An orthopaedic surgeon specializing in spinal care, Andrew Schoenfeld, M.D., M.S. decided early on that his medical career would encompass both caring for individual patients and addressing the larger societal need for more equitable, accessible healthcare.
A graduate of Kent State University, Schoenfeld graduated medical school at the Northeast Ohio Universities College of Medicine, completing a residency in orthopaedic surgery at Akron General Medical Center and a clinical fellowship in spine surgery at Harvard Medical School. An officer in the United States Army since 1998, Schoenfeld’s military service included active duty as a military surgeon in Afghanistan and serving as both Director of Orthopaedic Research at William Beaumont Army Medical Center and Acting Chief of Soldier Care at Fort Bliss, Texas.
Schoenfeld retired from the Army as a Major in 2013. That same year, he came to the University of Michigan as a Robert Wood Johnson Clinical Scholar. At the time he was already conducting health services research. “My work focused on understanding racial and ethnic disparities in the delivery of orthopaedic surgical care,” he explains. “The program allowed me to build on that work, filling in some important gaps in my knowledge base, and adding a level of scientific rigor to which I had not previously been exposed.”
Today, Schoenfeld continues to combine clinical practice in spinal surgery with disparities research at Boston’s Brigham and Women’s Hospital. “The work I do now would not be possible had I not trained as a scholar,” he says. “Beyond giving me the skill set to do my own statistical programming and plan my own studies, the curriculum and mentorship gave me a more sound understanding of what it means to be a clinician scientist in academic medicine,” says Schoenfeld. “I gained a broad-based understanding of everything from the keys to effective physician leadership to the policy implications of research. I put those skills to work every day, and they make me a better researcher.”
THEORY IN PRACTICE
Linking disparities in surgical outcomes to insurance coverage
Proponents of universal health insurance believe it has the potential to reduce disparities in care among minority populations. But the theory had never been tested. Schoenfeld was part of a team that set out to learn the extent to which universal health insurance might decrease surgical disparities for African Americans. As a surrogate for universal coverage, they utilized Department of Defense (DOD) health insurance (Tricare) outcomes data for both African American and white patients after 12 major surgical procedures across multiple specialties. That data was compared to outcomes for a similar cohort in California’s State Inpatient Database. Those patients underwent the same procedures, covered by either private insurance or Medicaid, or no insurance.
“Our study showed that in an equal access healthcare system like the DOD model, African American and white patients had similar outcomes,” says Schoenfeld. “On the other hand, we saw disparities in California, especially among those without private insurance. Those patients faced significantly higher risks of mortality, complications, failure to rescue, and readmission. These facts point toward the potential benefits of a federally administered system in which all patients are treated uniformly.”