A Modern Medical Disconnect
Maggie Kozel dreamed of being a doctor when she was a child, but the modern health-care system she experienced upended her idealistic view of medicine. In her new book, The Color of Atmosphere, Kozel writes about her days as a young pediatrician, her navy experience with universal medicine, and the strains of entering private practice. Her story illustrates the complexities of US health care and unrealistic patient expectations created by private insurance. To understand her ultimately, heart-wrenching decision to leave medicine is to grasp the systematic failure of our health-care delivery system—for patients and doctors alike. Find out why she and other doctors are increasingly walking away from a profession they love.
How does a girl from Point Lookout, Long Island, wind up at Georgetown Medical School?
I was fortunate to find something I was passionate about at a pretty young age. I was fifteen years old when I started studying biology, and I really became infatuated with it. Everything else paled in comparison. It’s what I wanted to do with my life. Being a doctor was the only career I was aware of in the life sciences, so it seemed the obvious choice. And the beauty of being a naïve fifteen year old was that it never occurred to me that it might be too hard or that I might not get into med school. I just assumed that if I wanted it badly enough, I could do it.
I think that’s a real advantage for a young person—to be a little oblivious to all the reasons a plan might not work. The other significant piece was that I saw a medical career as my ticket out of what was a pretty miserable home life. I needed to know that there was something much better out there waiting for me.
With so many doctors interested in lucrative specializations, why were you interested in becoming a pediatrician?
When I was 25 years old, I didn’t think money mattered. And truth be told, when you work a 100 hours a week or more in the hospital, money doesn’t matter all that much. Also, I think we were all more naïve about income than today’s young doctors are. Most of the established doctors we worked with all made extremely good incomes without a lot of hassle. We didn’t see what was coming down the road.
It was also a very idealistic age – I wanted to do direct patient care. That was being a “real” doctor. I probably felt a slight moral superiority over my peers who chose the more lucrative, procedure-oriented specialties. (Again, I was young.) But the truth was I loved the personal interaction and the holistic approach to health that you see in primary care. And most of all I loved how healthy children are; they don’t come in with the self-inflicted lifestyle ailments that plague so many adults in our society, and the restorative abilities of their bodies when they do become ill is practically miraculous. Pediatric medicine is an amazing field. Unfortunately, the way I earned a living came to be a far cry from what I was actually skilled in.
What advice would you give to parents on raising healthy kids?
Well, a couple of basic ones would include: Make educated decisions about what is best for your child and the strategies best suited to your goals and temperament—then stick to them. For example, decide what you think a toddler should eat, and that’s what you feed her. Decide what your approach is to sleep regimens – bedtime rituals, who sleeps where, and so on—and stick with that. The same goes for discipline, TV viewing, and all those other decisions we make for our kids. It’s not the rule that’s important: it's the consistency. The more we second-guess ourselves in an attempt to keep our children happy, the less they benefit from our wisdom and care. Above all, no matter what we do, it should be done with respect and kindness. This is why corporal punishment is one area where I draw the line. It doesn’t work, and sends a very confusing message about the ways we should behave.
Having said all that, I was a much better mother at 8:00 in the morning than I was at 5:00 in the afternoon. None of us are perfect. But we don’t need to beat ourselves up about that. Children growing up in stable, loving, predictable environments tend to be pretty resilient.
What do you see as the biggest challenge women in medicine face?
The culture of medicine has changed in many ways since I was in medical school, and I think that the growing number of women physicians has encouraged that. The top-down, authoritative doctor-patient relationship is just not tolerated as much anymore. A great value is now placed on physicians who know how to listen and express themselves in a caring way.
Many male physicians certainly do this too, but women coming into the field in large numbers changed the old notions of the doctor’s role, bringing more compassion and human warmth and partnership into the exam room. Greater female presence has also helped to ease medical education out of the survival-of-the fittest mode I experienced in med school.
The other challenges women face today are the same they face in other fields – balancing family responsibilities with their careers, and earning less income on average than their male peers.
Would you support a public health system similar to what you experienced in the Navy? Why?
In my thinking, the key elements to an effective health care system are: First, be smart about what we want. Priorities and clinical strategies should be set by medical experts based on scientific evidence and cost analysis, and those decisions need to be insulated from the kinds of financial incentives and disincentives that special interest groups exert.
Once we reach some sort of consensus about what smart, compassionate and effective health care is, then we can figure out the most efficient and cost-effective way of delivering it. My sense is that our entire health care system – not just the way we pay for it - would look very different from what it looks like now, and that the most effective way to fund it would be a national single-payer system. And from my experience in the Navy, I can attest that this is not a frightening or unrealistic proposition. I have seen it work firsthand.
Why did you decide to leave medical practice?
At the time I left, I was sure it was the right decision, but I couldn’t synthesize all the different factors together in an articulate way. That is precisely why I wrote the book and what it lays out. I was disentangling it as much for myself as for anyone.
The easiest, simplest answer is also the truth: I was exhausted. Crazy schedules and sleepless nights start to catch up with you in your forties. But that was just the tip of the iceberg. With each passing year, my practice reflected less and less what I was trained to do, and between the pressure from parents and the challenge to meet their expectations, my work too often became disconnected from best practices. My day became shaped more and more by what insurance companies paid for rather than what was best for my patients. It was demoralizing. When another opportunity–teaching—dropped in my lap, I surprised myself at how readily I jumped at it.
You keep your license up to date and fulfill your continuing education requirements. Are you planning to return to medicine? What would it take?
I miss pediatrics. While I don’t think I would take on a regular private practice again, I wish I could still practice on a part time basis. Nothing would make me happier than to volunteer in a community health center. But the problem is malpractice insurance. Even to work as a volunteer, you need to have insurance coverage. And you have to be earning a pretty hefty salary in order to justify the premiums.
There are a growing number of former primary care doctors out there who would reenter practice if there were mechanisms in place to help them. Maybe I’ll figure out a way to do that someday. For now, I get a great deal of satisfaction writing about my experiences in health care. And I love teaching chemistry.