Volume 33 No. 3

Profile

The Two Sides of Dr. Kruse

Jerry Kruse, M.D., MSPH, didn’t say much while he was training at the University of Missouri at Columbia School of Medicine. Since then, he’s shed that introversion to become a loquacious, passionate leader with an affinity for data. You can almost see his mind race with figures, charts, authors’ white papers, and PowerPoint presentations.

A lean, six-foot-three-inch tower of energy, Dr. Kruse, professor and chair of the Department of Family & Community Medicine, fidgets with excitement and his speech quickens when recalling dozens of studies and reports, citing authors and theses like he is reciting his daughters’ names. “Data show that the United States spends far more on health care than any other nation, and we’re less healthy,” he says. “Studies from other countries show that people are healthier when at least 40 percent of physicians are primary care physicians. Currently the U.S. level is 32 percent and declining.”

"A lot of people don’t think about the data,” he says. “It's amazing how little we are driven by data. Long-term decisions about health care are being made just on the basis of a few anecdotes.”

Data and public health have always been dear to Dr. Kruse’s heart. He did scholarly studies on the topic for his public health degree and fellowship at University of Missouri, where he studied prenatal outcomes in a county over a three-year period. His passion for data explains his popularity among the Quincy residents as being a trivia whiz.

When he’s not traveling to promote PCMH, he splits his time at SIU between his home in Quincy and work as chairman in Springfield. He first joined the Quincy program as an assistant director in 1984. He became program director in 1991 before becoming chair of the department in 1997. His assistant in Springfield, Kim Colgan,
describes him: “Words that come to mind are brilliant, yet unassuming; kind, and generous, with a great sense of humor. If you asked anyone who works with him you would get a similar answer — from the team here or the team in Quincy. I know that sounds corny, but it’s the truth.”

Among his associates, Dr. Kruse is known as one who has a good grip on the evidence and can boil it down to manageable facts for politicians and advocates, effectively analyzing and packaging information. He keeps his papers short — between 700 and 1500 words — includes visuals, and “humor never hurts,” he says.

Humor is as much a part of Dr. Kruse as is his passion for data. He has written humorous poetry and limericks since his residency, under his pseudonym “Dr. Kreuss.” (rhymes with Dr. Seuss). He keeps them mostly to himself as a stress reliever. “I write poetry in an insouciant style. Most have a king theme, caricaturing people who are at the top.” A specific medical situation may inspire him to write a caricature of it and expand it to a ridiculous extreme. “My poems do tend to try to deliver a message,” he says. “Most relate to relationships that people have and how people make decisions or how they make a difference.”

He’s also found that humor is a good teaching tool. During a recent lecture to fourth-year medical students, Dr. Kruse donned a Dr. Kreuss white coat, (complete with head mirror) and with the assistance of Associate Provost Phillip Davis, Ph.D., poeticized the public’s reaction to President Clinton’s health care plan as a parody of Dr. Seuss’s Green Eggs and Ham.

He writes when the mood strikes, perhaps on a Sunday afternoon or while waiting for a train or an airplane. One he began at 10 p.m. and stayed up all night to work on it. Some are set to music; some are inspired by faculty friends such as Deb Phillips, M.D. and James Daniels, M.D.

He recently submitted his poem, The Saga of Michael Klein for consideration by the journal Canadian Family Physician. In a perfect dovetail of his data-humor mix, the poem is an evidence-based true story — it includes an eight-citation bibliography — about a Canadian family physician’s crusade to reduce needless episiotomies. The theme of “Dr. Kreuss’s” poem mirrors Dr. Kruse’s ongoing crusade to promote a paradigm shift through data and evidence:

“Never give up!” Michael’s voice still rings clear.
The moral today is to be of good cheer
To persistently fight in the face of all odds.
To battle ideas of conventional gods
To fight for new facts, and new evidence find
To give power to reason and sight to the blind.

In the spirit of Michael Klein, Dr. Kruse is working to “give power to reason,” and turn U.S. health care toward the evidence for Patient Centered Medical Home (PCMH) (see feature story). “Why is it some people don’t hear the message when it’s so clear cut and based on evidence?” he ponders.

As Dr. Kruse heard the facts and evidence on PCMH, “I was astounded by the quality and power of all this information on PCMH. It was just dismissed or overlooked by virtually all of medicine.” At a national meeting of all the other chairs in 2005, his passionate push to implement the seven principles of the PCMH got him noticed. Officials asked him to lead a legislative affairs and advocacy committee on the model. “Senators and representatives didn’t have a good understanding of PCMH. I saw it as a chance to influence government and regulatory agencies to move policies toward things that make a better health care system.”

Since then, Dr. Kruse has become a national advocate, rubbing elbows with legislators, their staffers, lobbyists, industry leaders, educational institutions, businesses, and physicians, in an effort to augment the cause of PCMH. “I’ve recognized the number of people who have concerns about improving health care for the people of the United States, and I’m helping them doing it in a more efficient manner.”

In 2007, Secretary of Health and Human Services Michael Levett appointed Dr. Kruse to the Council on Graduate Medical Education (COGME) — the multispecialty advisory committee that reports to Congress and Secretary of Health and Human Services Kathleen Sebelius. COGME also reports to the Senate Health Education and Labor and Pensions Committee and House Energy and Commerce Committee’s Subcommittee on Health— the two Congressional bodies that authorize health care legislation. He later was selected to chair one of the writing groups. Highly sought after as an expert in Patient Centered Medical Home, his definitions of PCMH have been used in the Medical Homes Acts of 2007 and 2009, and countless other documents on PCMH. Read the Patient Protection Affordable Care Act and you’ll find some of Dr. Kruse’s language in the bill.

On the day of the release of COGME’s 20th Report, Advancing Primary Care, Dr. Kruse was chosen to present the report to the Council and the public. The document assessed workforce trends, training issues and financing policies and made recommendations to Secretary of Health and Human Services, the Senate Health Education Labor and Pensions Committee and the House Energy and Commerce Subcommittee on Health. “Presenting this document was a great honor for me,” he says. “Maybe the biggest honor of my life.”

His advocacy for the PCMH is just one tool Dr. Kruse uses in his mission to save primary care. “Most industrialized countries have a 50/50 balance of primary care and specialists. Here it’s 30/70,” he says.

“The literature shows that health care outcomes are optimized and health-care costs are lowered when 40 to 50 percent of physician work force is primary care physicians. That’s more important than total number of primary care physicians per capita. The ratio of primary care physicians among all physicians is a more powerful indicator of quality in a region than is the number of primary care physicians per population or total number of physicians per population.

“If we want a health-care system with better outcomes, lower costs, and more accessibility, then we need a system with 40-50 percent primary care physicians. That’s simply not going to happen until proper income ratios are distributed, among other things.”

“The United States is spending twice the amount of money on health care as other countries, and quality indicators are falling compared to other countries.” He notes that primary care and medicine in general have not done well in developing simple, data-driven messages about population health and advancing those messages to people in government, regulatory, and business ranks. “The focus has been too narrow and too much on specific issues rather than broader foundational principles. I know that to improve the health of people of central and southern Illinois, moving these foundational principles forward will have the bigger impact on health in this region.”

Dr. Kruse is moving the principles forward, leading the PCMH movement at SIU School of Medicine and on a national level. And “Dr. Kreuss” is still throwing in some humor to “make it joyful.”