KANSAS CITY, Mo. – The four-mile stretch of Independence Avenue, between Paseo Boulevard and Interstate 435, contains hundreds of businesses: taquerias, mechanics, and check-cashing agencies to name a few. But there's only one place where you can find basic medical care. It's the solo practice of Dr. Elaine Joslyn. Dr. Joslyn's been caring for residents in Kansas City's Northeast neighborhood for over two decades. But as KCUR's Elana Gordon reports, doctors like her are becoming increasingly hard to find.
Independence Avenue is a busy street. And each day, tens of thousands of cars and trucks speed by an easy-to-miss, hand-painted sign that marks a brick building on the corner of Elmwood as Dr. Elaine Joslyn's medical practice, NEighborhood Family Care.
Inside the light-peach colored waiting area, Sherrie Giddens, a patient of Dr. Joslyn's for over twenty years, checks in for an annual women's visit.
"Sometimes I've had past experiences where it's been kind of cookie cutter, where you walk in and a physician's like, 'here's your prescription, move on. This is what's wrong with you, take it, call me in the morning or whatever,'" Giddens says. "Dr. Joslyn always takes the time to individually address your concerns or questions and really makes you feel like you're special. It's a one on one time."
Dr. Joslyn says her office sees people of all ages and backgrounds.
"2 day old babies to 100 year old grandpas, I see it all," Dr. Joslyn says. "A lot of chronic care, diabetes, hypertension, hyperlipidemia, that's kind of the bread and butter of primary care."
And having been a resident in the area for nearly as long as she's been practicing, she's developed strong relationships with patients.
"I know, a lot of times, the neighborhood they live in, the home they live in," says Dr. Joslyn. "And all of that impacts health. So I have a deeper understanding of their needs medically, emotionally, spiritually. And I think I can practice better medicine because of that."
She says as a family doctor, her role is often to help patients navigate the larger health system, coordinate specialty care and translate to patients what different health problems and procedures mean.
Dr. Joslyn graduated in the mid 80s from Kansas City University of Medicine and Biosciences. She directed the school's family medicine program and clinic for about a decade. Around the time she then set up her own practice, HMO's were big. That involved large organizations, like hospitals or insurance companies, overseeing all aspects of care.
"So when I decided to open my own solo private practice in 1994, that was bucking the stream," says Dr. Joslyn. "The solo practices were all selling out to big entities."
Entities which were in other parts of the metro.
Today, the Northeast and the areas surrounding it need more Dr. Joslyns. The next nearest family practice to Dr. Joslyn's is about two miles southeast of her. Samuel Rodgers, a federally qualified health center two miles in the other direction, serves many of the area's low-income residents and is actually in the process of expanding. Truman Medical Center is another option. Even so, the U.S. Department of Health and Human Services has identified the region as a shortage area for primary care. It means about a dozen more full-time docs are needed. And more specifically, docs who see people without insurance on a sliding scale, who see people with Medicaid.
Experts say this is a big problem.
"It's a huge problem," says Dr. Todd Shaffer, head of UMKC's family residency program.
In the hallway outside his office at Truman's Lakewood campus, he looks at a U.S. map, which has pins marking where graduates of the program have gone on to practice. He points to the cluster of pins around the KC metro area.
"But look at this little gap that goes right through here. See that gap? That's pretty much 71 highway all the way up through Independence Avenue," says Dr. Shaffer.
Dr. Shaffer says the graduates that stick around Kansas City tend to practice in suburbs, often as part of larger groups, where there's a higher rate of insured residents. He says that brings a lot more financial stability. But he says even though the shortage of primary care doctors is greater in rural and urban areas, everyone should be concerned.
In Missouri alone in the next decade, where most counties are considered primary care shortage areas, another 650 family doctors are needed, according to the American Academy of Family Physicians. Dr. Shaffer doubts this will happen. Take the year 2009:
"In the state of Missouri, for instance, we have six medical schools. Out of that 846 grads, 103 went into family medicine, and only 34 stayed in Missouri," he says.
Dr. Shaffer says more and more students are choosing to go into higher paying specialties. And, he says Missouri's loan repayment program for students who choose primary care isn't enough. In fact, it's frozen right now. He also says med schools need to do a better job of recruiting students who want to go into primary care. At UMKC, for example, three to five students out of 100 are choosing primary care.
Back at her office, Dr. Joslyn has also been training medical students. Recently, she's been working with fourth-year student Bruce Ley.
"He thinks he wants to go into ER medicine. I think that's a poor choice for him," she says, chuckling. "He really likes the patient interaction and ongoing care [of family medicine]."
"Actually, I thought about it for a while," says Ley. "You get in touch with your patient, you know your patient really well."
Leh says he likes family medicine. He's from the neighborhood and has been a volunteer Vietnamese interpreter for Dr. Joslyn for a couple years. He says he plans to work in the Emergency Room after he graduates, though, mostly because he really enjoys it.
"If someone would have just paid for my student loans, I would work seven months in the E.R., or part time E.R. and part time helping the community [doing family medicine]," Ley says.
Primary care doctors now entering the field make around $140,000 a year. Dr. Joslyn takes home about half of that. And, that could be a tough salary with med school loans now averaging more than $100,000. The American Academy of Family Physicians says the average debt of a graduate of family medicine is about $180,000.
Dr. Joslyn says there have been times when she's had some financial trouble with her practice, but she's gotten through it. She says her heart's in this neighborhood.
"I feel needed here, I feel appreciated," she says. "Every day I go home feeling good about what I did that day and look forward to coming in the next day."
Dr. Joslyn is 65 years old now. She says what really worries is the future.
"I'm not a young woman," she says. "And someday I'm going to have to stop this. And there's no one to pick that up."
Dr. Joslyn doesn't plan on retiring anytime soon. But with a growing aging population, and with a lot more people soon to get coverage under the new health law, more and more people are likely to be seeking family doctors in the years to come.
Funding for health care coverage on KCUR has been provided by the Health Care Foundation of Greater Kansas City.
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