellowship.
Dr. Powell: I come from a multigenerational Mississippi family on both sides. My mother was a family medicine physician, and some of my earliest memories are of traveling to different clinics and hospitals and literally growing up in the call room. My great uncle, Dr. Albert Bazaar Britton Jr., practiced on the historic Farish Street in Jackson, caring for communities throughout the Civil Rights Movement. These moments grounded me in a sense of community-centered health care.
After residency, I made the intentional decision to return home to become a pediatrician in rural communities. A lot of thought went into this move. I was transitioning from an urban West Coast city where I had built community and social support to a small coastal community; while the city was familiar, navigating it as a new physician was completely different. As I studied for my pediatric boards, I would sit outside and think about the impact of flooding, storms, and extreme heat on access to care. That experience shaped how I understood environmental vulnerability and eventually led me to become a Climate and Health Equity Fellow in 2023.
Background and Early Influences
ACGME: How did your background and early experiences help shape your interest in medicine and your understanding of health care disparities, especially in underserved areas?
Powell: Growing up in Mississippi, I learned early that health statistics do not tell the full story of a place and its potential. While my home state is often described through rankings and deficits, my lived experience has been shaped by people, including the neighbors who check in on one another, families who care for elders across generations, and clinicians who remain deeply committed to their communities despite limited resources. Volunteering with veterans in high school and spending time in long-term care settings in college reinforced for me that care in these communities was and is sustained by relationships, continuity, and trust, not just infrastructure.
In college, I conducted spider research in Belize, across jungle and island environments, giving me a fundamental understanding of scientific protocol. Studying biodiversity made it clear how health, whether ecological or human, is influenced by the environment, history, and balance. That perspective helped me recognize similar patterns in Mississippi, where outcomes are often shaped by structural forces rather than individual failures.
Years later, my pediatric residency in the Bay Area, along with focused training in health equity, highlighted how policy decisions, geography, and historical disinvestment shape community health throughout this country. At the same time, it affirmed something Mississippi had already taught me, and this was that “underserved” does not mean lacking in strength, leadership, or the potential for quality care.
Choosing a GME Program
ACGME: When it came time to choose a residency or fellowship program, what inspired you to select a program focused on underserved areas, and which aspects of the program aligned with your goals or values?
Powell: To understand the Bay Area, I watched Take This Hammer, James Baldwin’s interview documentary, and The Last Black Man in San Francisco. Both offered a layered look at the city’s history, including its cycles of displacement, and the sense of belonging communities have built for themselves historically. I began drawing parallels between the forces shaping neighborhoods in San Francisco and those I had seen throughout Mississippi. Different coasts, but familiar patterns of disinvestment influencing housing, opportunity, and health.
Through the Pediatric Leaders Advancing Health Equity Track, I trained in primary care clinics serving families from around the world and long-standing community members, while I gained autonomy across inpatient settings. I trained in a NICU [neonatal intensive care unit]-heavy program and spent more time than I expected in the PICU [pediatric intensive care unit] and transitional care services, often serving as the sole provider. These experiences sharpened my clinical judgment, strengthened my confidence, and reinforced the importance of thoughtful, systems-aware decision-making.
Experiences During Residency/Fellowship
ACGME: Can you share some of the most meaningful challenges and lessons from your residency/fellowship program working in underserved communities, as well as how they have influenced the kind of physician you are becoming?
Powell: In our primary care clinic in residency, there was the challenge of not knowing when a family would be able to return for follow-up due to circumstances outside of their control. Many patients were newly arrived to the country, navigating a completely unfamiliar community and health system while juggling structural barriers like transportation, work schedules, and insurance. We relied heavily on phone-based follow-up. Any child we were concerned about was added to a shared list in the electronic health record (EHR), and someone from the team would call until we knew they were safe or needed to come back, which taught me that follow-up is core to care, not something that happens passively.
As an intern, I faced the challenge of having less intensive care exposure than some of my peers. The learning curve in high-acuity settings like the NICU and inpatient units was steep, and I leaned on colleagues, which taught me that medicine is collaborative at its core and that we become better physicians because of the people on the journey with us.
ACGME: What unique skills or insights have you developed through your residency program that you might not have gained elsewhere?
Powell: I really appreciate the beauty of learning how to adapt. I trained across different hospitals, each with its own EHR, workflows, and clinical culture. Moving between sites for three years pushed me to pay attention quickly, adjust my approach, and provide consistent care to families.
That experience shaped how I care for patients with complex social needs. We worked closely with community health workers, social workers, and multidisciplinary teams, and learned how to problem-solve in ways that matched what families could realistically access. It reinforced the importance of meeting people where they are rather than where the system expects them to be.
I also became more comfortable practicing in uncertainty. When referrals or diagnostics were delayed or unavailable in the moment, I learned to rely on clinical judgment, prevention, education, and follow-up. Training during the [COVID-19] pandemic made this even more of a necessity, particularly as pediatric mental health needs increased. When I later practiced in rural communities where psychiatry was limited, I realized how that prepared me.
Looking Ahead
ACGME: What does your future in medicine look like? Can you share the kind of difference you hope to make in underserved communities and any advice you have for physician learners considering similar paths?
Powell: I hope it includes the South, especially Mississippi, where hospitals and clinics are not just open, but also staffed to meet the needs of the people who rely on them. Too many rural health systems have closed in communities that truly need them, and that is a big part of why I care so deeply about rural health funding and programs that help physicians and health care practitioners return to and stay in rural, low-resourced areas.
I see my career blending clinical care, advocacy, education, and public health. Through organizations like the National Medical Association and the American Academy of Pediatrics, I’ve had the chance to be involved in this work. This feels like a natural extension of my clinical practice.
I also hope to continue mentoring learners interested in serving rural and historically under-resourced communities.
ACGME: What are important considerations for graduate medical education programs to help prepare residents and fellows for practice in underserved communities?
Powell: One of the most impactful parts of my medical education was a required family medicine rotation in medical school in a rural Mississippi community. I drove there each day instead of reporting to the medical center; it was the first time I felt like I was truly practicing medicine. On my first day, I sutured a patient who had fallen, removed staples from an older gentleman who came in for follow-up, got an on-the-fly teaching session while caring for a woman with COPD who walked in with her oxygen canister, and I’ll never forget the woman with longstanding rheumatoid arthritis; her hands were shaped by a time when early detection, biologics, and specialty care simply weren’t available. Those encounters shaped me more than any lecture ever could.
My most practical, hands-on skills came from that month in Mississippi. You become resourceful and present because each visit holds more weight when access to care isn’t guaranteed.
Meaningful exposure to rural and low-resourced communities shouldn’t be optional or limited to short electives; it should be built into training in intentional ways. These settings give learners procedural experience, real responsibility, and a clearer understanding of what patients face outside major medical centers.
Programs also need to acknowledge that this work brings emotional and logistical challenges. That means preparing residents and fellows with tools to be respectful partners in the communities where they rotate, as well as providing mentorship, leadership development, opportunities to discuss burnout honestly, and preparation for building sustainable careers. It can also mean identifying programs that offer financial support/loan repayment – resources that make it more feasible to choose and remain in rural practice.
If you are in your last year of residency/fellowship or a recent graduate serving in a rural or underserved area, and would like to be featured in a future post in this series, email underserved@acgme.org to share what you’re doing. Visit the Rural and Underserved GME section of the ACGME website to learn more about the ACGME’s work in this area.