- http://www.bakersfieldcalifornian.com/archive/x489416474/file?nodisp=1
- http://www.reportingonhealth.org/fellowships/projects/importing-doctors-more-half-kern-physicians-were-foreign-schooled
- http://www.bakersfieldcalifornian.com/health/x1408651409/IMPORTING-DOCTORS-More-than-half-of-Kern-physicians-were-foreign-schooled
Provide names of other journalists involved.
My editor Christine Bedell was instrumental in using her Excel skills to help me crunch statistics for the articles. Our graphics editor Kent Kuehl was also extremely helpful in illustrating the numbers of foreign-trained doctors in different parts of California with a visually-informative graphic. My advisor at the USC health journalism fellowships, senior fellow Steve Magagnini, offered advice throughout the project.
List date(s) this work was published or aired.
The three-day series began on Saturday, Jun 23, 2012 and ran through Monday, June 25.
Provide a brief synopsis of the story or stories, including any significant findings.
We determined the rate of foreign-trained doctors in all California counties, something that hadn’t been publicly available previously. This analysis revealed major discrepancies between physicians’ backgrounds in Kern County, which is an underserved area in the poor Central Valley, and doctors elsewhere in California and the United States. We found that 57 percent of doctors in Kern were foreign medical graduates, compared to 25 percent of all doctors in the United States and four-to-five times higher than other, more geographically-desirable California counties. We also analyzed the board certification rates of international medical graduates within Kern County and compared them to their U.S.-trained counterparts there. We found that board certification rates for U.S. medical graduates in Kern were 80 percent on average, compared with foreign medical graduates’ rate of 64 percent. These rates imply that the quality of care delivered in Kern County might not be at the same level as care delivered in areas with more US-trained, board-certified physicians. And, it underscores the need for recruiters and consumers alike to research physicians and find out if they’re board certified in a specialty. We also took a look at the influx of Caribbean-trained American physicians into the county and the impact. We delved into the cultural differences that can emerge between physicians and patients. And, we followed the personal journeys of physicians from the Philippines, Sudan and India who eventually landed in Kern County.
Explain types of documents, data or Internet resources used. Were FOI or public records act requests required? How did this affect the work?
I requested data from the Medical Board of California seeking the number of international medical graduates, their foreign medical schools and the counties in which they practice. We crunched the figures for all California counties and found that our county Kern ranked No.4 among the state’s 58 counties for the most foreign-trained doctors. Once we determined this, though, the question remained: What did it mean? I consulted with numerous academics and physicians and sought the best way to quantify a doctor’s qualifications. Some suggested looking into the rate of board certification in one’s specialty, which is becoming the de facto standard for full participation in the U.S. medical system. Since the American Board of Medical Specialties (ABMS) didn’t have a database with this information for all of Kern County’s doctors, I began the laborious task of creating my own. I typed in more than 500 physician names into the ABMS and recorded if they were board certified and, if so, in what specialty. That enabled us to analyze board certification rates for foreign medical schools whose graduates practiced in Kern County, and highlight the significant discrepancies among them. We did the same for the top U.S. schools sending graduates to Kern County. In the interview process, one leader of an overseas medical school pointed out that our analysis could be flawed because it didn’t take into account recent medical school graduates — residents at the county hospital who might be registered with the Medical Board as physicians but not had time to take the specialty board exams yet. To deal with this issue, I requested a list of all current and recent residency graduates from the county residency-training hospital and excluded them from our analysis. We also used the Medical Board data to highlight which countries sent the most doctors to Kern County and compared that to census data on the population of Kern County.
Explain types of human sources used.
I conducted dozens of interviews with international medical graduates, heads of hospitals, medical recruiters, residency directors, academic experts, medical students and leaders of foreign medical schools. I also interviewed patients in both Spanish and English to get their perspective on cultural differences that might arise in medical care. This was especially relevant since we’d found the countries where the most local doctors had trained did not reflect the county’s high Latino, Spanish-speaking population.
Results:
Our series received tremendous feedback from not only patients but medical professionals throughout the Central Valley and beyond. This story was published around the time Kern Medical Center was exploring a priority affiliation with a Caribbean medical school to provide training for its future graduates in exchange for $35 million. The articles provided important context for this unique partnership. Numerous readers called up to express gratitude that something they’d always wondered about had finally been explained. One wrote: “Thank you for researching so thoroughly this topic and adding personal stories to provide the public with such important knowledge and balanced perspective.” A professor at Cal State Bakersfield wrote the following: “Your exclusive on foreign-trained doctors was the best thing I’ve read in The Californian in a long time. The articles were timely and important, not only for Bakersfield but for the entire country.” The founder of a prominent local cancer center — a foreign-trained physician himself — wrote this: “Really enjoyed reading the series! Came out superb! Very well researched, informative and useful. A lot of effort and work. Great journalism!!” The head of emergency services for the county also lauded our work as “interesting, relevant, and fascinating. I can’t believe the extent of research this must have taken. Wow!” An academic at Kern Medical Center expressed interest in following up on the topic in his own research. And medical recruiters said they found the series useful in evaluating future hires. The series got picked up in tweets and blog posts throughout the county, including prominent health blogger William Heisel who wrote this piece about the series’ methodology and what other reporters could learn from it: tinyurl.com/7dh58hu
Follow-up (if any). Have you run a correction or clarification on the report or has anyone come forward to challenge its accuracy? If so, please explain.
We did not run any corrections. One reader did not like how we used both Burma and Myanmar on our graphic, but that was how the Medical Board of California presented the information, so we decided to replicate their categorization.
Advice to other journalists planning a similar story or project.
When I began preliminary interviews on this project, many experts shrugged about the issue of foreign-trained doctors, saying it was impossible to explore the topic beyond anecdotal evidence. But, by requesting the data and analyzing it, we were able to provide readers with an unprecedented look at the situation in the Central Valley and what it means to them as consumers seeking the best medical care. The database construction was laborious but essential. Once we were armed with the data, we had a much more interesting series rooted in facts. From there, the personal interviews conducted had much more meaning and impact. The hard work invested in crunching numbers paid off with a very compelling human story.