Office Visit

Many physicians consider their formal education complete when they finish their residency, but for John Schousboe, MD, PhD, that was just one step on his educational journey. After training and starting practice, Dr. Schousboe returned to school to earn a masters degree in health services research and policy at the University of Minnesota, and he earned a PhD in the field at the beginning of this year—all while running an osteoporosis center. Some may wonder why this busy physician felt the urge to jump back into school so early in his career. “I think you have to like the process of education,” he laughs, “and see some larger goal in that process. I felt that way about graduate school and specifically health policy. By learning health economics, sociology, and the political science aspect, it allowed me to understand issues in what we do in a completely different way.”

Growing up in Champaign, Ill., Dr. Schousboe attended the University of Illinois in his hometown, and then went to medical school at Rush University in Chicago. He followed medical school with internal medicine training in the Pacific Northwest for two years, and then he traveled to New Zealand as a medical registrant. It became clear to him by the time of his two-year rheumatology internship at Northwestern that this was the type of medicine which could truly make a difference. “It’s an area that I felt we had a lot more to learn about as doctors,” he says. “I knew I’d never be bored.” Finally, he joined Park Nicollet Clinic, in St. Louis Park, Minn., where he is currently a rheumatologist. “We are the fifth largest clinic in the country with 400,000 patients a year. But, it dawned on us that we could do a project and not have any idea if we made any impact,” he says. “We decided to do data collection and, as I got into it, I realized I needed more training to be confident in what I published.”

Dr. Schousboe did some research. “They had a program at [the University of] Minnesota designed for MDs to go beyond randomized controlled outcomes, and I believed it would make me a much better researcher. I cut my patient care load to a half-time status, but for the first two years had grant support. I had a real interest in cost-effectiveness modeling and seeing how things can translate to the clinical level and health system level, too.” Dr. Schousboe says he also has an interest in the psychological relationship with patients and the effect of medication adherence. “I’m always looking to see if they’ll stick with the medication or not. I’m also always looking to use additional skill sets in statistical analysis and in serving instrument development to measure attitudes and beliefs. These are hot areas in all facets of medicine.”

Along those lines, Dr. Schousboe’s future investigations will focus on practice-based and health services research, “which is really designed to look at outcomes, costs, and clinical practice, and how those things can be improved through changes in care practice,” he says. His PhD experience helped prepare him for this kind of work at a more rigorous level, he notes. He also believes that his PhD work gave him a new way to look at his patients. “I think differently now when I see patients. It’s given me a broader appreciation of the entire social context of their experience,” he says.

A typical day for Dr. Schousboe is split between research and seeing patients. “I’ll start the morning by looking through electronic records of folks I’ll be seeing,” he says. “I’ll usually be able to visit with nine patients in a morning, including consults and rechecks. My office always looks like ‘organized chaos’ with piles on my desk, but my eyes always see past that to my laptop since we’re so centered around electronic medical records. Toting my laptop between patient rooms, I’m always ready to show the patient the X-rays right on the computer or let them see a spreadsheet—not from last week’s piece of paper but letting them in on what’s been happening for as much as two years back.”

Change in Attitude

Dr. Schousboe’s philosophy today is a matter of W.I.T.—Whatever It Takes. “I have to attend to patients’ needs from their perspective even if it makes me run late,” he says. “I can be 40 minutes behind by the end of the day, but it saves time because the patients appreciate that they’re getting a complete appointment and won’t have to come back if it’s not necessary. I made the decision that, yes, we have time constraints in appointments, but you can’t treat [a patient] like they’re a number.”

Dr. Schousboe says that the biggest lesson he gained from his extra time in academia was a sense of perspective: “I feel much less frustration if a patient doesn’t want to follow my advice—I’ve learned an appreciation for why that may make sense and why it should be respected. There isn’t always a right or wrong answer. For example, if I prescribe medicine that now creates disruption in that person’s life, I may do more harm than good.”

As he prepares for a life without the “disruption” of education, Dr. Schousboe will have a new challenge: what to do with the extra time on his hands. “It’s an interesting idea, not being a student anymore,” he says. “But a doctor never stops learning. Not if he’s good at what he does.”

Eric Butterman is a freelance writer based in Texas.