Reporting on the doctor shortage in California’s Inland Empire

As California faces a statewide shortage of physicians, there’s one area that will be hit especially hard: the large collection of cities, suburbs and rural areas that make up Southern California’s Inland Empire. As the region’s population and economy grow, the number of doctors needed is going to keep growing with it; if left unchecked, the doctor shortage could become one of the Inland Empire’s primary public health problems.

That’s why I chose the doctor shortage as my topic for my 2018 California Health Journalism Fellowship.

For my first story, I wanted to give an in-depth background into the history and causes of the doctor shortage. I was lucky to stumble across an article by Joe Blackstock, a historian of the Inland Empire, in the Riverside Press-Enterprise. The article was about a polio outbreak in the 1950s, and I was planning to use that as my introduction to the larger story of the Inland Empire’s historical struggles with health care. However, once I got Mr. Blackstock into the studio, he told an intriguing story about an 1899 train wreck that highlighted the need for a hospital in the burgeoning Inland Empire. That story ended up serving as my introduction instead, because I thought it better illustrated the historical trend of a lack of health care in this area, as well as providing me with the opportunity to use “train wreck” to describe our current crisis, the doctor shortage.

I also knew that I would need a personal story from someone affected by the shortage. I found that in Karen Olson, a woman living with uterine cancer in Redlands. Olson chose to go to Los Angeles-based City of Hope rather than a local treatment center, because she wanted the best possible care for her cancer. I felt that Olson’s story illustrated the lengths people go to get the care they need in this area. After bringing her into the studio, I was confident that she added a human touch to the larger story.

For my second story, I focused on mental health and the lack of behavioral health care professionals in the Inland Empire. This story was one of the most difficult to report, because mental health is such a complicated topic and I was unsure how to find sources and scenes. I eventually settled on three different voices: a volunteer counselor treating patients at the Riverside Free Clinic; a representative from a local nonprofit that raises awareness of suicide and mental issues; and an academic at UCSF who studies the statewide doctor shortage.

My third story dealt with a program at UC Riverside designed to keep young doctors in the Inland Empire. In exchange for basically free tuition, UCR med students who receive a particular scholarship from the university must stay and practice in the area for at least five years. I encountered two main problems with this story: I did not want to sound like a promotional arm for the university and I wasn’t sure how I would incorporate sound into the story. The first problem was solved through editing; my fellowship supervisor, Taunya English, was able to help me shift my language so as not to sound like a public relations department. For the second problem, I found a solution in the Riverside Free Clinic. Many students from UCR volunteer there, and I was able to find an undergraduate who planned on applying to UCR’s med school and doing the tuition exchange program. I was able to use sound from the clinic to create ambience.

My fourth story required a lot of shuffling and compressing. When I initially pitched it to the fellowship, it was only supposed to focus on one institution: San Manuel Gateway College, an occupational learning center for health care jobs. However, I soon found myself drawn to another possible topic for the story: a new medical school that opened in San Bernardino called the California University of Science and Medicine. Initially, I considered combining the UCR segment with the CSUM segment to create a “tale of two medical schools,” but I decided that with the material I had, it would be better to give UCR its own four minutes and stick the CSUM segment elsewhere. With that in mind, I combined the San Manuel Gateway College and the CSUM material into one story, with the common thread that both schools are located in the city of San Bernardino. This fourth story was a good exercise in compressing and rearranging stories.

My last story dealt with a program at UCLA designed to train immigrant doctors to serve in underserved areas of California. I interviewed Dr. Michelle Bholat, the program’s executive director, in her office in Santa Monica. I then interviewed Dr. Iliana Aguila, an alumna of the program. My problem then was that I only had two voices in the story; I decided to emphasize Dr. Aguila’s voice, and elongate her section to include more of her background coming from El Salvador. The story then took on a narrative feel, with Dr. Aguila explaining how her background informs her experience and practice in the United States today.