Access Denied: Looking at a lack of health care availability

By Shannon Muchmore

Oklahoma residents face a shortage of physicians, particularly specialists, contributing to a lack of access to care and an underserved population. I reported on the scope of the problem and the reasons for it in a three-part project, Access Denied for my newspaper, the Tulsa World.

The impetus for my project was a New England Journal of Medicine article from February that ranked Oklahoma as the worst state for access to health care once federal Health Policy kicks in. I would think anyone in a state at the bottom – or top – of that list could have a good story.

I started with the list of registered medical doctors and doctors of osteopathy. This data was relatively easy to get, as the licensing boards give it out regularly. The data should include the name of each physician, location of practice, date of graduation from medical school (helpful for finding out how many doctors may be close to retirement) and specialty.

I put the data into Google Fusion and started to play with it. I had help from our data experts, but most anyone could do some basic analysis, such as where doctors tend to be located and what specialists are most prominent. Google has some helpful videos with some of the basic instructions.

The data can be huge, so it might help to start with a small area and look at where the doctors are and what specialists are most prevalent. If you have data or Web people to help, ask them to separate the specialties and the counties or ZIP codes and try making maps that show any disparities.

I broke down the specialties and looked at where they are geographically. I calculated the number of physicians per capita for each county and the state overall. These maps ended up running in print with the project, but they were essential to my reporting as well.

My main interviews were with academics who have been looking at these issues and could validate what my data showed. Oklahoma State University, a land-grant university with a college of osteopathy in Tulsa, has a rural health center that looks explicitly at the issues I was studying.

Next, I identified the faces that would bring the story more color and interest. I found a county with only one doctor, so that was a natural interview. I also found a rural doctor who has been practicing for years and is a great example of what Oklahoma needs more of. I used social service agencies and local free clinics to find patients who have to go through many hurdles to get access to care as well as those who don’t get access as often as they should. I also had a lot of help from the local federally qualified health center.

That said, one of the biggest difficulties was finding those faces to illustrate the lack of available care. It’s not as if we could take a picture of somebody NOT going to the doctor’s office. To get over this, I had to be persistent in talking with social workers and trying to get an interview with some of their clients. I went to many interviews that didn’t materialize because the interviewee never showed, but eventually I had enough to follow around and understand the obstacles they face.

Another obstacle was dealing with patients who happened to be visiting the doctor the day I was shadowing. It was hard to sit in on something as private as a doctor visit, particularly when there’s also a camera in the tiny room. I always prefaced our interactions by saying we would leave immediately if the patient wanted to discuss something private, and we were asked to step outside a couple of times. I told the patients we were focusing on the doctor that day, but people like them are a vital part of the story. Many did not give enough information

to be included and even more refused to talk, but after enough time with the doctor I had what I needed. Some days, no patients would agree to let me sit in. Other days, most of them were fine with it.

The physician shortage is a nationwide problem. To localize the story, look at how your area is trying to combat it, if at all. Here are the questions I would encourage reporters to ask:

• • Where are doctors concentrated in your city or state? What about specialists? What’s the farthest someone might have to travel to see a cardiologist?
  • How many more people are poised to get health insurance when, assuming the individual mandate is left intact, Medicaid starts accepting those at 135 percent of the federal poverty level? Are there enough primary care providers to care for them?
  • What is the average age of physicians in the area? Are many of them close to retirement?
  • Are there any physician assistants or nurse practitioners trying innovative ways to increase access to primary care? Look for medical homes or offices that use mid-level practitioners heavily.

• • How do patients get to free clinics? Is there adequate public transportation in your area for those who don’t have a car? Are any clinics open in the evening hours for people who can’t get off work in the afternoon?

• Has your state accepted or rejected money linked to federal health care reform? What could it have gone toward or what is it being used for? Is it actually helping the situation?
• Are there enough residency slots for people graduating from medical school? Are there enough in fields that are experiencing a shortage? Are medical school class sizes large enough?
• What solutions are being presented? Is there some technology that can help doctors connect to each other or new ways to coordinate care that could help with access?

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Tulsa World Reporter Shannon Muchmore reported the series as part of the California Endowment Health Journalism Fellowships, a program of the University of Southern California’s Annenberg School for Communication & Journalism.