Now she practices at the ETSU Family Medicine Physicians of Johnson City. The clinic is located on East Tennessee State University’s campus, is open to the entire community and specializes in family care.
While considering the option of pursuing a medical degree a family member’s health problem brought to light the issues facing rural residents who need proper health care.
Her grandmother, who lives in southwest Virginia, was treated over the phone because she lived in a rural area and could not conveniently get to a clinic or doctor. The doctor on the other end of the line listened to her health problems and made a decision to write a certain prescription. The resulting side effects of the medication led to more health issues that were more severe than the original problem.
“It really brought to the forefront that people in rural world need real medical care.”
- Dr. Joyce Troxler
The need for effective and efficient healthcare in rural areas led to the creation of the National Health Services Corps scholarship program. Troxler applied for and was granted the scholarship when she enrolled in East Tennessee State University’s Quillen College of Medicine. Founded in the 1970s in response to a lack of general physicians in certain areas of the country, the Corps program pays for school in exchange for time spent serving an in-need location.
Among the farming community there has been a steady increase in the percentage of migrant farm workers making up the population. Poverty, frequent mobility, low literacy, language and cultural barriers are just some of the problems that the farm workers face. For many of these workers it is not only their own personal health at risk but those of their families as well.
During the same time that Dr. Troxler was working towards her medical degree, the area around ETSU experienced a growth in its Hispanic population, due in part to a downturn in the economy in certain parts of the country.
According to a 2012 study conducted by the University of Tennessee and the Tennessee State Data Center, the Hispanic population in northeast Tennessee increased from 2000, when 123,838 Hispanic residents called Tennessee home, to 290,059 in 2010, more than doubling the Hispanic population. The 2012 study also pointed to the desire for a more rural lifestyle as a reason for the population increase.
With rural healthcare being an issue of concern for Troxler, she sought out opportunities during her schooling to gain first-hand experience with rural patients. Aside from her course work Troxler took part in a research grant with ETSU’s College of Nursing and the Department of Family Medicine. From 2001 to 2005, through the research grant, students and instructors set up mobile clinics across the area, specifically targeting the Hispanic community.
“All they were doing was gathering baseline health information on the Hispanic community,” Troxler said. “Every Sunday in the summer we were out there at the Scott’s Strawberry Farms camp.”
In locations ranging from migrant camps to Wal-Mart parking lots clinics were set up. The main goal of these clinics was to give blood pressure and blood glucose screenings. During these clinics baseline health data was collected from the patients via question and answer sessions. With her experience speaking Spanish, Troxler would earn the distinction of “the one who spoke Spanish.” What started as a high school requirement became an essential tool.
In high school Troxler chose Spanish as an elective, thinking it would lead to learning Italian. That ability, honed with a month spent in Spain as an undergraduate, would be key in her ability to communicate with patients everywhere she has practiced.
She recalled the exact moment when the switch finally flipped in her head and it became second nature and all the noise turned into meaning.
“I was standing on a bus and there was water dripping from an air conditioning unit,” Troxler said as she described the moment. “A woman beside me told me ‘Agua sucia.’ I was like 'Oh, I understood what she said!'"
A doctor's ability to communicate with their patients is critical. Troxler’s colleagues believe she may be one of the best when it comes to this.
“Her ability to engage with patients is really wonderful,” said a former co-worker, Dr. Barbara Cichosz. “She has a very genuine presence in the exam room that I think allows people to really relax and talk to her.”
Cichosz worked with Troxler in Silver City, N.M. in a primary-care facility. Troxler chose the Silver City location from a list of underserved communities provided by the National Health Service Corps. During this time her wide range ofskills brought a needed service to the residents of the small town and surrounding rural area.
“Being a general practitioner she knew lots of everything,” said Cichosz. “That’s really helpful in a rural area like this, a person who does everything.”
Her time spent working with the clinics and camps let Troxler see first-hand the many issues facing rural healthcare. While working in Silver City she learned that the problems faced by those who live a rural lifestyle in Tennessee are very similar to those faced by their New Mexico counterparts. In cases of the Hispanic immigrants, some of whom were not authorized residents, a fear of seeking out healthcare was evident.
“As far as other avenues of care, yeah, they weren’t going there,” Troxler said. “They knew they had a place they could go to, no questions asked.”
Since returning to Johnson City she has not been as involved as she was during her time in school, but she does recall that the majority of services had to be set up specially for the Hispanic community.
Middle Left: Third-year resident physician Dr. Shyam Odeti presents a patient's case to Dr. Troxler for her recommendations.
Bottom: First-year resident physician Dr. Susan Carter presents her patient's case to Dr. Troxler before proceeding with the patient.
Photos: Aaron Hodge