Q&A: Becoming a DO in midlife
At the Kingman (Ariz.) Regional Medical Center, oncologist and hematologist Kathleen M. Naegele, DO, goes over some details with Jeff Winger, a nurse practitioner (left), and Christopher Ramage, DO, a second-year resident. (Photo by Warren Adams-Ockrassa)
After 17 years of running an interior design and upholstery business, Kathleen M. Naegele, DO, MPH, fulfilled her lifelong dream of becoming a physician in 2005, when she graduated from the Midwestern University/Chicago College of Osteopathic Medicine (MWU/CCOM) in Downers Grove, Ill.
Unable to attend college straight out of high school, she earned an associate’s degree, a bachelor’s degree, an MBA and an MIS degree years later while managing her business and raising four children.
Although unfulfilled in her previous career as a businesswoman, Dr. Naegele, who is 54, says that those years gave her confidence, valuable managerial and negotiation skills, and self-awareness—traits that have served her well in medicine.
Dr. Naegele trained in a three-year internal medicine residency followed by a three-year hematology and oncology fellowship, both through MWU/CCOM. After careful consideration of what type of position and location would best suit her professional goals and her family’s needs, she joined Kingman (Ariz.) Regional Medical Center (KRMC) in 2011 as a hematology and oncology specialist and the medical director of the KRMC Cancer Center.
Passionate about teaching, Dr. Naegele serves as a preceptor to osteopathic medical students and residents and hopes to one day start an AOA-approved internal medicine residency at KRMC. She is currently a member of the AOA Council of New Physicians in Practice and the AOA Bureau of Socioeconomic Affairs but has been active in the AOA since her second year of medical school.
Following is an edited interview with Dr. Naegele.
What led to your going to osteopathic medical school later in life?
From the age of 12, I had wanted to be a physician. But my father wouldn’t let me go to college after I graduated from high school, which was devastating to me. Neither of my parents graduated from high school, so they thought that my being a high school graduate was enough. Because funds were limited, they understandably considered it more important for my younger brother to get a college education, assuming he would be a breadwinner one day.
I was fortunate to find the right man, and I got married and started a family. We raised four children, who are grown up now. Along the way, I started my business in interior design products, manufacturing window treatments and upholstery. Self-taught, I was successful as a businesswoman in the Chicago area for 17 years. But I was unhappy and unfulfilled in my professional life. I still wanted to be a physician.
At the age of 37, I went back to college, first to a community college and then to Loyola University in Chicago as a premed and psychology major. During this time, I learned more and more about the osteopathic medical profession. I found that I liked the osteopathic approach of taking all of a patient’s social issues into consideration along with medical issues and treating the patient more comprehensively.
I was accepted into the DO-MPH dual degree program at the Des Moines University (DMU) College of Osteopathic Medicine. During the year before med school, I earned an MBA with a concentration in health care administration and an MIS degree with a health care emphasis from Benedictine University in Lisle, Ill. I did this to spend my time productively while I was waiting to start at DMU. I also wanted to learn more about the business of medicine and how information technology could assist me later on in my practice.
I enjoyed DMU very much, but I missed my husband and children, who were living in the Chicago area. So I transferred to MWU/CCOM in my third year to be closer to my family. I was able to finish my MPH degree from DMU remotely while earning my DO degree from MWU/CCOM.
How did being an older medical student and resident affect you?
Being older affected me in both positive and negative ways. But in retrospect, despite my early disappointments, I wouldn’t have had it any other way because my background and experiences have made me a more well-rounded physician.
First, because of my age, I have had more personal experience with illness. Various friends, family members and I have been on the receiving end of medicine. This perspective makes me more sensitive and empathetic when I am providing care.
Second, self-awareness comes with age. I had a better understanding of what I wanted and how to get there. But this wasn’t instinctual. I proactively sought out experiences to help me make the right choices. I tried to be open to everything, never passing judgment until I experienced something. After years of not being happy in business, I knew I had to find a niche in medicine that would be the right fit for me while also being right for my family. I wasn’t about to spend many years in medical school and training without gaining valuable insights about myself at each step along the way.
Third, my business background and the knowledge I gained getting my MBA have been very valuable to me in understanding practice management issues. The experience I had managing employees and negotiating with vendors and clients has been particularly helpful. In addition, I taught at a community college part time before starting med school. So I already knew that I loved teaching and wanted eventually to teach medical students as well as go into practice. These prior work experiences made me more confident in myself.
On the down side, as an older student, I had a harder time forming close relationships with those I was training with. It’s not that we didn’t respect one another or share many laughs together. It’s just that I didn’t fit in as well with those who were much younger because we were at different stages of our lives.
Do you feel more comfortable as an attending physician?
Absolutely. It’s very different the minute you become an attending. The medical students look for you to guide them. And the residents love being around you. Because many attending physicians are my age, I no longer stand out.
Why did you decide to specialize in internal medicine and become an oncologist?
In my third year, when I was doing my core rotations, internal medicine especially intrigued me. I knew I didn’t want to be a surgeon. And I liked the fact that in internal medicine, you build relationships with patients that last for years. I also toyed with pursuing family medicine, but I had the notion that I might want to subspecialize later on. Internal medicine has more opportunities for subspecialization.
I originally entered a combined residency program in internal medicine and emergency medicine but decided after a few months that it wasn’t for me. Then I switched to a program that was solely internal medicine. At that point, I wasn’t yet sure where I would find myself in the future or even whether I would do a fellowship.
At the time, I did a lot of self-reflection. Do I really want to spend three more years in training after residency? Where do I fit? Where don’t I fit? Fortunately, I discovered in my second year of residency that oncology is perfect for me.
Oncology is ever-changing and intellectually challenging, which appeals to me. Having lost a dear friend to breast cancer years ago, I already had a strong personal interest in this field of medicine. And I have the right personality for it. As an oncologist, you have to immediately be thought of as trustworthy. And having a good bedside manner is of utmost importance. My bedside manner has always been my forte.
What drew you to Arizona and Kingman Regional Medical Center?
I started interviewing early, in my second year of fellowship, because I knew I was a different sort of candidate. And I interviewed across the country. Being older, someone who had life experiences, someone who had all of these other degrees, I knew I had a lot to offer and would have many options. But I wanted the opportunity to be right.
Arizona is an osteopathic training ground, which was a big plus. Half of the physicians at Kingman Regional Medical Center are DOs, and the state is very DO-friendly. I have a huge passion for teaching, so I wanted to be in a state where I would be able to work with osteopathic medical students and residents and perhaps eventually serve on the faculty of an osteopathic medical school. I’m currently a preceptor for students from three DO schools and for family medicine residents. I want to start an internal medicine residency program but can’t right now because of Medicare caps.
Arizona’s weather was also a big pull, especially for my husband, who retired when we moved.
The position at Kingman Regional Medical Center appealed to me for many reasons. I knew that I didn’t want to go into private practice because having owned my own business before, I didn’t want to worry about paying the electric bill, employee salaries, and so forth. I wanted someone else to take care of those things. But I also didn’t want to work somewhere where I wouldn’t have autonomy.
At Kingman, I’m a hospital employee, but I run my practice the way I want to. And when I want to implement a strategic plan, I receive a lot of support. Since I started here, we’ve tripled our number of patients at the KRMC Cancer Center. I’m so happy with what we’re doing. I feel we’re providing a great service to the community.
I love my daily work and am finally at peace with my career choice.
What advice do you commonly give other new physicians?
Many new physicians in practice are intimidated by coding, which typically isn’t addressed sufficiently during residency. There just isn’t enough time to teach residents everything they need to know. As a fellow, I didn’t want to wait until practice to learn how to code. So I would moonlight as a hospitalist on weekends and learned a lot about coding that way. I advise all trainees to moonlight if their residencies and fellowships allow it.
Beyond coding, the more you immerse yourself in different and challenging experiences and engage in self-reflection, the more likely you are to find the perfect niche for yourself.
Many residents and fellows need guidance in how to find the right job. They start their job search too late. They don’t know the right questions to ask. They don’t know the things to look for on a contract.
I firmly believe that the first job out of residency or fellowship is the most important for your future. It sets the pace for further jobs. If you underestimate your abilities in the beginning, you are going to be stuck in that situation for a long time. It’s going to be hard to move up the ladder salarywise and positionwise.
So I tell residents and other new physicians to ask themselves, “What am I strong at? What do I like and what do I not like about small groups, big groups, hospitals? What do I need to do to get there?”
While I had years of experience to guide me, most new physicians don’t have the foresight to understand the different working relationships in various practice settings. They are not used to negotiating, and they may lack confidence because of their age. This greatly hinders their future.
Why do you remain active in the osteopathic medical profession?
I’m very proud to be a DO. The AOA helped me fulfill my dream of becoming a physician, so I want to give back to the profession I love.
I’ve had three major mentors, who helped shape me as a physician: AOA Past President Karen J. Nichols, DO, the dean of MWU/CCOM; Teresa A. Hubka, DO, a former president of Illinois Osteopathic Medical Society, which I served as a member of the Board of Trustees before moving to Arizona; and Krishnan Srinvasan, MD, who was my fellowship program director. I am so grateful to these individuals. In turn, I hope that my own experiences and insights can motivate others to take risks and pursue their dreams.