What Three Decades of Caring for Patients Taught One Researcher About Making Healthcare Work Better 

Ira Wilson, MD, MSc, has spent more than three decades focused on a deceptively difficult problem: understanding how much of the gap between patients and the care they need comes down to the structure of the system itself.

A primary care physician, epidemiologist, and professor at the Brown University School of Public Health, Dr. Wilson’s research spans medication adherence in chronic conditions, the quality of physician-patient communication, and the ways Medicaid policy shapes whether patients living with HIV actually take the medications that keep them alive. He has advised Governor Raimondo’s Working Group to Reinvent Medicaid in Rhode Island, served on the National Board of the HIV Medicine Association, and helped build Brown’s community health program into a standalone School of Public Health. He has also kept seeing patients throughout his career.

At Boston Medical Center’s (BMC) inaugural Research Day, Dr. Wilson sat down with Megan Bair-Merritt, MD, MSCE, BMC Health System’s first Chief Scientific Officer, for a fireside chat on his career, his research, and what he thinks the field needs to focus on next.

A researcher who started at the bedside

For much of his career, Dr. Wilson navigated clinical medicine and public health research simultaneously. He trained at Harvard Medical School and earned a master’s degree in Epidemiology from the Harvard School of Public Health. Through years of seeing patients and asking why the system around them so often fails to support them, Dr. Wilson sought to better understand what actually happens between patients and the healthcare system, not just what is intended, to help improve health outcomes.

His interest in those questions began well before medical school. “I didn’t come to medical school or to medicine from a scientific direction that was biochemical or cellular,” he said. “I came to it through an interest in the structural and social aspects of care.”

Seeing patients grounded his research questions in clinical reality and over time, his research evolved to span medication adherence measurement, clinical trials of adherence interventions, large Medicaid pharmacy claims analyses, and studies of physician-patient communication quality. Caring for patients with HIV early in the epidemic further reinforced his interest in understanding how health systems and the policies that shape them affect patient outcomes.

How policies impact patient medication adherence

Dr. Wilson’s recent work has focused on medication prescribing and management for patients living with HIV, with particular attention to how Medicaid policies shape real-world adherence. He found that patients who do not adhere to antiretroviral regimens face significantly higher rates of hospitalization and worse clinical outcomes, and the factors driving poor adherence were system-level issues related to insurance structure, coverage type, and baseline access to treatment. Longitudinal Medicaid data have also shown meaningful improvements over time in how long patients stay on HIV therapy, a trend Dr. Wilson has called evidence of real reductions in illness and transmission.

His interest in medication adherence stemmed from what he observed caring for patients with HIV as effective therapies emerged. “If you get resistant to medicines, you can lose them as a treatment tool,” he said, explaining why ensuring patients could consistently access and stay on treatment became central to his research.

With ongoing changes to Medicaid at federal and state levels, the methods Dr. Wilson has developed — combining claims databases, policy analysis, and clinical expertise — offer a direct model for understanding how coverage decisions translate into patient outcomes.

Looking ahead, Dr. Wilson said the science has advanced dramatically, but ensuring patients can benefit from those advances remains an urgent challenge. “Treatment of HIV requires access to medications, which requires insurance,” he said. As coverage policies continue to change, he encouraged researchers to study how patients move between insurance programs and what those transitions mean for continuity of care.

Advice for the next generation

Dr. Wilson has described healthcare as a “much more complicated ecology than most people understand,” with more meaningful ways to contribute than any single career path suggests. For trainees considering careers in research, he encouraged them to define success on their own terms.

“Know who you are, know what turns you on, know what you care about, and what you’re passionate about doing,” he said. “Don’t necessarily believe that the pathways you see other people taking… are necessarily the right pathways for you.”

He also emphasized the importance of persistence. “Research is a marathon. It’s not a sprint,” he said. “The people who do the best in research are not the smartest people. They’re the people who stick with it and work hard over long periods of time.”

That long view also shapes his optimism. While he acknowledged that healthcare faces significant structural challenges, he encouraged researchers to see those challenges as opportunities to generate evidence that can improve policy and patient care.

What Dr. Wilson’s career makes clear is that the structural features of healthcare are not fixed, but rather are the product of decisions that can be studied, understood, and changed.