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  • 1. 2008 Edition State of the State’s Rural Health Workforce Issues: Physicians & Hospitals 
  • 2. On the Cover: 2007 honors The the Cover: for Rural Health was honored in 2007 for its leadership and contributions to rural health. William Pettit, D.O., OSU Center for On OSU Center Health Sciences associate dean and assistant professor for rural health, is shown here with a BlueCross BlueShield of Oklahoma - Champions of 2007 honors Health award and the Rural Health Association of Oklahoma’s Rural Organization of the Year for 2007 plaque. (Photo by Terry Drenner) The OSU Center for Rural Health was honored in 2007 for its leadership and contributions to rural health. William Pettit, D.O., OSU Center for Health Sciences associate dean and assistant professor for rural health, is shown with a BlueCross BlueShield of Oklahoma - Champions of Health award and the Rural Health Association of Oklahoma’s Rural Organization of the Year for 2007 plaque. (Photo by Terry Drenner)
  • 3. Preface Welcome to the Oklahoma State University Center for Rural Health’s second edition of the State of the State’s Rural Health. The theme for this year’s publication is “Workforce Issues: Physicians & Hospitals.” Oklahoma, like the rest of the nation, is facing a critical shortage of physicians, particularly among the various primary care specialties. Some data indicate that Oklahoma is already suffering a physician shortage. In 2007, the American Medical Association reported that Oklahoma ranked last in the nation with the fewest number of patient care and primary care physicians per 00,000 population. This dearth of physicians led, in part, to the United Health Foundation ranking Oklahoma 47th in overall health status. On a more ominous note, the Commonwealth Fund ranked Oklahoma 50th in health system performance. While the causes of the physician shortage are many, the solution to the problem is simple: Oklahoma needs more physicians, especially in rural areas, and physicians with primary care specialties. How to increase the physician supply is debatable. The OSU Center for Health Sciences is committed to guiding more primary care physicians to rural Oklahoma through increasing its medical school class sizes, expanding graduate medical education programs into rural areas, and fostering a rural pipeline to return physicians back to the communities where they were raised. This publication outlines the characteristics of Oklahoma’s rural physician workforce. Evident is the maldistribution of physicians between urban and rural portions of the state and an aging physician workforce. This edition also provides an overview of medical education in the state and the characteristics of the state’s hospital infrastructure. More physicians alone cannot improve Oklahoma’s health status. Oklahomans must be willing to make social and behavioral changes like those outlined in Governor Brad Henry’s “Strong and Healthy Oklahoma” initiative if we want to have a truly healthy state. For more information about Oklahoma’s rural health, please visit our web site: http://ruralhealth.okstate.edu/ Chad Landgraf, M.S. Jeff Hackler, J.D., M.B.A. Tulsa, Oklahoma 
  • 4. Defining Rural Oklahoma R ural means different things to different people. of their population living in urban coded tracts were No single definition of rural exists. The federal classified as Mixed, and counties with less than 65 government commonly uses four different percent of their population living in urban coded tracts definitions of rural just within its various health were classified as Rural. programs. The OSU Center for Rural Health uses The development of these three categories (Rural, the definition that is most widely accepted among Urban, and Mixed) allowed us to compare the health those who conduct rural health research: the Rural- and socioeconomic data of a county versus its place Urban Commuting Area codes developed by the along the urban-rural continuum. Washington, Wyoming, Alaska, Montana, and Idaho Rural Health Research Center housed at the University The table at the right shows selected socioeconomic of Washington School of Medicine in Seattle. and demographic characteristics of Rural, Urban, and Mixed Oklahoma. These characteristics are often Most publicly accessible health and demographic data cited as macro-level determinants of health status for are compiled at the county-level, while RUCA codes a population. For example, lower levels of educational provide detail down to the spatially smaller census attainment are directly related to lower incomes, tract-level. For each county in the state, we calculated which in turn generally lead to lower overall health the total percentage of the population living in census status. A county-by-county breakdown of these data tracts designated with urban and rural RUCA codes. is presented in a table on the next two pages, followed Counties with more than 95 percent of their population by two maps that show the distribution of population living in urban coded tracts were classified as Urban, among the counties and county-level population counties with between 95 percent and 65 percent change between 990 and 2000. 2
  • 5. Designation of Counties as Urban, Rural, or Mixed Based on Rural-Urban Commuting Area Codes CIMARRON TEXAS OTTAWA BEAVER HARPER WOODS WASHINGTON ALFALFA GRANT KAY CRAIG NOWATA OSAGE WOODWARD ELLIS GARFIELD NOBLE DELAWARE ROGERS County Designation MAJOR PAWNEE MAYES Rural (68) PAYNE TULSA DEWEY KINGFISHER WAGONER Mixed Urban & Rural (5) BLAINE LOGAN CREEK CHEROKEE ADAIR Urban (4) ROGER MILLS LINCOLN CUSTER OKMULGEE MUSKOGEE Source: Adapted from WWAMI Rural Health Research Center (2006) CANADIAN OKLAHOMA OKFUSKEE SEQUOYAH BECKHAM McINTOSH POTTAWATOMIE WASHITA C CL SEMINOLE EV CADDO HASKELL V EL AN M Mc D D GRADY HUGHES Mixed C CL GREER KIOWA AIIN PITTSBURG Le FLORE 304,803 LATIMER 8.5% HARMON PONTOTOC COMANCHE GARVIN JACKSON COAL STEPHENS TILLMAN MURRAY PUSHMATAHA Rural COTTON JOHNSTON ATOKA Urban 1,667,573 CARTER JEFFERSON McCURTAIN 1,606,836 46.6% MARSHALL CHOCTAW 44.9% LOVE BRYAN Population by Rural, Urban, or Mixed Selected Socioeconomic & Demographic Comparison of Rural, Urban, and Mixed Counties in Oklahoma Rural Urban Mixed Oklahoma White 76% 7% 82% 74% Black 4% 2% % 7% Native American % 4% 6% 8% Hispanic 4% 7% % 5% Other 5% 6% 6% 6% Avg. Median Age 8.2 years 2.7 years 6. years 7.8 years % Population Living in Poverty 7% % 0% 5% Avg. Median Household Income $28,856 $7,247 $8,882 $29,94 % of Population Over Age 65 5% % % % % Adult Population without High School 2% 6% 8% 9% Degree or G.E.D. Source: U.S. Census Bureau (2000) 
  • 6. Native Median Pop. in Med. HH No H.S. White Black Hisp. Other Age 65+ County American Age Poverty Income Diploma (%) (%) (%) (%) (%) (%) (yrs) (%) ($) (%) Adair 47.7 0.2 4.8 . 7.2 .2 22.7 24,88 2.0 . Alfalfa 88.4 4. 2.6 2.9 2. 42. . 0,259 20.4 8.6 Atoka 75.4 5.9 .2 .4 6. 8. 7.5 24,752 4.8 0.6 Beaver 86.6 0. .2 0.8 .2 9. .5 6,75 6.9 8.8 Beckham 84.7 5. 2.4 5.4 2. 6.6 6.4 27,402 5.5 24. Blaine 7.7 6.5 8.5 6.6 4.7 7.6 4.6 28,56 6.8 24.5 Bryan 78.9 .4 2.0 2.6 5. 5.8 7.9 27,888 5.4 25. Caddo 64. 2.9 2.0 6. .8 6.0 20.8 27,47 4.9 24. Canadian 85.0 2. 4. .9 4.9 5.4 7.7 45,49 9.5 2.7 Carter 76.8 7.5 8. 2.8 4.8 8.0 6.2 29,405 6.0 2.0 Cherokee 55.2 .2 .9 4. 7.5 2. 22.0 26,56 2.0 2. Choctaw 67.8 0.9 4.8 .6 4.9 8.7 2.9 22,74 7.4 .0 Cimarron 8.0 0.5 .0 5.4 2.0 9. 7. 0,625 8.6 2.4 Cleveland 8.5 .5 4.2 4.0 6.7 2.2 0. 4,846 8.4 .9 Coal 74.5 0.4 7.0 2. 6.0 8. 22.6 2,705 7.9 .4 Comanche 62.0 8.6 4.8 8.4 6.2 0. 4.2 ,867 9.8 4.8 Cotton 82.8 2.8 6.8 4.9 2.7 8.6 7.6 27,20 7.8 2.0 Craig 68. . 6.2 .2 .5 9. 2.8 0,997 6.2 2. Creek 8.4 2.5 8.9 .9 5.2 6.9 .2 ,68 2.8 22.4 Custer 79. 2.8 5.5 9.0 . 2.7 7.6 28,524 .7 8.8 Delaware 69.4 0. 22. .8 6.6 40.8 8.0 27,996 7.5 24.6 Dewey 90.6 0. 4.5 2.7 2.0 4.0 4.5 28,72 2.0 20.2 Ellis 94.8 0.0 . 2.6 .4 45. 2. 27,95 22.0 8.8 Garfield 86.9 .2 2.0 4. .7 7.7 .5 ,006 6.0 7.8 Garvin 8.4 2.5 7.2 .4 .4 9.0 5.7 28,070 7.9 27.0 Grady 86. .0 4.7 2.9 . 6.5 .6 2,625 . 20.5 Grant 94. 0. 2.4 .8 .4 4.4 .4 28,977 2.4 4. Greer 78.7 8.7 2.4 7.4 2.8 40.0 6.4 25,79 20.0 2. Harmon 65.8 9.2 .0 22.8 .2 9.9 28.6 22,65 2.0 6.8 Harper 92.9 0.0 0.9 5.6 0.5 4. 0.0 ,705 2.7 7.9 Haskell 77.5 0.6 4.5 .5 5.9 8.6 20.2 24,55 7.2 . Hughes 7.8 4.5 5.8 2.5 5.4 9. 9.9 22,62 8.6 29.2 Jackson 7.5 7.9 .6 5.6 .4 .0 5.7 0,77 .9 20.9 Jefferson 8.7 0.6 5.0 7.0 .7 40.4 8.2 2,647 20. 0.7 Johnston 75.4 .7 4.9 2.5 5.6 8.0 2.4 24,592 5.4 0.9 Kay 82.5 .8 7. 4. 4. 8. 5.7 0,762 7.0 9. Kingfisher 86. .5 .0 6.9 2.5 8.0 0.6 6,676 5.4 8.8 Kiowa 80.5 4.6 5.9 6.7 2. 40.9 8.6 26,05 20. 22.6 Latimer 72.5 0.9 9.2 .5 5.9 6.8 2. 2,962 6. 26.2 4
  • 7. Native Median Pop. in Med. HH No H.S. White Black Hisp. Other Age 65+ County American Age Poverty Income Diploma (%) (%) (%) (%) (%) (%) (yrs) (%) ($) (%) Le Flore 78.4 2.2 0.6 .8 5.0 6. 8.4 27,278 .8 29.6 Lincoln 85.7 2.4 6.4 .5 .9 7.5 4. ,87 .9 22.5 Logan 80. 0.9 2.8 2.9 . 6. 2. 6,784 2. 8.5 Love 8. 2.2 6.4 7.0 .2 9.4 .7 2,558 6.2 26.4 Major 9.8 0.2 0.9 4.0 .2 4.6 .8 0,949 9.4 2.4 Marshall 76.5 .8 8.7 8.6 4.4 4. 7.5 26,47 9.5 29.0 Mayes 7. 0. 8.9 .9 7.6 7.2 4.0 ,25 4.9 2.9 McClain 85. 0.6 5.4 4.9 .7 6.9 0.4 7,275 2.0 20.7 McCurtain 69.5 9.2 .2 . 5.0 6.0 24. 24,62 4.0 0.8 McIntosh 72.0 4.0 6. . 6.7 44. 7.8 25,964 2.8 28.4 Murray 79.2 .9 .4 . 4.4 9.8 .7 0,294 8.5 25.7 Muskogee 62.8 . 4.7 2.7 6.8 7.0 7. 28,48 5. 24.9 Noble 85.8 .6 7.4 .8 .4 8. 2.5 ,968 5.2 8.5 Nowata 7.9 2.5 6. .2 8. 9.0 .8 29,470 7. 2.8 Okfuskee 64.9 0.4 7.9 .6 5.2 8.6 2.2 24,24 6. 0.6 Oklahoma 67. 4.9 .2 8.7 6. 4.2 4.9 5,06 2.2 7.5 Okmulgee 69.0 0.2 2.6 .9 6. 6.9 8.4 27,625 5. 25. Osage 66. 0.7 4.2 2. 6.9 8. 2.7 4,477 . 9.8 Ottawa 72.9 0.6 6.4 .2 7.0 7. 6. 27,507 6.9 24. Pawnee 8.7 0.7 2.0 .2 4.5 8.5 2.9 ,66 4.8 2.2 Payne 8. .6 4.5 2. 6.5 27.6 8.2 28,7 0.8 . Pittsburg 76. 4.0 2. 2. 5. 9.4 6.0 28,679 7. 2.8 Pontotoc 74.8 2.0 5.2 2. 5.6 5.7 5.9 26,955 5.0 2.8 Pottawatomie 78.8 2.9 0.9 2.4 5. 5.5 .9 ,57 .8 20.7 Pushmataha 77. 0.7 5.4 .6 5. 40. 22.6 22,27 8. .0 Roger Mills 90.2 0. 5.2 2.6 .6 4.7 6. 0,078 8.7 20.7 Rogers 79.0 0.7 .9 .8 6.6 6.2 8.5 44,47 . 6.6 Seminole 69.9 5.5 7. 2.2 5. 8. 20. 25,568 6.7 26.8 Sequoyah 67.4 .8 9.4 2.0 9. 6.4 9.5 27,65 .5 29.8 Stephens 96.2 2.2 4.8 4.0 2.9 40. 4. 0,709 8.5 2.0 Texas 66.7 0.6 0.9 29.9 .9 0.4 .8 5,872 0.2 28. Tillman 68.5 8.9 2.5 7.7 2.4 8.9 2.0 24,828 9. 2.6 Tulsa 72.5 0.8 5. 6.0 5.7 4.4 .4 8,2 .8 4.9 Wagoner 78.9 .7 9.2 2.5 5.7 6.2 8.8 4,744 0.2 8.7 Washington 79.9 2.5 8.5 2.6 6.5 40. .7 5,86 7.8 4.8 Washita 90.4 0.4 2.8 4.5 .9 9.2 5. 29,56 8.8 20. Woods 9.9 2. .5 2.4 .8 7.8 . 28,927 9.9 7. Woodward 90. . 2.0 4.8 .8 7.4 .9 ,58 4.2 20. Totals on Page 3 Source: U.S. Census Bureau (2000) 5
  • 8. Total Population by County 2006 (Estimated) CIMARRON TEXAS OTTAWA BEAVER HARPER WOODS WASHINGTON ALFALFA GRANT KAY CRAIG NOWATA OSAGE WOODWARD ELLIS GARFIELD NOBLE DELAWARE ROGERS MAJOR PAWNEE MAYES Total Population TULSA PAYNE 200,001 to 691,266 DEWEY BLAINE KINGFISHER WAGONER LOGAN CREEK CHEROKEE ADAIR 100,001 to 200,000 ROGER MILLS LINCOLN 50,001 to 100,000 CUSTER OKMULGEE MUSKOGEE CANADIAN OKLAHOMA 10,001 to 50,000 OKFUSKEE SEQUOYAH 2,807 to 10,000 BECKHAM McINTOSH POTTAWATOMIE WASHITA CL SEMINOLE EV Source: U.S. Census Bureau (2006) CADDO HASKELL EL AN Mc D GRADY HUGHES CL GREER KIOWA AIN PITTSBURG Le FLORE LATIMER HARMON COMANCHE GARVIN PONTOTOC JACKSON COAL STEPHENS TILLMAN MURRAY PUSHMATAHA COTTON JOHNSTON ATOKA CARTER JEFFERSON McCURTAIN MARSHALL CHOCTAW LOVE BRYAN County-Level Population Change 1990-2000 CIMARRON TEXAS OTTAWA BEAVER HARPER WOODS WASHINGTON ALFALFA GRANT KAY CRAIG NOWATA OSAGE WOODWARD ELLIS GARFIELD NOBLE DELAWARE ROGERS MAJOR PAWNEE MAYES Percent Population Change TULSA PAYNE 1990 - 2000 DEWEY KINGFISHER WAGONER BLAINE LOGAN CREEK CHEROKEE ADAIR 20.2% to 32.1% ROGER MILLS LINCOLN 12.0% to 20.1% CUSTER OKMULGEE MUSKOGEE CANADIAN OKLAHOMA 6.4% to 11.9% OKFUSKEE SEQUOYAH 0% to 6.3% BECKHAM McINTOSH POTTAWATOMIE WASHITA CL SEMINOLE EV -7.5% to -0.1% CADDO HASKELL EL AN Mc -17.1% to -7.6% D GRADY HUGHES CL GREER KIOWA AIN PITTSBURG Le FLORE Source: U.S. Census Bureau (2000) LATIMER HARMON COMANCHE GARVIN PONTOTOC JACKSON COAL STEPHENS TILLMAN MURRAY PUSHMATAHA COTTON JOHNSTON ATOKA CARTER JEFFERSON McCURTAIN MARSHALL CHOCTAW LOVE BRYAN 6
  • 9. Physicians
  • 10. Oklahoma’s Physicians O klahoma is home to between 6,800 and 7,200 active (non-retired) physicians. The exact number varies depending on the data source, method of analysis, and timeliness of the data. The typical source of most physician data is the American Medical Association’s Physician Masterfile. The AMA Masterfile is a comprehensive database that is designed to catalogue information about every physician, both osteopathic (D.O.) and allopathic (M.D.), in the United States. However, our review of the Masterfile revealed some limitations, particularly among osteopathic physicians practicing in Oklahoma. To overcome these limitations, we opted to use the medical licensure databases maintained by Oklahoma’s two medical licensing boards. The data provided in this edition of the State of the State’s Rural Health assumes that 7,54 active physicians were practicing in Oklahoma during January and February of 2007. This total includes those physicians in graduate medical education programs and employed by various federal and state agencies. Of these physicians, 5,98 (7%) practice in an Urban setting, ,795 (25%) in Rural, and 6 (2%) in Mixed. Oklahoma County has the largest number of physicians with 2,565 individuals. Five counties (all Rural) have only one physician. The table on pages 2- shows a county-by-county breakdown of physicians. Osteopathic physicians account for 20% (,454) of all active physicians in the state. Most (66%) practice in Urban Oklahoma, followed by Rural (%), and Mixed (%) Oklahoma. Tulsa County is home to 605 osteopathic physicians, reflecting the presence of the state’s two leading osteopathic medical education facilities: OSU College of Osteopathic Medicine (medical education) and the OSU Medical Center (residency training). Comprising 80% of the physician workforce in the state, allopathic physicians total 5,700 active individuals. Most (74%) practice in Urban Oklahoma, followed by Rural (24%), and Mixed (2%) Oklahoma. The largest concentration of allopathic physicians is in Oklahoma County with 2,45, reflecting the presence of the state’s allopathic medical education facilities at the OU Health Sciences Center. 8
  • 11. Active Osteopathic (D.O.) Physicians, 2007 CIMARRON TEXAS BEAVER HARPER KAY NOWATA CRAIG OTTAWA WASHINGTON ALFALFA GRANT WOODS OSAGE GARFIELD ROGERS NOBLE WOODWARD MAJOR MAYES DELAWARE Active Osteopathic Physicians ELLIS PAWNEE 1 dot represents 1 physician PAYNE TULSA DEWEY KINGFISHER WAGONER LOGAN CREEK CHEROKEE Source: Oklahoma Board of Osteopathic Examiners (01/2007) BLAINE ADAIR ROGER MILLS Mixed CUSTER OKMULGEE LINCOLN MUSKOGEE 44 CANADIAN OKLAHOMA OKFUSKEE SEQUOYAH 3% McINTOSH POTTAWATOMIE CL BECKHAM CADDO SEMINOLE WASHITA EV EL GRADY HASKELL AN Mc D GREER HUGHES PITTSBURG CL KIOWA Le FLORE AIN LATIMER Rural COMANCHE GARVIN PONTOTOC 456 HARMON COAL JACKSON 31% Urban STEPHENS MURRAY TILLMAN PUSHMATAHA 954 COTTON CARTER JOHNSTON ATOKA 66% McCURTAIN JEFFERSON CHOCTAW MARSHALL LOVE BRYAN Osteopathic Physicians by Rural, Urban, or Mixed Active Allopathic (M.D.) Physicians, 2007 CIMARRON TEXAS WOODS KAY CRAIG NOWATA OTTAWA WASHINGTON BEAVER HARPER ALFALFA GRANT OSAGE GARFIELD ELLIS NOBLE ROGERS WOODWARD MAJOR MAYES DELAWARE Active Allopathic Physicians PAWNEE 1 dot represents 1 physician PAYNE TULSA DEWEY KINGFISHER LOGAN WAGONER CHEROKEE Source: Oklahoma Board of Medical Licensure and Supervision (02/2007) BLAINE CREEK ADAIR ROGER MILLS LINCOLN CUSTER OKMULGEE CANADIAN MUSKOGEE OKLAHOMA SEQUOYAH Mixed OKFUSKEE 117 WASHITA McINTOSH POTTAWATOMIE 2% CL BECKHAM CADDO SEMINOLE EV EL GRADY HASKELL AN Mc D GREER PITTSBURG CL KIOWA HUGHES AIN Le FLORE LATIMER Rural COMANCHE GARVIN PONTOTOC HARMON 1,339 JACKSON COAL 24% STEPHENS MURRAY TILLMAN ATOKA PUSHMATAHA COTTON JOHNSTON CARTER Urban McCURTAIN 4,244 JEFFERSON CHOCTAW MARSHALL LOVE BRYAN 74% Allopathic Physicians by Rural, Urban, or Mixed 9
  • 12. Primary Care Physicians in Oklahoma P rimary care is the most fundamental element of healthcare. Research by Starfield, Shi, and Macinko (2005) shows that access to Number of Primary Care Physicians in primary care physicians and a functioning primary Oklahoma and Neighboring States per care delivery system both result in more equitable 100,000 Population, 2005 healthcare among the population, fewer illnesses, and ultimately fewer deaths. The primary care physician is on the frontlines in battles against illness and disease. Of the 7,54 active physicians in Oklahoma, 47% Arkansas 98.7 (,2) specialize in primary care. For the purposes Colorado 116.6 of the State of the State’s Rural Health, we classified Kansas 101.6 any physician as “primary care” who had a primary specialty of family medicine/general practice, internal Missouri 106.2 medicine, pediatrics, and obstetrics/gynecology. New Mexico 113.6 Like the larger universe of physicians, most primary Oklahoma 79.7 care physicians practice in Urban Oklahoma (64%), followed by Rural (%), and Mixed (%). One county, Texas 95.5 Alfalfa, has no primary care physicians in active U.S. 119.9 practice. The table on pages 2 and  shows a 0 20 40 60 80 100 120 county-by-county breakdown of the various primary Primary Care Physicians per 100,000 Population care specialties. As a state, Oklahoma ranks last in Source: American Medical Association (2007) the nation in access to primary care physicians. 0
  • 13. Primary Care Physicians, 2007 TEXAS CIMARRON KAY NOWATA CRAIG OTTAWA WASHINGTON BEAVER HARPER ALFALFA GRANT WOODS OSAGE ROGERS NOBLE WOODWARD MAJOR MAYES Active Primary Care Physicians ELLIS GARFIELD DELAWARE PAWNEE 1 dot represents 1 physician PAYNE TULSA Source: Oklahoma Board of Osteopathic Examiners (01/2007) DEWEY WAGONER KINGFISHER LOGAN CREEK CHEROKEE Oklahoma Board of Medical Licensure & Supervision (02/2007) BLAINE ADAIR ROGER MILLS CUSTER OKMULGEE LINCOLN MUSKOGEE CANADIAN OKLAHOMA OKFUSKEE SEQUOYAH McINTOSH Mixed POTTAWATOMIE CL BECKHAM WASHITA SEMINOLE EV 117 CADDO EL GRADY HASKELL AN 3% Mc D GREER HUGHES CL KIOWA PITTSBURG AIN LATIMER Le FLORE COMANCHE GARVIN PONTOTOC HARMON JACKSON COAL Rural STEPHENS MURRAY TILLMAN PUSHMATAHA 1,090 JOHNSTON COTTON CARTER ATOKA 33% Urban McCURTAIN JEFFERSON CHOCTAW 2,125 MARSHALL BRYAN LOVE 64% Primary Care Physicians by Rural, Urban, or Mixed Primary Care Physicians per 10,000 Population, 2007 CIMARRON TEXAS OTTAWA BEAVER HARPER WOODS WASHINGTON ALFALFA GRANT KAY CRAIG NOWATA OSAGE WOODWARD ELLIS GARFIELD NOBLE DELAWARE ROGERS Primary Care Physicians MAJOR PAWNEE MAYES per 10,000 Population PAYNE TULSA DEWEY 12.6 to 16.5 BLAINE KINGFISHER LOGAN CREEK WAGONER CHEROKEE ADAIR 7.6 to 12.5 ROGER MILLS LINCOLN 5.1 to 7.5 CUSTER CANADIAN OKMULGEE MUSKOGEE OKLAHOMA OKFUSKEE SEQUOYAH 3.3 to 5.0 BECKHAM McINTOSH 1.4 to 3.2 POTTAWATOMIE WASHITA CL SEMINOLE EV CADDO HASKELL No Primary Care Physicians EL AN Mc D GRADY HUGHES CL Source: Oklahoma Board of Osteopathic Examiners (01/2007) GREER KIOWA AIN PITTSBURG Le FLORE Oklahoma Board of Medical Licensure & Supervision (02/2007) LATIMER HARMON COMANCHE GARVIN PONTOTOC JACKSON COAL STEPHENS TILLMAN MURRAY PUSHMATAHA COTTON JOHNSTON ATOKA CARTER JEFFERSON McCURTAIN MARSHALL CHOCTAW LOVE BRYAN 
  • 14. Total Primary Care Family Medicine/ Internal County Pediatrics OB/GYN Physicians Physicians General Practice Medicine Adair  2 9 2 0  Alfalfa  0 0 0 0 0 Atoka 4   0 0 0 Beaver 2 2 2 0 0 0 Beckham 4 8     Blaine  9 9 0 0 0 Bryan 6 4 27 9 4  Caddo 4 2 9  0 0 Canadian 64 47  5 6  Carter 92 40 7 5  5 Cherokee 67 4 8  6 6 Choctaw 7 7 6 0 0  Cimarron 4 4 4 0 0 0 Cleveland 59 57 8 6 6 22 Coal    0 0 0 Comanche 27 97 54 20 0  Cotton    0 0 0 Craig 5 7 6 0 0  Creek 42 4  2  0 Custer 27 20 5 2 0  Delaware  2 6 2  2 Dewey    0 0 0 Ellis 6 6 6 0 0 0 Garfield 25 45 2 9 6 7 Garvin 24 9 4  2 2 Grady 4 24  5 4 4 Grant    0 0 0 Greer 5 5 5 0 0 0 Harmon 2 2 2 0 0 0 Harper    0 0 0 Haskell 9 6 4 2 0 0 Hughes 2 2 2 0 0 0 Jackson 6 8 9 4 2  Jefferson    0 0 0 Johnston 5 5 4  0 0 Kay 6 0 7 7   Kingfisher 7 7 6  0 0 Kiowa 6 4 4 0 0 0 Latimer  9 6 2 0  Le Flore 8 27 9   2 2
  • 15. Total Primary Care Family Medicine/ Internal County Pediatrics OB/GYN Physicians Physicians General Practice Medicine Lincoln 0 9 9 0 0 0 Logan 7 0   4 0 Love 4 4 4 0 0 0 Major 4   0 0 0 Marshall 7 6 5  0 0 Mayes 25 9   2  McClain 6   0 0 0 McCurtain 22 7  2 2 2 McIntosh  0 8 2 0 0 Murray  9 7 2 0 0 Muskogee 52 72 27 4 6 5 Noble 5 5 5 0 0 0 Nowata 6 6 6 0 0 0 Okfuskee 5   0 0 0 Oklahoma 2,565 95 25 2 5 25 Okmulgee 4 27 2 8 5 2 Osage 2 20 5  2 0 Ottawa 6 2 4 4  2 Pawnee  8 7  0 0 Payne 8 68  7 8 0 Pittsburg 6 28 2 9 2 5 Pontotoc 8 45 8 4 7 6 Pottawatomie 67 47 20 2 8 7 Pushmataha 7 5 5 0 0 0 Roger Mills 2 2 2 0 0 0 Rogers 8 59 6 0 5 8 Seminole 9 7    0 Sequoyah 2 6 5  0 0 Stephens 7 2 20 2 0  Texas 8 6 7 5 2 2 Tillman 5 5 5 0 0 0 Tulsa 2,057 956 82 0 68 05 Wagoner 22 5 4  0 0 Washington 9 40 24 8 4 4 Washita   2  0 0 Woods 5  2  0 0 Woodward 22 4 0 2   Totals 7,154 3,332 1,605 907 451 369 Source: Oklahoma Board of Osteopathic Examiners (01/2007); Oklahoma Board of Medical Licensure and Supervision (02/2007) 
  • 16. The Aging Physician Workforce M imicking macro demographic trends, the physician workforce in Oklahoma is growing older. The median age for all active physicians in the state is 50 years. Physicians practicing in Urban Oklahoma tend to be younger, with a median age of 49 years, followed by Mixed at 50 years, and Rural at 5 years. The population pyramids to the right show the number of rural and urban physicians by age cohort. More than 60% of all rural physicians are older than age 50 compared with 49% of urban physicians. Among the primary care specialties, 57% of rural physicians are older than age 50 versus 44% for urban physicians. In 2007, 97 currently active physicians reached age 65. By 208, 24 of the currently active physicians will reach age 65. This overall trend is true for both rural and urban Oklahoma. A recent nation-wide survey, conducted by the Association of American Medical Colleges, revealed that / of active physicians older than age 50 would retire today if they could afford to do so. The eagerness to retire was most prevalent among physicians between the ages of 50 and 59. Undoubtedly, the looming retirement crisis will be especially hard felt in rural Oklahoma where the number of physicians is already at a critical low. 4
  • 17. Population Pyramid of All Active Physicians in Oklahoma, 2007 Over 85 0.4% 0.5% Urban Physicians Rural Physicians 80 to 84 0.9% 1.1% 75 to 79 2.1% 2.2% 70 to 74 3.9% 4.7% 65 to 69 5.2% 6.8% Age Range (Years) 60 to 64 8.8% 11.4% 55 to 59 13.0% 15.8% 50 to 54 14.8% 18.0% 45 to 49 14.1% 13.0% 40 to 44 12.4% 11.4% 35 to 39 12.8% 10.3% 30 to 34 9.8% 4.7% Source: Oklahoma Board of Osteopathic Examiners (01/2007) Oklahoma Board of Medical Licensure & Supervision (02/2007) 20.0% 15.0% 10.0% 5.0% 0.0% 5.0% 10.0% 15.0% 20.0% % of Physicians in Urban or Rural Note that a portion of the physicians in the age 30 to 34 cohort are typically in residency training programs, of which a disproportionate share are located in Urban counties. Population Pyramid of All Active Primary Care Physicians in Oklahoma, 2007 Over 85 0.3% 0.6% Urban Physicians Rural Physicians 80 to 84 0.9% 1.0% 75 to 79 1.8% 2.4% 70 to 74 3.4% 4.4% 65 to 69 3.7% 5.2% Age Range (Years) 60 to 64 7.2% 10.5% 55 to 59 12% 14.8% 50 to 54 14.8% 18.3% 45 to 49 13.7% 13.2% 40 to 44 12.7% 10.8% 35 to 39 14.8% 12.4% 30 to 34 12% 6.0% Source: Oklahoma Board of Osteopathic Examiners (01/2007) Oklahoma Board of Medical Licensure & Supervision (02/2007) 20.0% 15.0% 10.0% 5.0% 0.0% 5.0% 10.0% 15.0% 20.0% % of Physicians in Urban or Rural Note that a portion of the physicians in the age 30 to 34 cohort are typically in residency training programs, of which a disproportionate share are located in Urban counties. 5
  • 18. Physician Education and Training in Oklahoma O f the 7,54 active physicians in Oklahoma, 6% graduated from an Oklahoma medical school. The distribution of these physicians reflects the larger physician universe with most (7%) practicing in Urban Oklahoma, followed by Rural (26%) and Mixed (%) counties. Rural Physicians by Medical School (five According to the Association of American Medical Colleges, largest alumni base), 2007 Oklahoma ranks th in the nation in physician retention. 700 Oklahoma’s two medical schools are in Tulsa (Oklahoma State Source: Oklahoma Board of Osteopathic Examiners (01/2007) Oklahoma Board of Medical Licensure & Supervision (02/2007) University College of Osteopathic Medicine) and in Oklahoma 613 600 City (University of Oklahoma College of Medicine). The combined enrollment of the schools during the 2007-2008 500 Academic year was 99 students. 400 328 Oklahoma also ranks th in the nation in retaining physicians 300 who complete their graduate medical education in the state. Rural Graduate medical education in Oklahoma occurs in only six 200 Primary Care 367 Rural counties. There are 88 residency programs in the state (2 Primary Care 100 253 osteopathic and 65 allopathic) with four osteopathic internship 47 47 35 32 programs. The relatively high retention rates among medical 0 24 25 University of Oklahoma State Kansas City University University of A.T. S ll University students and GME graduates means that Oklahoma does a Oklahoma University of Medicine & Biosciences Kansas (Kirksville, Mo.) good job of retaining the physicians that it trains in-state. 6
  • 19. Physicians Graduating from an Oklahoma Medical School, 2007 TEXAS CIMARRON BEAVER KAY NOWATA CRAIG OTTAWA WASHINGTON HARPER ALFALFA GRANT WOODS GARFIELD OSAGE ROGERS NOBLE WOODWARD MAJOR MAYES DELAWARE Active Graduates of Oklahoma ELLIS PAWNEE Medical Schools PAYNE TULSA DEWEY WAGONER LOGAN CHEROKEE 1 dot represents 1 physician BLAINE KINGFISHER CREEK ADAIR Primary Care ROGER MILLS CUSTER OKMULGEE Non-Primary Care LINCOLN MUSKOGEE CANADIAN OKLAHOMA OKFUSKEE SEQUOYAH Source: Oklahoma Board of Osteopathic Examiners (01/2007) Oklahoma Board of Medical Licensure & Supervision (02/2007) McINTOSH POTTAWATOMIE CL BECKHAM WASHITA SEMINOLE EV CADDO EL GRADY HASKELL AN Mc D GREER HUGHES CL KIOWA PITTSBURG Le FLORE AIN LATIMER COMANCHE GARVIN PONTOTOC HARMON COAL JACKSON STEPHENS MURRAY TILLMAN PUSHMATAHA COTTON CARTER JOHNSTON ATOKA McCURTAIN JEFFERSON CHOCTAW MARSHALL LOVE BRYAN Graduate Medical Education Program Locations, 2008 CIMARRON TEXAS BEAVER OTTAWA KAY WASHINGTON HARPER WOODS ALFALFA GRANT NOWATA CRAIG OSAGE WOODWARD Enid Ramona NOBLE ROGERS Graduate Medical Education Programs ELLIS MAJOR GARFIELD Tulsa MAYES DELAWARE PAWNEE Osteopathic Residency Program Location PAYNE TULSA DEWEY KINGFISHER WAGONER Osteopathic Internship Program Location BLAINE LOGAN CREEK CHEROKEE ADAIR ROGER MILLS LINCOLN Allopathic Residency Program Location CUSTER Oklahoma City OKMULGEE MUSKOGEE Source: American Osteopathic Association (2008) CANADIAN OKFUSKEE SEQUOYAH Accreditation Council for Graduate Medical Education (2008) OKLAHOMA WASHITA McINTOSH POTTAWATOMIE BECKHAM CL SEMINOLE EV CADDO EL HASKELL AN Mc D GREER GRADY HUGHES CL KIOWA AIN PITTSBURG Lawton LATIMER Le FLORE HARMON GARVIN PONTOTOC JACKSON COAL COMANCHE TILLMAN STEPHENS MURRAY PUSHMATAHA COTTON JOHNSTON ATOKA CARTER McCURTAIN JEFFERSON MARSHALL Durant CHOCTAW LOVE BRYAN 7
  • 20. Top Ten Current Out-of-State Practice Locations of Oklahoma Medical School Graduates, 2007 Washington 102 Colorado 138 Kansas Missouri California 139 182 320 North Carolina 98 Oklahoma Arizona Arkansas 97 New Mexico 124 44 Hawai’i Texas 594 Florida Alaska 157 Source: American Medical Association (2007); American Osteopathic Association (2007) Top Ten Out-of-State Sources of Active Physicians Practicing in Oklahoma, 2007 New York 93 Nebraska Pennsylvania 72 118 Illinois 115 Kansas Missouri California 387 80 134 Oklahoma Arkansas 84 Hawai’i Louisiana 96 Texas 489 Alaska Source: American Medical Association (2007); American Osteopathic Association (2007) 8
  • 21. Hospitals
  • 22. Hospitals in Rural Oklahoma A rural hospital is more than bricks-and-mortar. In Number of Hospital Beds rural communities across Oklahoma the local per 1,000 Population, 2007 hospital is often a primary driver of the local economy. Typically, the healthcare infrastructure in rural United States 2.7 communities is the second largest employer, after the local school system, and at its center is the hospital. Currently, there are 6 licensed hospitals in Oklahoma. Rural Oklahoma 3.8 Oklahoma is served by 82 hospitals providing 5,90 certified beds. Three counties, Alfalfa, Cotton, and Grant do not have Urban Oklahoma 5.1 hospitals. This section explores the characteristics of rural hospitals Rural Oklahoma 3.1 in Oklahoma and provides an overview of the two primary federal grant programs that support many rural hospitals, the Mixed 1.1 Medicare Rural Hospital Flexibility Program and the Small Sources: Oklahoma State Department of Health (2006); U.S. Health Resources and Services Administration (2007) Hospital Improvement Program. 0 1 2 3 4 5 6 20
  • 23. Licensed Hospitals, 2007 TEXAS KAY NOWATA WOODS OTTAWA WASHINGTON CIMARRON ALFALFA GRANT CRAIG BEAVER HARPER OSAGE ROGERS MAYES GARFIELD NOBLE WOODWARD MAJOR PAWNEE DELAWARE Licensed Hospitals by Bed Size ELLIS PAYNE TULSA 50 Beds or Fewer DEWEY BLAINE KINGFISHER LOGAN WAGONER CREEK CHEROKEE ADAIR 51 to 150 Beds ROGER MILLS CUSTER CANADIAN LINCOLN OKMULGEE MUSKOGEE OKLAHOMA OKFUSKEE SEQUOYAH 151 to 250 Beds McINTOSH POTTAWATOMIE CL BECKHAM SEMINOLE WASHITA CADDO EV GRADY EL AN HASKELL 251 to 500 Beds Mc D GREER CL KIOWA HUGHES AIN Le FLORE LATIMER PONTOTOC PITTSBURG HARMON COMANCHE GARVIN COAL More than 501 Beds JACKSON MURRAY PUSHMATAHA STEPHENS JOHNSTON TILLMAN COTTON CARTER ATOKA Sources: Oklahoma State Department of Health (2006); McCURTAIN U.S. Health Resources and Services Administration (2007) JEFFERSON MARSHALL CHOCTAW LOVE BRYAN Number of Hospital Beds per 1,000 Population, 2007 CIMARRON TEXAS OTTAWA BEAVER HARPER WOODS WASHINGTON ALFALFA GRANT KAY CRAIG NOWATA OSAGE WOODWARD ELLIS GARFIELD NOBLE DELAWARE ROGERS MAJOR PAWNEE MAYES Certified Hospital Beds per 1,000 Population PAYNE TULSA DEWEY BLAINE KINGFISHER WAGONER LOGAN CREEK CHEROKEE ADAIR 10.2 to 20.2 ROGER MILLS LINCOLN 5.3 to 10.1 CUSTER OKMULGEE MUSKOGEE CANADIAN OKLAHOMA 3.7 to 5.2 OKFUSKEE SEQUOYAH 2.3 to 3.6 BECKHAM McINTOSH POTTAWATOMIE WASHITA CL SEMINOLE EV 0.7 to 2.2 CADDO HASKELL EL AN Mc No Hospital Beds D GRADY HUGHES CL GREER KIOWA AIN PITTSBURG Le FLORE LATIMER Sources: Oklahoma State Department of Health (2006); U.S. Health Resources and Services Administration (2007) HARMON GARVIN PONTOTOC COMANCHE JACKSON COAL STEPHENS TILLMAN MURRAY PUSHMATAHA COTTON JOHNSTON ATOKA CARTER JEFFERSON McCURTAIN MARSHALL CHOCTAW LOVE BRYAN 2
  • 24. Discharges by Average Discharges Leaving Licensed Certified Beds/1,000 County County Residents L.O.S. (Days) Cnty. for Treatment Hospitals Beds Population (2005) (2005) (2002) Adair  50 2.2 2,427 4.2 7% Alfalfa 0 0 0 857 5.6 00% Atoka  25 .7 2,45 4.6 56% Beaver  24 4.5 4 4.6 54% Beckham 2 28 6.6 ,750 4.66 22% Blaine 2 42 . ,67 4.68 57% Bryan  20 . 5,909 .9 % Caddo 2 47 .6 ,665 5.0 8% Canadian 2 94 0.9 2,22 4.44 87% Carter 2 200 4.2 7,55 5.05 2% Cherokee  82 .8 6,079 4.78 52% Choctaw 2 94 6. 2,4 5.52 5% Cimarron  20 7. 27 4.26 00% Cleveland 5 528 2. 26,28 4.97 54% Coal  20 .5 ,25 4.8 46% Comanche 2 572 5.2 ,79 5.2 % Cotton 0 0 0 656 5.59 00% Craig  62 4. ,585 4.7 59% Creek  70 .0 0,258 4.90 84% Custer 2 89 .5 4,262 4.22 4% Delaware  62 .5 2,854 4.26 28% Dewey  8 4.0 822 4.67 64% Ellis  79 20.2 45 4.06 6% Garfield  449 7.9 0,9 5.60 0% Garvin 2 82 .0 ,897 4.97 82% Grady  99 2.0 8,9 4.6 55% Grant 0 0 0 698 5.08 00% Greer  7 2.9 ,8 5.60 6% Harmon   0.2 ,50 .60 45% Harper  25 7.5 ,69 4.44 62% Haskell  40 . ,805 4.57 52% Hughes  25 .8 ,990 4.80 76% Jackson   5.0 5,226 4.72 2% Jefferson  25 .9 85 4.75 70% Johnston  25 2.4 ,850 4.5 00% Kay 2 9 4.2 7,07 4.46 28% Kingfisher  25 .7 2,7 4.75 62% Kiowa  50 5. 2,20 4.95 67% Latimer   . ,756 4.5 5% 22
  • 25. Discharges by Average Discharges Leaving Licensed Certified Beds/1,000 County County Residents L.O.S. (Days) Cnty. for Treatment Hospitals Beds Population (2005) (2005) (2002) Le Flore  84 .7 ,645 4.6 22% Lincoln 2 50 .5 5,40 4.6 89% Logan  25 0.7 6,59 4.7 8% Love  25 2.7 ,7 4.89 68% Major  25 .4 ,894 4.94 00% Marshall  25 .7 2,478 .87 78% Mayes  52 . 5,529 4.8 75% McClain  9 . 4,59 5.2 80% McCurtain   . ,464 4.22 8% McIntosh   .7 ,8 5.0 9% Murray  25 .9 ,92 5.40 72% Muskogee  66 5.2 0,60 4.85 29% Noble  26 2. 2,447 4.4 74% Nowata  25 2. ,229 4.72 79% Okfuskee  25 2.2 2,69 5.58 00% Oklahoma 25 4,257 6.2 99,074 5.05 2% Okmulgee  44 .6 6,907 5.06 50% Osage 2 40 0.9 7,520 4.66 90% Ottawa  4 .5 6,27 4.09 25% Pawnee  4 0.8 ,97 4.60 7% Payne 2 29 .0 8,5 4.76 25% Pittsburg  82 4.0 7,48 5.46 27% Pontotoc  52 4. ,67 4.69 00% Pottawatomie 2 224 . 8,986 4.60 5% Pushmataha  49 4.2 2,066 5.00 00% Roger Mills  5 4.6 687 4.56 76% Rogers  8 .0 9,628 4.5 6% Seminole  2 . ,95 5.0 68% Sequoyah  4 .0 ,9 5.0 70% Stephens  26 2.9 6,507 4.8 4% Texas  47 2. ,977 .2 8% Tillman  7 4.4 ,675 4.56 50% Tulsa 4 2,880 5.0 78,9 4.70 2% Wagoner  00 .5 9,07 4.5 8% Washington 2 254 5.2 7,89 5. 28% Washita  25 2.2 2,729 4.68 80% Woods  7 4.4 ,472 4.6 48% Woodward  7 .8 ,074 4.74 9% Total 136 13,755 3.8 518,608 4.81 33% 2 Source: Oklahoma State Department of Health (2005; 2007); U.S. Health Resources and Services Administration (2007)
  • 26. Critical Access Hospitals T he  Critical Access Hospitals in Oklahoma are • Make available 24/7 emergency care services; a vital component of the health and well-being • Provide no more than 25 beds for acute inpatient of rural Oklahoma. Certified by the Centers for care (some exceptions apply to swing bed Medicare and Medicaid Services and the state, these facilities); and hospitals receive 0% cost-based reimbursement • Provide an annual average length of stay of less for their Medicare patients. For CAH designation the than 96 hours per patient for acute care patients. hospitals must meet the following criteria: Aside from the enhanced Medicare reimbursement, other advantages of CAH status include cost report deductions • Be a rural public, non-profit or for-profit hospital; that allow for many expenses to be covered by Medicare • Be located more than a 5-mile drive from and patient-based staffing for payroll flexibility. any other hospital (other mileage rules apply in mountainous terrain or in areas served by secondary roads); SHIP Hospitals T he Small Hospital Improvement Program (SHIP) Hospitals may expend their grant funding on any of the is an annual grant program administered by following expenses: the Office of Rural Health Policy in the Health • Complying with provisions of Health Insurance Resources and Services Administration of the U.S. Portability and Accountability Act; Department of Health and Human Services. The SHIP • Implementing Prospective Payment System; and grant provides approximately $8,500 annually for every • Reducing medical errors and supporting quality hospital in the country that meets the following criteria: improvement. In 2007, the OSU Center for Rural Health distributed SHIP • Is located in a rural area (outside of a Metropolitan grant funding to 60 rural hospitals. Statistical Area); and • Has fewer than 50 beds on its most recently filed 24 Medicare Cost Report.
  • 27. Critical Access Hospitals, 2007 Boise City Beaver Buffalo TEXAS NOWATA OTTAWA WASHINGTON CIMARRON WOODS ALFALFA GRANT KAY Pawhuska Nowata CRAIG BEAVER HARPER Fairfax OSAGE WOODWARD GARFIELD NOBLE MAJOR Fairview Cleveland ROGERS MAYES DELAWARE PAWNEE ELLIS Okeene PAYNE TULSA Seiling KINGFISHER LOGAN Sapulpa BLAINE Drumright Critical Access Hospital DEWEY Kingfisher Guthrie WAGONER CHEROKEE ADAIR CREEK Cheyenne Stroud CUSTER Watonga LINCOLN Weatherford OKMULGEE MUSKOGEE ROGER MILLS Prague CANADIAN OKLAHOMA OKFUSKEE Source: Flex Monitoring Team (2007) SEQUOYAH Oklahoma Office of Rural Health (2007) Cordell McINTOSH Okemah POTTAWATOMIE BECKHAM WASHITA CADDO CL SEMINOLE Carnegie EV Holdenville EL AN GREER HASKELL Mc D GRADY Mangum CL KIOWA HUGHES PITTSBURG AIN Anadarko Le FLORE LATIMER GARVIN PONTOTOC COAL HARMON COMANCHE JACKSON Sulphur Coalgate STEPHENS Atoka TILLMAN MURRAY PUSHMATAHA JOHNSTON COTTON Healdton Waurika ATOKA CARTER Tishomingo Madill McCURTAIN JEFFERSON MARSHALL Marietta CHOCTAW LOVE BRYAN Hospitals Qualifying for the Small Hospital Improvement Program (SHIP), 2007 Boise City Guymon Beaver Buffalo Alva Blackwell NOWATA CRAIG OTTAWA WASHINGTON CIMARRON TEXAS ALFALFA GRANT KAY Pawhuska Nowata BEAVER HARPER WOODS Vinita Fairfax NOBLE OSAGE ELLIS WOODWARD Fairview GARFIELD Perry Cleveland ROGERS MAYES MAJOR DELAWARE PAWNEE Shattuck Okeene PAYNE TULSA Pryor Seiling KINGFISHER LOGAN Sapulpa SHIP Qualifying Hospital BLAINE Drumright DEWEY Kingfisher Guthrie WAGONER CHEROKEE ADAIR Cheyenne CREEK Stroud Stilwell Source: Oklahoma Office of Rural Health (2007) CUSTER Watonga Bristow LINCOLN Clinton El Reno OKMULGEE MUSKOGEE ROGER MILLS Prague Sallisaw OKLAHOMA OKFUSKEE Henryetta Elk City SEQUOYAH Sayre Weatherford CANADIAN McINTOSH WASHITA Seminole Okemah POTTAWATOMIE CADDO Stigler CL EV BECKHAM Cordell Carnegie SEMINOLE Holdenville EL Purcell Eufaula AN GREER HASKELL D Mc GRADY Mangum CL Hobart Anadarko HUGHES PITTSBURG AIN Hollis Le FLORE KIOWA Lindsay Wilburton PONTOTOC COAL LATIMER HARMON COMANCHE GARVIN Talihina JACKSON Sulphur Coalgate Frederick STEPHENS Atoka MURRAY PUSHMATAHA JOHNSTON Antlers TILLMAN COTTON Healdton Waurika ATOKA CARTER Tishomingo Madill McCURTAIN JEFFERSON MARSHALL Hugo Marietta CHOCTAW LOVE BRYAN 25
  • 28. Metadata The data used to prepare the State of the State’s Rural Health were assembled from public sources, both state and federal, and private organizations. The data were the most recent available at the time of publication. The OSU Center for Rural Health does not accept any responsibility for the completeness and/or accuracy of the data. Below is a page-by-page list of the data we used, including the timeliness of the data, any significant processing/manipulations we performed, and where the original data can be obtained. Page 1 America’s Health Rankings. 2007. United Health Foundation. http://www.unitedhealthfoundation.org/shr.html Health System Performance. 2007. The Commonwealth Fund. http://www. commonwealthfund.org Page 2 “Rural Definitions for Health Policy and Research.” 2005. L. Gary Hart, Eric H. Larson, and Denise M. Lisher. American Journal of Public Health. Vol. 95(7): 1149-1155. Page 3 Census Tract-Level Rural Urban Commuting Areas (RUCA). 2005. Aggregated to county-level. Data supplied by the WWAMI Rural Health Research Center. http://depts.washington.edu/uwrhrc/index.html County-Level Population Estimates. 2006. Aggregated by Urban, Rural, Mixed status. Data supplied by the U.S. Census Bureau (2006 Population Estimates). http://www.census.gov Pages 3, 4-5 Selected Socioeconomic and Demographic Statistics. 2000. Aggregated by Urban, Rural, Mixed status. Data supplied by the U.S. Census Bureau (Summary File 3). http://www.census.gov Page 6 County-Level Population Estimates. 2006. Data supplied by the U.S. Census Bureau (2006 Population Estimates). http://www.census.gov County-Level Population Totals. 2000 and 1990. Data supplied by the U.S. Census Bureau. http://www.census.gov Pages 8-18 Active Osteopathic Physicians. 2007. Data supplied by the Oklahoma Board of Osteopathic Examiners. http://www.docboard.org/ok/ok.htm Active Allopathic Physicians. 2007. Data supplied by the Oklahoma Board of Medical Licensure & Supervision. http://www.oklahomamedicalboard.org Page 10 Primary Care Physicians per 100,000 Population. 2007. “Physician Characteristics and Distribution in the U.S. - 2007 Edition.” American Medical Association. http://www.ama.org “Contributions of Primary Care to Health Systems and Health.” 2005. Barbara Starfield, Leiyu Shi, and James Macinko. The Milbank Quarterly. Vol. 83(3): 457-502. 26
  • 29. Page 14 “State of the Physician Workforce: Trends, Developments, and Lessons.” 2007. Information supplied by the Association of American Medical Colleges. http://www.aamc.org Page 16 “2007 State Physician Workforce Data Book.” 2007. Information supplied by the Association of American Medical Colleges. http://www.aamc.org Allopathic Residency Programs. 2008. Data supplied by the Accreditation Council for Graduate Medical Education. http://www.acgme.org Osteopathic Residency Programs. 2008. Data supplied by the American Osteopathic Association. https://www.do-online.org/ Page 18 Graduates of Oklahoma Medical Schools Practicing in Other States. 2007. Data supplied by the American Medical Association and the American Osteopathic Association. http://www.ama.org & https://www.do-online.org/ Graduates of Other Medical Schools (by State) Practicing in Oklahoma. 2007. Data supplied by the American Medical Association and the American Osteopathic Association. http://www.ama.org & https://www.do-online.org/ Pages 20-23 Distribution of Licensed Hospitals. 2007. Data supplied by the Oklahoma State Department of Health. http://www.health.state.ok.us Certified Hospital Beds. 2007. Data supplied by the U.S. Health Resources and Services Administration. http://www.hrsa.gov Pages 22-23 Hospital Inpatient Discharges. 2007. Data supplied by the Oklahoma State Department of Health. http://www.health.ok.gov/stats/discharge.html Discharges Leaving County. 2005. Data supplied by the Oklahoma State Department of Health (Planning for Healthy Communities - 2005 Community Health Profiles). http://www.health.state.ok.us Pages 24-25 Distribution of Critical Access Hospitals. 2007. Data supplied by the Flex Monitoring Team and the Oklahoma Office of Rural Health. http://www.flexmonitoring.org & http://ruralhealth.okstate.edu Additional information supplied by the Centers for Medicare & Medicaid Services. http://www.cms.hhs.gov/CertificationandComplianc/04_CAHs.asp 27
  • 30. About the OSU Center for Rural Health Photo by Terry Drenner 28
  • 31. The Center was founded in 200 by the Oklahoma legislature as the Oklahoma This annual report is published Rural Health Policy and Research Center, but its name was changed in 2006 to by the Center for Rural Health, better fit within the OSU family. With offices in Tulsa and Oklahoma City, the Oklahoma State University Center is able to meet the health advocacy needs of all rural Oklahomans. The Center for Health Sciences, map below shows the footprint of the Center’s health services and activities  West 7th Street, through November 2007. The Center is home to the Oklahoma Office of Tulsa, Oklahoma 7407-898. Rural Health, the OSU Center for Health Sciences Division of Rural Medical Education, and the Oklahoma Area Health Education Center (OkAHEC). OSU is an equal The mission of the Center is to improve health care in Oklahoma through opportunity/affirmative residency training, research, program applications, advocacy and alliances action institution. with others in the state who share our goals. Moreover, the Center’s vision is to uniquely impact osteopathic physicians from the time they are students Chad Landgraf & Jeff Hackler through the time they are practicing in rural communities by ) training Editors osteopathic medical students, 2) providing support services to osteopathic physicians and their rural practices, and ) strengthening the broader health Ellen Stockton care delivery system in the rural communities where they practice. Art Director For more information about the OSU Center for Rural Health, please visit Angela Byers our web site. It contains current information about the various programs Designer administered by the Center, our research activities, and our educational endeavors. Our web site can be found at: Terry Drenner Photographer http://ruralhealth.okstate.edu (cover photo and page 28) This publication, issued by Oklahoma State University Center for Health Sciences, Caldwell, Ks. Joplin, Mo. Boise City Alva as authorized by John Guymon Beaver Buffalo Miami Blackwell Bartlesville Felt Balko Pawhuska Nowata Vinita SW City, Mo. Fernandes, D.O., M.B.A., Fairfax Woodward ENID Chelsea Grove president and dean, was Shattuck Oologah Legend Fairview Perry Skiatook Claremore Rural Medical Education Site Cleveland Sand Owasso printed by Spectra Press, Inc., Okeene Springs TULSA Hennessey at a cost of $4,989. Stillwater Mannford Critical Access & SHIP Eligible Hospital Seiling Broken Arrow Drumright Watonga SHIP Eligible Hospital Kingfisher Guthrie Jenks Tahlequah Cushing Sapulpa Telemedicine Site Cheyenne Porter OSU Stroud Stillwell Distance Learning Site Hydro El Reno Bristow Okmulgee Clinton Oklahoma City Prague Vian Future Telemedicine Site Elk City Okemah Salisaw Weatherford OSU Mobile Telemedicine Clinic Visit Site Sayre Harrah Henryetta Eufaula Stigler Advisement Cordell Northwest AHEC (Enid) AHEC Regions Seminole Northeast AHEC (Tulsa) Mangum Hobart Carnegie Purcell POTEAU The OSU Center for Rural Health, Holdenville McAlester Southwest AHEC (Lawton) Hollis Anadarko Lindsay Wilburton OSU to the best of its ability, provides Talihina Southeast AHEC (Poteau) Altus LAWTON Pauls Valley Ada Hartshorne OSU the most accurate information Note Coalgate possible. Readers should be Distance learning sites and telemedicine sites in Oklahoma City and Tulsa are omitted for Frederick Sulphur Atoka aware that the data used to compile clarity. Waurika Healdton Tishomingo Antlers the State of the State’s Rural Health Ardmore Hugo Broken Bow is constantly changing. The data Durant Marietta Madill Idabel presented in this volume are only valid for the moment in which they were collected. Readers should consult the “Metadata” section for more information about specific data elements.
  • 32. Oklahoma State University Center for Rural Health 1111 West 17th Street Tulsa, OK 74107-1898 (918) 584-4310 ruralhealth.okstate.edu