University of New England

Touch a Million: Jacquelyn Cawley, D.O., UNECOM ‘89

[Editor's Note: This profile originally appeared in the October 2007 COMmunicator.]

There are risks and costs to action. But they are far less than the long-range risks of comfortable inaction. - John F. Kennedy

Kings and Queens of England

Long before she was interim dean of UNECOM, before she was president of this and vice-president of that, Jacquelyn Cawley sat rapt at the dinner table in Albany and listened to her father talk about the kings and queens of England. “He was a schoolteacher and a politician both,” she recalls, “as comfortable in the classroom as he was at a podium.” She grew to love the role of literature in life. Public speaking, politics, and education were in the air that she breathed.

Jackie’s mother helped write her father’s speeches, and the whole family went door-to-door or stumped for votes as Jackie’s dad entered the world of New York politics in the state legislature. Both parents worked on Jack Kennedy’s campaigns, then on Bobby’s, buying in to the democratic principles of social welfare and liberalism that the Boston men espoused. It was not difficult to see why the handsome fellows with their flashing smiles, fetching wives and big ideas had captured the imagination of a generation. Camelot, some thought, had come to Washington. The person on the street eyed the man on the moon. Anything could happen.

And anything did. Double assassinations crumbled Camelot, and the sudden, soaring triumph of the moon-landing launched national self-esteem into orbit. It was a bittersweet lesson about the clay feet of power and the risks and rewards of action. “Change is always scary,” Dean Cawley says, “but I am a catalyst for change. You need to have a clear sense of where you’re going so that people can see it and feel it. I want to help transform our health-care delivery system so that life is better for the community and for the patient. When you treat a patient, you help a person. When you change a system, you touch a million.”      

Not On Her Knuckles

She was poor. Well, not poor, but at least strapped. Jackie had only $1,000 to pay for college, and it steered where she went. “I received a scholarship to Canisius College,” she recalls, “and then transferred to SUNY Buffalo for my last three years.” There was no doubt what she’d do – her family doc had made house visits when Jackie contracted chickenpox or cut her knee, and Jackie had developed a 15-year plan for herself to become a family-practice physician when she was just a candy-striper at St. Peter’s hospital – so she plunged into pre-medical studies with abandon. Her female housemates pursued allied health professions like nursing, PA, or PharmD programs, and Jackie got a sense for how those fields fit into the greater scheme of all things medical. But she was going to be a doctor, and no glass ceiling was going to stop her.

“I went into college with advanced credits,” she says, “which gave me the flexibility to take fascinating courses like medical ethics and medical history.” She became president of the pre-medical club, wrote poetry from time-to-time, kept physically fit after a high school career in dance and cheering, volunteered at the VA hospital, and worked in the on-campus lab. Over-committed? “I always get involved,” she laughs self-consciously. “I always get into things. It’s sort of my M.O.”

It was a different era in those days, and her determination was necessary. A young woman who wanted to become a physician had to really knock the props off her peers to stand out. It was a time when some female medical students had to sign waivers promising they wouldn’t become pregnant during rotations and certain men made snide remarks about the cognitive ability of women. “You must have been the smart one in your class,” they’d say, “you’re not dragging your knuckles on the ground.” Dean Cawley managed to lift her knuckles long enough to graduate near the top of her class.

“Whoa, This is Really Important.”

During her senior year, a guest speaker came from NYCOM. Jackie heard that he was an osteopathic physician. “What the heck is an osteopath?” she muttered. But when she heard him speak about physician-patient relationships, she sat up a bit straighter. “Wait a second,” she said, “that’s the type of doctor I would want to go to. Shouldn’t I become that sort of doctor?” Dean Cawley did some more research into osteopathy and then applied to osteopathic schools in the East.

UNECOM stole her heart. “When I came for the interview it was sunny, beautiful, and the people were so friendly,” she smiles. “There was a tremendous sense of community and camaraderie.” A letter came in the mail on December 23rd or 24th, and upon opening it, Dean Cawley learned that she had been accepted to that medical school in Maine. “I thought, ‘What a great Christmas present! I love that school!’” she recalls. “But my family was all like, ‘What the heck is an osteopath?’” Once they saw pictures of the beautiful location and learned from Jackie about osteopathy, they began to notice D.O.s all around the area.

Jackie entered in the fall of ’85 with 70 other terrified newbies, only 11 of whom were women. Anatomy professor Neal Cross immediately set everyone on a level playing field. “He scared us to death!” Dr. Cawley laughs, her eyes flashing. She loved school, studied like it was her job, and thrived in the tense academic setting. She also met her future husband, a second-year student, on the third day of school. “We were engaged by spring,” she says, “and studied together nearly every day.” But medical school was far more than academics and courtship. “You enter the Gross lab for the first time,” Dean Cawley remembers, “and there is the smell of formaldehyde. You see the bodies lying there, covered, but with perhaps a hand or an arm in view. And you realize, ‘Whoa, this is really important.’”

The Humanness of Medicine

She calls it “the humanness” of medicine. “I remember when I was doing my CORE rotations in Pennsylvania,” Jackie says, “and I met a woman who was dying of breast cancer. She had been diagnosed twenty years earlier, fought it, was in remission, and then the disease recurred. I was able to be a part of her life as she went through the whole cycle of getting a disease, fighting it with dignity – you know, just the strength of people – and I realized that this is what I wanted to do.” 

Handed her diploma at graduation, Dean Cawley thought to herself, Ok, when do I learn to become a doctor? Even though she was near the top of her class, Jackie did not yet feel like a physician. “You learn most during internship,” she smiles. Hers was at UMDNJ, and then Stratford Hospitals across from Philly, as her husband also was an internist in the area. While there, Jackie began to take flak. “People would tell me, ‘You’re too smart to be a family practice doc,’” she recalls. “They’d say, ‘You should be an OB/GYN.’” Even today, those comments offend her.

“I have always been drawn to family practice,” she says, “where you get a chance potentially to care for the whole person, from birth to old age. Not only that, but it is multi-generational, and you can be caring for entire families, or entire neighborhoods and communities. It is amazing how much you can learn about a patient from others in their family.” Contextualizing is important for Dean Cawley, and it helps to explain both her love for family medicine and also her patience as an administrator. She is a careful, empathic listener who likes to think globally and systemically.  

“I Can Do More By Leaving.”

It wasn’t long before both Dean Cawley and her husband began to look back at Maine. “My husband was doing work for Art Vanderburgh [clinical professor in biochemistry at UNECOM],” she says, “and I was asked to become a faculty member at the Petts Health Center on the UNE campus in Biddeford.” She began to see the need to enhance the quality of the Center, and when her administrative gifts became apparent, Jackie accepted the position of medical director at Petts. “You shouldn’t complain about things if you aren’t going to make changes,” she states. “Don’t bark if you won’t follow through and make a difference.” 

Getting involved was a natural response for Dr. Cawley, as natural as breathing. “It wasn’t conscious,” she insists, “it was instilled from my parents. An active leader can make changes that affect everyone in the practice. I’d seen my dad get involved in politics from my earliest days. I suppose my kids are the same way now.” She became pregnant at that time with her first child, Katie, and towards the end of her term was asked a most unusual question. “Boyd Buser [former interim Dean of UNECOM] asked if he could use me as an example of how to treat a pregnant patient in OMM class!” Dean Cawley laughs. She agreed, sportingly, and still thinks it’s funny.

But having children also posed some challenges. “Things got hard,” Jackie admits. “Both my husband and I were working full time; my mother-in-law was ill and was living with us; and I wanted to spend more time with the kids. Plus, I was on call at multiple places and always, always seemed to be called at the strangest times. It really seemed overwhelming.” To throttle back seemed wise, so Dr. Cawley began to look for tamer time commitments. A part-time family practice position opened at Maine Medical Center in Portland, and the hours seemed promising. “I thought it would be more balanced,” she says, “but then they offered me a medical director position.”

An easy ‘no,’ right? Not for Jackie. It was an opportunity too good to pass up. “Maine Medical wouldn’t even let me in the door for residency,” she says, “and now they wanted to give me a medical director position? I thought to myself, As a woman, and as an osteopath, I have to do this. I can do more for the profession by leaving UNECOM.” She accepted the position, and found that it was slightly more balanced than her previous schedule. That was good, because her son C.J. came along, and life at home was more hectic than ever. There was always something to get involved in.

A Paver and a Melter

Over the next nine years, Jackie got involved in a lot. She was able to design a new building around patient flow, helped improve healthcare delivery, was the family practice medical director, and was elected president of the Maine Medical Center Staff. She was the first woman, and the first osteopath, ever to be elected to that office. “I feel like I was paving the way for those after me,” she says. Her highly developed people skills were refined even more during those years, and she learned how to work within established systems to achieve new and dramatic results.

Recalling the years when Maine Medical would not accept osteopathic residents, Dean Cawley set up a CORE rotation site at the hospital for UNECOM, increased the number of osteopathic residents, and encouraged the application and hire of osteopaths. Currently, there are more than 140 D.O.s on staff. What led to the precipitous reversal? “I think when you allow people to work side-by-side, their fears and mistrust melt away,” she surmises. M.D.s discovered the competence of D.O.s, and now there’s no turning back. Jackie likes that legacy.

After making such an impact at Maine Med, one could forgive Dean Cawley for staying comfortably in place and enjoying the fruits of her labor. But comfortability equals stagnation in Jackie’s book. “I was ready for a new role,” she says. When the family babysitter developed breast cancer, Jackie decided that it was time to step back for a while, spend more time with her kids, and develop some new ideas. Martin’s Point Healthcare in Portland was more than happy to take advantage of her skills. “They offered me a vice-president position,” she says, “which they had just created, so it intrigued me. It was going to give me a lot of experience with insurance and the business-side of health care.”

Dr. Cawley was able to re-work an entire health care management system focusing on health and wellness, patient self-management, and principles of physician leadership, while also developing a pilot study on team-based care. In short, Jackie was able to synthesize many of her interests and experiences in the public and private sectors, and have lots of fun in the process. Her name began to come up in conversations around the state as a catalyst for change in the healthcare realm - a person who could take a system and re-work it with fresh ideas to create a better product. And a better product is just what a former employer was looking for.

“Are You Crazy?”

At the AOA meeting last fall, new UNE President Danielle Ripich, and former UNECOM Dean Steve Shannon, approached Jackie to talk to her about throwing her hat into the ring of applicants for the dean’s position. She immediately declined. “I’m not an academic,” she protested, “I haven’t published anything.” But as she talked further with the two leaders, their vision began to resonate with her. “They spoke about enhancing the brand of the institution and its quality,” Dean Cawley recalls. She began to warm to the notion, but her husband cheerfully commented, “No way, Jackie, you’re not a dean.” The position seemed too fraught with complications.

In May, when the dean’s search had failed to produce a consensus candidate, President Ripich again approached Jackie with an offer, this time to take the reigns temporarily – just for a year – in order to effect change and then move on. “I had two weeks to decide,” Dr. Cawley says, “And my husband said, ‘Are you crazy?’ But I kept thinking about how it was a way that I could give back at a time when the school is reinventing itself and is charting a new trajectory. I kept thinking, What if? What if?” The opportunity for personal professional development, working with an entirely new constituency of people, and the potential to greatly impact the future of the school were too much to refuse. She accepted the position of interim Dean of UNECOM for the 2007-2008 academic year.

There was an immediate hue and cry. Some local osteopaths viewed the appointment as a back-door deal cut between a new president and an alum who some viewed as not friendly enough to osteopathy. Jackie couldn’t believe the accusations. As a person who blazed the trail for osteopathic physicians at Maine Medical Center, she was hurt by the charges. “It was very difficult initially,” she confesses. “I really had to stop looking for external approval and continue to follow my star. I was hired at Martin’s Point as a ‘change agent,’ and it was the same here at UNECOM. I think I’m the right person for right now. I may not be in the future, and that’s fine. But I think that trust develops over time.”

The Only Responsible Course

Dean Cawley’s goals for this year are ambitious. “We obviously want to have a continued strong commitment to the osteopathic community,” she states. “But the question is, how do we change for the future while maintaining our core commitments? What baggage needs to be jettisoned?” She has started a COM-specific strategic planning process in conjunction with the larger University-wide overhaul of mission, values, and goals. In her estimation, the process needs to be comprehensive, inclusive, and incisive. “We need to listen to folks,” she says. “There needs to be face-to-face time in order to understand where people are. What’s the best that we can be? Where are we at today? What is the gap between those two places? Most people want to close gaps like that when they see them, so we need to articulate them, give data to people, and understand what motivates them. Different groups have different needs. Usually, a process like this takes about three years.”

A concern, of course, is to avoid high-level meetings that fail to deliver significant changes. There needs to be an infusion of capital to effect change, and Dean Cawley’s vision is to ultimately see the health-care delivery system transformed at a fundamental level, starting with how osteopathic medical students are trained and equipped. “Students are our healthcare future,” she says. “We need to train them in a different way. Each student will eventually touch thousands of people. I see moving toward a new system of care integrated around primary care, patient-centered interaction, and the home-care model. It needs to be all about the patient: How can I make the person in front of me better?”

Change can be scary, but Jackie Cawley believes that not changing is even scarier. “Currently, as physicians, we earn more when a patient is sick,” she says. “That’s a paradox. We need to move toward outcome-based reimbursement and incentives, where the patient is given the info, tools, and support to be healthy, and physicians are compensated for promoting wellness rather than just treating illness. Physicians need to step up to the plate and lead this movement. We need to drive these changes in medicine. We need to be active agents, rather than spectators.” With the costs of healthcare in the United States rising exponentially, Dean Cawley believes that these changes are the only responsible course for osteopathic physicians to take.

And for herself? “I’d love to get my MPH,” she confesses with a laugh. It was John F. Kennedy who said, “Leadership and learning are indispensable to each other,” and Dr. Cawley puts that into practice. “What will bring the most value?” she asks. “How can I impact the most people? I love to come up with crazy ideas and pilot them and get people on board. There are so many options as a physician; you always continue to grow. The key is to marry your passions with your path as a physician. We all have a purpose, and you begin to see what yours is and how it unfolds.”

In her case, it’s to touch a million.

- Steve Smith, RSAS