Family Medicine Clinician Spotlight: Dr. James Hougas III

James Hougas III, MD, FAAFP, joined the University of Minnesota St. John's Hospital Family Medicine Residency in 2017. Before this, he served on active duty with the United States Air Force for five years after residency. His assignments included outpatient practice at Malmstrom Air Force Base in Montana; residency faculty and full-spectrum family medicine at Offutt Air Force Base in Nebraska; and deployment to Afghanistan, Qatar, and elsewhere. He is interested in infectious diseases, antimicrobial stewardship, trauma care and systems, office-based procedures, physician leadership, and colonoscopy.

What brings you joy in practicing your specialty and why?

I like to be a problem solver. Sometimes you have guidelines and published science to help you in certain circumstances, but so often our patients don't fit that and they're not written about in the textbooks. They're not mentioned in the guidelines.

And so, when sitting with a person who hurts or feels bad, I enjoy solving that puzzle and sometimes having to make it up as I go—in a very scientific way, of course. I like to help people understand their own bodies to be able to move toward health.

Why did you choose family medicine?

Because I have too much ADHD to do the same thing all day long.

As I went through medical school, especially around the second year, I found everything to be cool. Cardiology was cool, lungs were cool—except cancer. I knew I didn’t want to do that. Just about everything was really interesting. Eventually, I boiled it down to OB/GYN, pulmonary critical care, or family medicine. 

I like delivering babies, but I thought that passing off the baby after its birth meant that you were losing half the fun in not caring for them anymore. Being able to take care of the dad or the grandparents or the siblings, well, I can do all of those things in family medicine. While I do a lot of surgical things, I am not a straight-up surgeon—even though every personality test I ever took told me to be a surgeon.

I just enjoyed too many things, and I always wanted my day to be different, not only day to day, but patient to patient.

What advice would you give to yourself as a physician just starting out?

That's an interesting one. I would tell myself that doing your best is basically always good enough. There are going to be days where there's nothing on the face of this planet that can help or save the person in front of you. And that is not a failing of you as a physician. That is because they are in a tough situation that is potentially unfixable or they're not currently in a place where they can get help.

And so, being good enough as the person and physician that I am and being able to take that to heart is probably the advice I would give myself.

What do you enjoy doing in your spare time?

I really enjoy playing board games with my four kids and wife. I enjoy running medium distances. Marathons are not for me—that's too far, and I get bored.

I am too handy for my own good, and so making a pile of sawdust and fixing things around the house is another way that I fill my time. 

What are your key messages when teaching residents clinical care?

For one, I am convinced that learners know more than they're willing to admit to themselves and the outside world. And so I view it as one of my tasks to help them commit to that and, like the adage goes, “Be strong and wrong.” But more often than not, they're right, and that fear of being wrong keeps them from finding the confidence that they deserve to have.

You know way more than you give yourself credit for as a learner. And even if you don't know it, you actually still know a lot more than you think, and you can piece a lot of things together. You have worked for so long and so hard, and we just need to help you find the physician that you're meant to be because the world needs that person.

What are you particularly proud of as you consider your clinical career so far?

I'm proud of a couple of things. I'm proud of creating, with a lot of help, the colonoscopy program that we have here at St. John's Hospital Family Medicine Residency Program that is unique in our department and to the state of Minnesota.

I'm proud of the team and the work that I did when I was in Afghanistan and the other deployed environments across the Middle East, doing some of the missions and supporting those in ways that I didn't even think I could flex into.

I'm pretty proud of all the residents that I watched grow into themselves going off to do compassionate and comprehensive care for all of these people. It's so cool to watch them grow up into their own skin and grow into their own practice. From a career perspective, those are the things I'm proud of.

What do you hope to achieve in the years to come?

To figure out what I want to be when I grow up. I want to find how I can, as a family medicine physician, serve Minnesotans to the best of my ability with the talents that I've been given. And I don't know what that looks like. I don't know where those things are needed the most and how that helps the most people.

How do I best use my relatively unique career to improve our department, to improve our medical school, to improve the health of Minnesota? That's what I hope to achieve. I hope to find the answer and be able to apply myself to that. I think that that'll keep me in the department for decades to come.