One Satisfied Country Doctor Tells of Living His Professional Dream : New Mexico: Dr. Richard Kozoll figures his income would double if he moved to Albuquerque. But money isn’t everything. ‘I stayed because I could see the difference I was making,’ he says.

The way Dr. Richard Kozoll figures it, his income would double if he moved his family practice to Albuquerque.

“About $85,000,” he says, as if guessing the temperature. It is a figure to consider this Sunday morning as his battered pickup skitters down the icy road from his mountainside house to his office trailer, where a mother waits with her sick child.

“You don’t do it for the money,” says Kozoll, who has spent his professional life in empty stretches of the Southwest. “I stayed because I could see the difference I was making. If you’re practicing in a place like Albuquerque, you lose touch with the effect you have.”

Kozoll is a country doctor, a semiprecious health care commodity and the subject of debate among policy makers.

Advocates of the National Health Service Corps, which plants young doctors in medical backwaters, might claim Kozoll’s years with the corps as a success story.

Others, noting the expensive program’s high dropout rate, could say Kozoll is an exception who stayed while others fled to financial security of the city.

The 48-year-old family practitioner takes neither side. It was his dream, growing up in suburban Chicago, to practice rural medicine.

“I was predisposed to this practice,” he says, “and public health service was a vehicle to do this.”

Kozoll is key to health care among residents of the Checkerboard, 3,000 square miles of high desert and mountain in northwest New Mexico dotted by Navajo chapters, old Spanish villages and ranches.

He drives long distances to see homebound patients. Office hours stretch into the evening as patients drop in without appointments. He is on call weekends, making the five-mile trip to his office several times a day.

This service helped build a loyal following. Checkerboard residents choose Kozoll over Albuquerque specialists to whom they are strangers.

“He seems to be more knowledgeable than other doctors and can handle kids better,” says Patricia Pointer, whose 3-year-old daughter Katie’s ear infection brought Kozoll down the mountain.

Kozoll coaxes Katie out of her tears as she clutches a well-worn Barbie. “What am I listening to?” he asks, getting her to accept the stethoscope. “Does it go ‘thump, thump, thump?’ ”

There is another attraction: convenience. Pointer’s drive to Cuba took 25 minutes; Katie’s pediatrician is 90 minutes away in Albuquerque and not readily available on weekends.

“It’s comforting to me to know Dr. Kozoll is here when I need help,” she says.

Kozoll encounters unique problems. His Navajo patients face twice the risk of diabetes and attending complications of kidney disease, gangrene and blindness.

Such chronic conditions require close monitoring; Kozoll’s office hours are filled with brief visits covered by low-paying Medicare and Medicaid.

“An ophthalmologist in Albuquerque doing an office procedure covered by private insurance can earn in 35 minutes what it takes me 2 1/2 days to make,” Kozoll says.

But not all is sacrifice. Kozoll and his wife, Sally, live in a spacious house on 35 acres shared with four dogs and two cats--some inherited from health service doctors who did not last. They vacation in Europe. Tall and scarecrow-thin, Kozoll runs mountain trails and skis cross country.

“A doctor can make a comfortable living out here. Maybe not compared to Albuquerque, but by the income standards of Cuba, I’m doing real good,” he says, laughing.

Kozoll works hard. Shuttling between two tiny rooms in white lab coat and sneakers, he sees a range of ailments: children with flu, high blood pressure and diabetes among older patients.

Kozoll switches among three languages, telling an elderly Spanish woman she needs a dentist, asking a wide-eyed Navajo child to breathe deeply and counseling a teen-ager whose mother died.

“In this kind of practice, you get to know most everybody,” he says. “You see the natural history of disease and life.”

Kozoll charts the Checkerboard’s medical currents. Annual physicals for the Cuba Rams football team reacquaint him with teen-agers he saw as children. He knows the coronary profiles of heart patients, an advantage for late-night calls about chest pains.

Kozoll came to Cuba in 1975 after serving in the Indian Health Service in Oklahoma and the Health Service Corps in Gallup.

He has mixed feelings about the service, questioning regular transfers that break patient relationships and the effectiveness of loans that buy doctors’ servitude for just a few years.

“The program is successful in getting young graduates out to underserved areas, but the majority leaves when the time is up,” he said. “It would work better if the right people were selected up front and given incentives to make 20 years of federal health service worthwhile.”

Kozoll’s first job in Cuba was as head of a clinic run by the Presbyterian Medical Service. Subsidized by government grants, it had a nine-bed hospital with a 24-hour emergency room, four doctors, four dentists and outreach services to screen for tuberculosis and rheumatic fever.

The hospital closed in 1988, a victim of funding cuts and a new alignment of Indian Health Services. The new building across from Kozoll’s office is mostly empty; ambulance service was cut from two crews to one. The clinic operates on a limited basis; they often give patients Kozoll’s number.

Kozoll said cutbacks in services, not personnel, hurt health care.

“The issue isn’t the number of doctors. We have enough for Cuba,” he says. “The breakdown comes with emergency medical services.”

This gap is apparent when Cecilia, a mother of six, comes in. Thirty-seven weeks pregnant, Cecilia’s water has just broken. It was only the week before, during her first prenatal visit, that Kozoll diagnosed pre-eclamsia, dangerously high blood pressure found in some pregnant women.

With Cecilia well into labor, Kozoll recommends an ambulance to Albuquerque. But the crew is out; a second ambulance sits useless in its garage.

Cecilia had to wait an hour. She later delivered a healthy boy.

“We need more well-trained family physicians in rural areas, but more importantly, we need the infrastructure to support them,” Kozoll says.

But with the frustrations come little victories.

Kozoll has good news for Pablo Arragon, a 79-year-old man with unexplained paralysis of his left eye.

An Albuquerque specialist had suggested an expensive MRI scan for neurological problems. But Kozoll’s gentle questions uncovered another explanation: Arragon’s thyroid was removed three years ago, but he had never received a necessary synthetic hormone.

“In a rural practice, you don’t immediately jump to the high-tech solution,” he says. “You try the simple approaches at first.”