Q&A with Isabelle Walker: Primary care is personal

Isabelle Walker says that it is important to get beyond just the emergency room stories and look at longer trends, something difficult to do if you are not dedicated to the field.

Walker is the health and medical reporter for the weekly Santa Barbara Independent. This two-time California Endowment Health Journalism Fellow has a unique approach to writing features that humanize complex health stories. In one recent feature, she gave life to a long-term issue decidedly outside the realm of the acute problems that make headlines every day. She took the bold step of putting herself into the cover story, Are Primary-Care Doctors Going the Way of the Dodo?, and talked to The Fellowships Blog about why she did it. The transcript has been edited for clarity.

Q: In your work at the Santa Barbara Independent, you open many articles with a personal anecdote or story about someone's experience. In this article, you opened with your own experience. Why did you decide to do it and was it natural for you to write about yourself?

It was very natural to me. I've been writing about doctors in Santa Barbara for ten years. I don't do a story about doctors in Santa Barbara every year, but the issue of doctors having a tough time has come up many times. The Medicare rates in Santa Barbara are particularly low -- freakishly low -- because of the way Medicare pays. They have a complicated and arcane geographic formula, but basically Santa Barbara County got lumped in with other counties that are rural. Physicians here are reimbursed by Medicare at the same rate as physicians who work in Yolo or Shasta, where the cost of living is much lower. A combination of the high cost of living and low Medicare reimbursement rate has really put doctors between a rock and a hard place.

As a reporter, it's come up again and again. As a person who lives here and needs a doctor, I happened to have lost two of my favorite primary care physicians in the past four years. I don't have a primary care doctor now because my two favorite doctors closed their practices. So when I was going to write the story I thought, what better way to write than to talk about what happened to me? I didn't decide how I was going to write it until I did all my reporting, all my interviewing, and then I sat down and just thought, well, this is obvious. It seemed very clear that I should do it from my point of view because it's very compelling to readers when you're writing a longer feature story. It's really nice when you have that at your fingertips.

Q: On the website, you see a lot of comments and people engaging with the issue. Why do you think the story got over 20 very long comments?

It's the issue. It's definitely the issue. No one's written about primary care doctors, about this particular issue before here [in Santa Barbara]. These doctors have been struggling for years and to have someone finally come in and write a story about it -- an in-depth story -- I think they felt a sense of relief. Our daily paper doesn't have a dedicated health writer. The Santa Barbara News-Press is struggling right now because of various issues. I'm the only dedicated health writer at the Independent, so I'm really the only one writing about what doctors are going through. There are other websites, a small daily that comes out, but their stories are a little shorter.

Q: This year in the California Broadcast Fellowship, there was a panel in the first seminar where they really highlighted the problem of a shortage of primary care physicians in California. Why do you think this story has escaped the debate on health care so much?

I think it's a little bit under the radar. There are so many other issues that seem a more acute and urgent -- the fact that there are long waiting lines in emergency departments is flashy and dramatic. I think the primary care doctors' story doesn't have a lot of drama to it. The fact that there are people who are uninsured, people can't get care, people losing their health insurance, the cost of medical care going up -- those seem really acute. I think the loss of primary care doctors has been slow and steady.

Q: There is a lot of attention to acute, dramatic stories about health care. You came away with just under 2700 words in your feature. How did you pitch this to your editor at the Independent?

We have weekly meetings, and I had been talking to them about it for some time. I got a call from a doctor who had alerted me to the fact that it was getting worse. When I mentioned it in the meeting, they were all really interested. They thought it was great, said, "Go write it."

A good angle is the fact that primary care doctors are having trouble making a living but studies have shown that if you have an adequate number of primary care doctors, the community is healthier. [The American College of Physicians' 2008 White Paper on the shortage (PDF) is one such study.] That really propelled my work, and helped them be more excited by the story.

Also, I think people really harken back to the days when they had really good relationships with their family doctors. I think people really enjoyed that, and were more apt to go to the doctor, more apt to take care of themselves. If you have somebody who you can joke with, who knew your mom and your sisters, who knows what kind of job you have, whether you like you job -- all these things make going to the doctor more pleasant, make you apt to reveal something about your health you might not tell somebody who you're just meeting for the first time.

You can read more of Walker's work on the Santa Barbara Independent's website.