2010-01-21 / Front Page

Island author share her experience with healthcare system

By Stacy Jones

Maggie Kozel Maggie Kozel Islander Maggie Kozel had wanted to be a doctor ever since her sophomore year at Maria Regina High School in Baltimore, Md. But given her family’s dysfunctions and a lack of money, her goal seemed more like a far-fetched dream.

Ultimately, however, Kozel’s dream began to come true when she graduated from Georgetown University Medical School in 1980. And after a three-year pediatrics internship, it was official: Dr. Maggie Kozel, pediatrician.

But the dream wasn’t quite what she’d hoped it would be, she said.

Seventeen years later, disappointed, disillusioned and frustrated, Kozel left the profession. For the last eight years she has been a science and chemistry teacher at Lincoln School in Providence.

Kozel’s personal journey from professional fulfillment to futility is the focus of her soon-to-bereleased book, “My Time With Hippocrates: A Doctor’s Journey In and Out of Medicine.” Through her experiences, Kozel documents a changing healthcare system and its effects on patients and doctors.

“It’s a personal perspective of one of the foot soldiers, someone working in the trenches,” said Kozel, who lives in Jamestown with her husband, Randy – also a doctor, and their two daughters. “There’s a growing disconnect between healthcare delivery and medicine. What happened to me is just a small example of a larger problem.”

What happened to Kozel, it seems, is at the heart of this country’s current debate about what type of healthcare system would best serve its citizens.

During her medical career, Kozel observed “more and more, the way we deliver healthcare was being decided in the insurance boardrooms rather than by medical professionals.”

The result, she said, is a multitiered healthcare system in which the people with the most need are often the people who can’t get in to see a doctor, or those whose insurance or lack of it – prevents them from seeing a needed specialist. This multi-tiered system, with poor children and children of the working poor squarely at the bottom, “had an influence on how children were treated,” she said. “There was no way for the healthcare system to cover the kinds of problems faced by patients, especially the poor, such as dental needs or developmental issues like speech or behavioral problems.”

Such a class-based system was a shock to Kozel, who worked as a Navy doctor for 10 years, including an internship and a pediatric residency, before venturing out into private practice. She had enlisted in the Navy after medical school tuition jumped, and the Navy covered the cost of her pediatrics specialty internship.

“The military operates on a universal healthcare system,” she said. “When I encountered the civilian healthcare system, the contrast was shockingly different. It took some getting used to.”

It was a real eye-opener and quite frustrating, Kozel said.

If a poor child needed a specialist, she often couldn’t find one that would accept the child’s insurance, she said. Meanwhile, on the other end of the private practice spectrum, a patient with better insurance coverage had a completely different experience.

“I could spend an hour with a patient that had great insurance talking about strained carrots, but a poor child with real medical needs couldn’t get in to see a doctor,” she said.

In Kozel’s mind, the gap between what she was trained to do and what she was actually doing was maddening.

“I was getting paid to react to the normal travails of childhood – nutrition, tantrums – instead of addressing the many needs of the poor or healthcare problems,” she said.

Soon, something had to give and ultimately, Kozel decided it would be her profession.

“Choosing to leave medicine shook up everything, my entire sense of identity,” she said. Writing the book was her attempt to clarify things in her own head.

“When people asked why I did it, I didn’t have the answer and I had to choose my words carefully. It’s a very difficult thing to explain in three minutes,” she said.

In the book, Kozel offers some compelling, clear and controversial observations about this country’s current healthcare system. For starters, she equates access to healthcare with access to public education.

“I don’t think as a society we should ever make education private,” she said. “Education should be public and healthcare seems very much like that kind of thing. Healthcare shouldn’t be left to a capitalistic venture.”

She said she would also adjust the expectations of patients.

“We have been trained to be consumers. We want our money’s worth. That’s not a healthy way of looking at healthcare,” she said.

For example, when treating patients for back problems “the question should not be ‘How can we best pay for everyone’s MRIs?’” Instead, she said, we should ask, “What is the best approach to back pain?”

The very discussion has to change, she said.

While Kozel said she doesn’t think the healthcare reform offered by the federal government asks the right questions or offers real fixes, she is realistic about the attitudes of Americans and their willingness to support change that limits their access to testing, however unnecessary.

“People wouldn’t embrace it, not yet,” she said. “We are programmed to think that more is better. I’m hopeful that it will eventually dawn on us as a society that there is a better way.”

These days, Kozel enjoys teaching and relishes the time she has to write. While she misses practicing pediatrics, she also admits that her way of practicing medicine went out of style 15 years ago. Still, her career change did have one immediate, positive effect, she said.

“As far as our nuclear family, it made our family better overnight,” she said. Gone are the fatigue, the migraines and her daughters “home alone making macaroni and cheese,” she said.

While more family time has been an upside to Kozel’s decision, she doesn’t want her readers to think that was the driving force behind her exit from the medical field.

“I want the reader to understand that I wasn’t unhappy because I wasn’t cut out to be a doctor or was in the wrong career,” she said. “I want it to be clear that I loved being a doctor.”

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