I Chose a Climate Resilient Practice for My Career
by Ashray Maniar MD
Medical Oncologist
I have had many moments wracked with climate despair. Each annual report from the Intergovernmental Panel on Climate Change has felt like gasoline being poured on an actual wildfire, and all I had to fight back with was water balloons. I knew when I began looking for a place to practice the career that I love—hematology and oncology – that the values and culture of where I choose to work would be as important as the salary and the lifestyle.
It took the wisdom of Jon Stewart, spoken in response to a different tragedy, to shift my perspective from despair to possibility: “I want to tell you why I grieve, but I won’t despair.” He went on to highlight the power of humanity during recovery and our shared, enduring spirit—the ability to find beauty even amidst a sea of despondence. As physicians, we understand this distinction well. We must grieve losses honestly without slipping into despair, so that we can continue to support our patients, colleagues, and families. It took me a while, but I eventually learned how to channel that same resilience into doing my part to mitigate climate change.
Most clinicians acknowledge climate change and make some efforts to reduce their personal carbon footprints. What often comes as a surprise, however, is that our healthcare sector is responsible for nearly 5% of global greenhouse gas emissions. To be fair, medicine is inherently energy intensive—saving lives tends to require electricity, supplies, and overly packaged pharmaceuticals. But that familiar mentality of “you gotta break a few eggs to make an omelet” has been stretched too far, particularly in the United States.
From 2010 to 2018, U.S. healthcare greenhouse gas emissions rose by 6%, reaching 1,692 kilograms of carbon dioxide equivalents per capita— by far the highest rate for healthcare in any country. Even as we seek to preserve life, the air pollution created by our industry is taking lives due to heart attacks, asthma, COPD, and cancers. In 2018 alone, emissions from greenhouse gases and toxic air pollutants were associated with the loss of 388,000 disability-adjusted life-years.
What makes this especially unsettling is that these rising emissions are not matched by superior health outcomes compared to peer nations. In other words, we are ruining the planet – breaking lots of eggs—without commensurate better health for our people. This realization pushed me to think differently about where I chose to practice medicine.
I became committed to practicing medicine in ways that reduce healthcare-related emissions while protecting both current and future communities. Individual actions, while important, are not enough to meaningfully address climate change. When I finished my medical training and began searching for my first practice, I prioritized finding a climate-conscious institution—one where my wilted water balloons could be replaced with effective action on climate change.
My search led me to Northwest Permanente at Kaiser in Portland, Oregon. Northwest Permanente is the first physician-led group to earn B Corp Certification, a rigorous international standard that reflects Northwest Permanente’s commitment to environmental sustainability, accountability, and transparency. While the designation itself is impressive, what matters most are the day-to-day practices that I have observed: not pre-opening surgical packs, reducing climate-warming inhaled anesthetics, and prioritizing more sustainable products. These changes may sound small, but collectively they represent a meaningful shift in how healthcare can be delivered more responsibly. Since joining, I’ve been welcomed into climate-focused initiatives, particularly within my department of hematology-oncology. I feel that here my climate values are supported and empowered.
Through this work, I’ve witnessed the resilience of people and the power of collective action. There are still moments when I grieve the damage we’ve caused—both as a profession and as a species—but I no longer despair. My water balloon may still be imperfect, but now it’s backed by a team, a system, and the belief that medicine can be part of the solution rather than part of the problem.
Dr. Maniar is a medical oncologist at Kaiser Permanente in Portland, OR. He focuses on treating patients with head and neck and thoracic malignancies. He grew up in Glen Dale, WV. He is an avid basketball fan (go Blazers!), nature enthusiast and is trying to learn to surf (but spends most of the time belly flopping into the ocean).
