Mia Yang’s formative years living with her grandparents in China would greatly shape the trajectory of her career.

Although Yang identifies as an immigrant, her family’s presence in the U.S. dates back to the 1970s. That’s when her paternal grandfather’s younger brother moved with his family to start a new life. Unfortunately, he died of a heart attack shortly afterward. Family members suspected it was because of the stress of caring for his family while settling into a new country. So when Yang’s father moved to the U.S. in 1988 to attend graduate school, he did so without 3-year-old Mia or her mom. Her mother followed him to the U.S. a year later. Mia lived with her paternal grandparents for the next nine years. They, along with her aunt, raised her. She describes her childhood with them as wonderful.

“I definitely felt loved and supported,” she says.

Through her time with them, she became a precocious child who preferred the company of adults.

“I was always a kid who gravitated towards adults,” Yang recalls. “I enjoyed talking to older adults, even when I was a kid. I didn’t particularly like playing with kids my own age. I much preferred reading books rather than going out and playing with other kids in the neighborhood.”

After Yang’s brother was born in the U.S., their mother brought him to live with them in China because securing childcare in the U.S. was challenging. It was the only time Yang saw her mother during the time the family was separated. At that time, China still enforced the one-child policy, so she didn’t know anyone else her age with a sibling.

Despite weekly phone calls with her parents, it was hard to get to know them. Yang was so young when they left China that she didn’t have many memories of them. It was her grandparents, with whom she felt the strongest connection. Her grandparents really valued education, which was an area in which she always felt compelled to excel. She also believes she inherited her attention to detail from her grandfather and her parenting style from her aunt.

“They really shaped the person I am today,” she says. “In many ways, I’m more similar to them than necessarily my parents. Probably because it’s hard to catch up all those years apart.” 

Yang was 12 when was reunited with her parents in the U.S. It was an awkward transition. She had to adjust to living with her parents again, while also navigating a new country, language, and culture.

“I was a pretty moody teenager for all the reasons that teenagers go through, plus this big adjustment at age 12,” she recalls.

Upon arrival in the U.S., she wasn’t sure what to expect. Yang grew up in one of the poorest provinces in China, but it was situated in a densely populated urban area. One of the things that she noticed after landing in Newark, N.J. were the paved roads. There were only dirt roads in her native province. The other thing she noticed after arriving at her parent’s suburban home in Charlotte, was the distance between the houses. Her neighbors seemed far away, compared to where she had lived in China.

Yang didn’t speak any English at all and enrolled in an ESL (English as a Second Language) program at school. None of her teachers spoke Mandarin, but there were two other Chinese girls around her age in the ESL program. They were placed in the same classes so that they could help each other. Yang turned all of her attention towards learning English and doing well in school.

By the time she entered high school, she began to hit her stride. She made friends through the academically rigorous International Baccalaureate program in high school. From there, she—and many of her friends—attended UNC-Chapel Hill. Yang initially thought she might study dentistry or pharmacy. But a study abroad opportunity in Mexico yielded the chance to gain real-world experience in a hospital. It gave her a true sense of what a career in medicine might be like, she says.

And that is how her medical journey began.

After earning her medical degree from UNC-Chapel Hill, Yang felt it was time to leave N.C. for a little while. She continued her medical studies at John’s Hopkins University, where she completed her residency and fellowship. It was there that she narrowed her focus to geriatrics, dementia, and Alzheimer’s care.

In residency, her program directors were geriatricians. Yang began seeing patients living in Baltimore in their own homes. That experience led her to believe that home-based care was the best approach to treating geriatric patients.

“Home is where we all want to be and our health and determinants of health are 95 percent happening in our homes and non-clinical environments,” Yang says. “I believe that home-based medical care is the epitome of patient and family-centered care.”

Treating a patient at home allows her to see how they function in their daily lives, she says. She can see how they’re taking medications and their support network. She can also get to know them better as people, not just patients.

Research indicates that those who are homebound, with physical or cognitive impairment find leaving home difficult. They also tend to be racial minorities, lower-income, and female, with more complex medical care.

On average, 40 percent of those who are homebound pass away within two years, Yang says.

“So this is a particularly vulnerable and impactful stage of life where traditional access to outpatient medical care may be limited.”

Yang also began to see geriatrics as an extension of her internal medicine training. It helped her think about medicine in all of the different settings that patients may go through, such as a nursing home, rehab, Hospice, or palliative care.

Back in North Carolina, Yang’s role at Wake Forest Baptist Health evolved into one that includes clinician, researcher, and professor. She discovered she enjoyed research so much that she earned a Master’s Degree in Clinical Research 2020 while working full time and having her second child.

Geriatrics research is important, she says, because older adults not only contribute disproportionately to healthcare expenditure/utilization, but they’re also a growing population, worldwide.

“Our healthcare system is actually NOT friendly to older adults,” she says. It’s overly complex and can even contribute to their physical and mental decline. Yang wants to help significantly change the way that older adults are treated.

“Looking back, definitely growing up with my grandparents was a strong influence,” she says. “I just don’t think that I realized it at that particular time. But, in talking with other geriatricians, they also had really great formative years with the grandparent figures in their lives. That wasn’t something that I realized until later on.”

Yang calls herself a “1.5” generation immigrant because she straddles both her Chinese and American cultures. Now that she’s lived most of her life in the U.S., she identifies more as an American, but those formative years in China greatly influenced her values and who she became. Last year, Yang shared her immigrant story in the book, “The Warrior Women Project: A Sisterhood of Immigrant Women.” It is a collection of stories by 22 women from 13 countries and is the inspiration of Lulu Umeh, an LGBTQ parent, coach, retired pediatrician, and Nigerian immigrant.

Yang, who is a part of a physician moms group on Facebook, responded to a post about the book. She wrote about her grandparents for it. She hadn’t really identified with the immigrant experience until this project.

“I’ve always struggled with not feeling like I belong either as a Chinese person or as an American person and this dichotomy felt particularly challenging in high school, college, and probably even in medical school,” she says.

As a young adult, she didn’t connect with other immigrants. She says both subtle and overt influences made her feel that assimilation should be her main priority.

“I haven’t quite sorted through all of the thoughts as to why that was the way it was. I do think that a part of the reason why I didn’t particularly gravitate towards other immigrants was because of the way that my family was and was not in my life has always been very painful for me,” she says. “The fact that leaving my grandparents and my aunt at age 12, I really felt like I lost a lot of that connection with them. So sometimes being back in a very Chinese environment was particularly painful for me.”

It wasn’t until she had her own children that she began to think about how much of her Chinese culture she wanted to pass on to them. Now she’s proud to be an immigrant because she’s able to empathize with people from all backgrounds, and she’s curious about everyone’s stories. She also proudly embraces the Chinese value of honoring and respecting elders.

Ultimately, Yang wants to make meaningful changes that would improve the daily lives of older adults with dementia and their family of caregivers. And personally, she wants to raise her children to be compassionate, socially active individuals who believe in their own power.