Following doctors on the path to primary care Date: 02/09/15
By Karen Brown
When I started following a group of residents in a primary care training program, I expected to produce a lively radio documentary on idealistic young doctors who are bucking the trend against frontline medicine. After all, pay and prestige are much lower in primary care than specialties, while workload and stress are generally higher. It must take a special kind of person to go into the field anyway.
To be sure, they were all lovely people, compassionate and clearly committed to medicine. But by the end of my year of reporting, two out of the three had changed their minds about primary care, deciding instead on more lucrative specialties. Their decisions may have been disappointing for the field, but they did make for a more compelling story. I was able to use their personal dilemmas, unfolding in real time, to illustrate the crisis in primary care.
I had help in doing this – a yearlong fellowship from the Association of Health Care Journalists that paid for travel expenses and some production help. But I believe this kind of long-term project is doable without a fellowship, as long as you have a forward-thinking editor and the patience to let the story reveal itself slowly.
The seeds of my reporting were planted by a public relations representative for Baystate Medical Center in Springfield, Mass. Over coffee one day, he pitched me a story on the new primary care residency – recently launched with ACA money. I had been trying to think of a longitudinal reporting project with behind-the-scenes potential. This seemed like a good fit.
My editor agreed, and offered me three to four days a month on the project, so that the reporting could be spread out in bursts over a long period. (When he announced the project to the rest of the news staff, he was clear that I wouldn’t be checking out of daily reporting tasks – something that might have led to hard feelings.)
Once I started reporting, access was my greatest challenge. It’s one thing for hospital administrators to let me publicize a new program, but quite another to let me loose among young, nervous doctors in the middle of a hectic residency.
In general, Baystate’s policy requires the public relations liaison to chaperone almost every interview at the hospital. But, for this story to work, I told him, I needed my own, unfettered relationships with the residents. I needed to be able to contact them on my own, hang out with them whenever they were free (and often at the spur of the moment), and ask anything I wanted, in private.
The PR guy got it, and agreed – with the exception of any times I wanted to be present for a resident-patient interaction. Given the legal and patient privacy issues that hospitals face, that felt like a fair, and probably non-negotiable, compromise.
At first, the residents in the program were hesitant to commit to anything outside their training. So I asked for a meet-and-greet where I would simply describe my intent and let them ask questions. Afterwards, eight residents gave me their email addresses. Over a round of (fairly time-consuming) interviews, I settled on three residents who seemed to represent a range of backgrounds, and who seemed responsive to letting me hang around.
Since I work in radio, it was important to get into the thick of their experience, and to get a vivid, sound-rich picture of how chaotic primary care can be day-to-day. I had to check in with them frequently to find times when their clinic shifts coincided with my reporting days. I also asked them to think of patients who wouldn’t mind me sitting in on visits. They were nervous about that, until they saw that most patients don’t really mind and will give their consent.
Within about six months, the key story twists had taken place – maybe that was luck, maybe just being there. That’s when I reached out to national experts to find out if this was indicative of the national landscape, and how it related to ACA efforts to shore up primary care. In the end, I didn’t feel the need to quote directly from the expert interviews, although I included that context. I felt it was more important, in the half hour of air time, to offer a close-up glimpse into the thought processes of these young doctors.
The last stage in a radio documentary is production. I spent about a month editing the sound, mixing the tracks, recording narration, and finding bridge music that would fit the tone of the story (not an easy feat in a health policy story.)
I would have liked to spend even more time with my main characters – at their homes, with their families, to get a fuller picture of the pressures that go into major career decisions like this. But I still had regular deadlines to meet, and I imagine that might have been pushing my subjects’ comfort level.
I wasn’t sure how the residents would appreciate becoming stand-ins for the difficulty in attracting new doctors to primary care. But those who got back to me said they appreciated the realistic picture. A few of the residents felt it was unfair that out of a program of eigth people, I ended up highlighting the few who decided against the primary care career. I explained to them that, when I started, I expected quite the opposite, but when you stay on a story long enough, you’re obligated to report how things shake out.
Apart from this central narrative, the AHCJ fellowship allowed me to check in on a range of primary care advocates, leaders, and programs across the country – and watch some unconventional tactics in health care activism. Most of that material went into a follow-up feature story.
Karen Brown is a health reporter for New England Public Radio in Springfield, Mass., and a freelancer for several print and radio outlets. She was a 2014 AHCJ Reporting Fellow on Health Care Performance.