Finding a Balance between Work and Life

Dr. Jennifer Troiano’s first impression of the busy reception room at the Community Health Association of Spokane Washington’s downtown clinic was eye opening. A mix of Caucasians, Latinos, and Native Americans waited patiently for their names to be called. Despite the diversity of the group, however, Dr. Troiano noticed that the clinic’s staff greeted each patient with the same respect and sincerity. Just then, the clinic’s director stepped through a door and called her name.

Dr. Troiano was there to interview for a position that would fulfill her commitment as an NHSC Scholar. “The providers I met were great,” she recalls. “They were energetic, even though they were seeing a lot of patients. It just seemed exciting. Even sitting in the waiting room, I remember looking around at the patients and thinking, ‘I would like to take care of these people.’”

Dr. Troiano is a Brooklyn, NY, native, but her husband—who is a pediatric cardiologist—is originally from Spokane, WA, and his family still lives there. The two of them married during their residencies at Tulane University in New Orleans. When it came time for them to find work, she admits it was difficult to decide where to look.

“I wasn’t sure whether I wanted to stay in the Southeast or move to the Northwest. But because of my husband’s specialty, we needed to be in a city that would accommodate his career,” she says. With family ties in Spokane, as well as the work opportunities for both of them, they decided to move west.

That was in 2001. Now, several years later, Dr. Troiano is a solid fixture in the Community Health Association of Spokane’s medical staff, which consists of five doctors working in tandem with 15 nurse practitioners and physician assistants. On any given day, she sees about 20 patients, usually by appointment. Because of her dual specialty in internal medicine and pediatrics, the patients she sees range from newborn to elderly, with visits requiring everything from acute care to routine checkups and preventive medicine.

Aside from her patient visits, Dr. Troiano is making lasting contributions to the clinic through procedures and institutional resources. For example, many of her patients are indigent or isolated by transportation and language barriers. Because she never knows when she might see them again, Dr. Troiano incorporates elements of routine health checkups in her appointments as frequently as she can. She has also contributed to the clinic’s preventive medicine program by writing a consumer fact sheet, A Word to the Wise…Immunize!, that addresses the importance of childhood and adult immunization. And as a participant in The National Depression Collaborative, a program sponsored by the Bureau of Primary Health Care, the clinic also uses the EMR system to screen all their patients for mental and behavioral health disorders.

“We see a lot of people with schizophrenia, depression, substance abuse, and anxiety,” she says, adding that homelessness and poverty can be the result of these disorders. As a result, she often uses the depression screenings to refer her patients to clinic staff who can provide them with specialized treatment.

Dr. Troiano is comfortable working at Community Health Association of Spokane. “I just feel really satisfied at the end of the day,” she says. But it wasn’t always so comfortable. When she first came to Spokane, there were a lot of adjustments to make, one of which was working with mid-level clinicians. Throughout her medical training at Tufts University in Boston and her residency at Tulane, she rarely worked with nurse practitioners or physician assistants. But her experience working with them at the Community Health Association of Spokane has inspired her to teach classes at the University of Washington School of Medicine’s MEDEX Northwest Physician Assistant Training Program. In 2003, she received a “Golden Apple” faculty award from the graduating class at MEDEX for her outstanding contributions as a lecturer.

Another adjustment was moving, as a native of Brooklyn—the most populated borough of the largest city in the United States—to what Dr. Troiano describes as “a medium-size town” in eastern Washington. But the region has grown on her.

“It’s a beautiful place,” she says. “Three are a lot of outdoor activities, and it’s a small enough city that everything’s right here, so it’s very easy to do things. The people are very nice here, very polite, very friendly. Everybody says that it’s a good place to raise children.”

Dr. Troiano thinks so, too, which is why, now that she has finished her NHSC commitment, she is switching to a part-time schedule to focus more attention on her children. But between her ongoing commitment to CHAS and her teaching activities at MEDEX, she’s still very involved in patient care.

“This community is very glad that the Community Health Association of Spokane is here,” she says. “If it weren’t, a lot of people would be forced to go to the ER for routine care.” But it’s not just duty to the community that keeps her in the clinic. “I like working here,” she adds. “I like the mission. I’ve become involved in other things, too, but I plan to continue working here at some level.”