Transcript
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Workforce Issues:Physicians & Hospitals
State of the State’sRural Health
2008 Edition
On the Cover:
2007 honors
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 here 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)
On the Cover:
2007 honors
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)
�
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
2
Rural means different things to different people. No single definition of rural exists. The federal government commonly uses four different
definitions of rural just within its various health programs. The OSU Center for Rural Health uses the definition that is most widely accepted among those who conduct rural health research: the Rural-Urban Commuting Area codes developed by the Washington, Wyoming, Alaska, Montana, and Idaho Rural Health Research Center housed at the University of Washington School of Medicine in Seattle.
Most publicly accessible health and demographic data are compiled at the county-level, while RUCA codes provide detail down to the spatially smaller census tract-level. For each county in the state, we calculated the total percentage of the population living in census tracts designated with urban and rural RUCA codes. Counties with more than 95 percent of their population living in urban coded tracts were classified as Urban, counties with between 95 percent and 65 percent
of their population living in urban coded tracts were classified as Mixed, and counties with less than 65 percent of their population living in urban coded tracts were classified as Rural.
The development of these three categories (Rural, Urban, and Mixed) allowed us to compare the health and socioeconomic data of a county versus its place along the urban-rural continuum.
The table at the right shows selected socioeconomic and demographic characteristics of Rural, Urban, and Mixed Oklahoma. These characteristics are often cited as macro-level determinants of health status for a population. For example, lower levels of educational attainment are directly related to lower incomes, which in turn generally lead to lower overall health status. A county-by-county breakdown of these data is presented in a table on the next two pages, followed by two maps that show the distribution of population among the counties and county-level population change between �990 and 2000.
Defining Rural Oklahoma
�
OSAGE
TEXAS
ELLIS
KAYBEAVER
Le FLORE
CADDO
CIMARRON
WOODS
GRADY
McCURTAIN
CREEK
ATOKA
KIOWA
GRANT
BRYAN
DEWEY
CUSTER
BLAINE
MAJOR
HARPER
PITTSBURG
CRAIG
LINCOLN
NOBLE
PAYNE
WASHITA
GARFIELD
CARTER
ALFALFA
LOGAN
LOVE
GARVIN
PUSHMATAHA
MAYES
COAL
GREER
TILLMAN
HUGHES
WOODWARD
TULSA
ADAIR
COMANCHE
BECKHAM
JACKSON
STEPHENS
ROGERS
ROGER MILLS
LATIMER
CANADIAN
CHOCTAW
COTTON
KINGFISHERCHEROKEE
MUSKOGEE
HASKELL
DELAWARE
JEFFERSON
PAWNEE
McINTOSH
NOWATA
PONTOTOC
SEQUOYAH
McCLAIN
OKMULGEE
SEM
INOL
E
OKFUSKEE
JOHNSTON
OKLAHOMA
HARMON
OTTAWA
WAGONERCLEVELAND
MURRAY
MARSHALL
POTT
AWAT
OMIE
WAS
HIN
GTON
County Designation
Source: Adapted from WWAMI Rural Health Research Center (2006)
Rural (68)
Mixed Urban & Rural (5)
Urban (4)
Rural1,667,573
46.6%Urban
1,606,83644.9%
Mixed304,803
8.5%
Population by Rural, Urban, or Mixed
Designation of Counties as Urban, Rural, or MixedBased on Rural-Urban Commuting Area Codes
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 $29,94�
% of Population Over Age 65 �5% ��% ��% ��%
% Adult Population without High School Degree or G.E.D.
2�% �6% �8% �9%
Source: U.S. Census Bureau (2000)
Selected Socioeconomic & Demographic Comparisonof Rural, Urban, and Mixed Counties in Oklahoma
OSAGE
TEXAS
ELLIS
KAYBEAVER
Le FLORE
CADDO
CIMARRON
WOODS
GRADY
McCURTAIN
CREEK
ATOKA
KIOWA
GRANT
BRYAN
DEWEY
CUSTER
BLAINE
MAJOR
HARPER
PITTSBURG
CRAIG
LINCOLN
NOBLE
PAYNE
WASHITA
GARFIELD
CARTER
ALFALFA
LOGAN
LOVE
GARVIN
PUSHMATAHA
MAYES
COAL
GREER
TILLMAN
HUGHES
WOODWARD
TULSA
ADAIR
COMANCHE
BECKHAM
JACKSON
STEPHENS
ROGERS
ROGER MILLS
LATIMER
CANADIAN
CHOCTAW
COTTON
KINGFISHERCHEROKEE
MUSKOGEE
HASKELL
DELAWARE
JEFFERSON
PAWNEE
McINTOSH
NOWATA
PONTOTOC
SEQUOYAH
McCLAIN
OKMULGEE
SEM
INOL
E
OKFUSKEE
JOHNSTON
OKLAHOMA
HARMON
OTTAWA
WAGONERCLEVELAND
MURRAY
MARSHALL
POTT
AWAT
OMIE
WAS
HIN
GTON
County Designation
Source: Adapted from WWAMI Rural Health Research Center (2006)
Rural (68)
Mixed Urban & Rural (5)
Urban (4)
Rural1,667,573
46.6%Urban
1,606,83644.9%
Mixed304,803
8.5%
Population by Rural, Urban, or Mixed
4
CountyWhite(%)
Black(%)
NativeAmerican
(%)
Hisp.(%)
Other(%)
Median Age(yrs)
Pop. inPoverty
(%)
Med. HHIncome
($)
Age 65+(%)
No H.S. Diploma
(%)
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 �6,7�5 �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 45,4�9 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 26,5�6 �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 27,2�0 �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 �0,7�7 ��.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
5
CountyWhite(%)
Black(%)
NativeAmerican
(%)
Hisp.(%)
Other(%)
Median Age(yrs)
Pop. inPoverty
(%)
Med. HHIncome
($)
Age 65+(%)
No H.S. Diploma
(%)
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 26,4�7 �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.� 28,4�8 �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 27,6�5 ��.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 �5,8�6 �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)
6
Total Population by County2006 (Estimated)
County-Level Population Change1990-2000
OSAGE
TEXAS
ELLIS
KAYBEAVER
Le FLORE
CADDO
CIMARRON
WOODS
GRADY
McCURTAIN
CREEK
ATOKA
KIOWA
GRANT
BRYAN
DEWEY
CUSTER
BLAINE
MAJOR
HARPER
PITTSBURG
CRAIG
LINCOLN
NOBLE
PAYNE
WASHITA
GARFIELD
CARTER
ALFALFA
LOGAN
LOVE
GARVIN
PUSHMATAHA
MAYES
COAL
GREER
TILLMAN
HUGHES
WOODWARD
TULSA
ADAIR
COMANCHE
BECKHAM
JACKSON
STEPHENS
ROGERS
ROGER MILLS
LATIMER
CANADIAN
CHOCTAW
COTTON
KINGFISHERCHEROKEE
MUSKOGEE
HASKELL
DELAWARE
JEFFERSON
PAWNEE
McINTOSH
NOWATA
PONTOTOC
SEQUOYAH
McCLAIN
OKMULGEE
SEM
INOL
E
OKFUSKEE
JOHNSTON
OKLAHOMA
HARMON
OTTAWA
WAGONER
CLEVELAND
MURRAY
MARSHALL
POTT
AWAT
OMIE
WAS
HIN
GTON
Percent Population Change1990 - 2000
20.2% to 32.1%
12.0% to 20.1%
6.4% to 11.9%
0% to 6.3%
-7.5% to -0.1%
-17.1% to -7.6%
Source: U.S. Census Bureau (2000)
OSAGE
TEXAS
ELLIS
KAYBEAVER
Le FLORE
CADDO
CIMARRON
WOODS
GRADY
McCURTAIN
CREEK
ATOKA
KIOWA
GRANT
BRYAN
DEWEY
CUSTER
BLAINE
MAJOR
HARPER
PITTSBURG
CRAIG
LINCOLN
NOBLE
PAYNE
WASHITA
GARFIELD
CARTER
ALFALFA
LOGAN
LOVE
GARVIN
PUSHMATAHA
MAYES
COAL
GREER
TILLMAN
HUGHES
WOODWARD
TULSA
ADAIR
COMANCHE
BECKHAM
JACKSON
STEPHENS
ROGERS
ROGER MILLS
LATIMER
CANADIAN
CHOCTAW
COTTON
KINGFISHERCHEROKEE
MUSKOGEE
HASKELL
DELAWARE
JEFFERSON
PAWNEE
McINTOSH
NOWATA
PONTOTOC
SEQUOYAH
McCLAIN
OKMULGEE
SEM
INOL
E
OKFUSKEE
JOHNSTON
OKLAHOMA
HARMON
OTTAWA
WAGONER
CLEVELAND
MURRAY
MARSHALL
POTT
AWAT
OMIE
WAS
HIN
GTON
Total Population200,001 to 691,266
100,001 to 200,000
50,001 to 100,000
10,001 to 50,000
2,807 to 10,000
Source: U.S. Census Bureau (2006)
Ph
ysic
ian
s
8
Oklahoma 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.
Oklahoma’s Physicians
9
Active Osteopathic (D.O.) Physicians, 2007
Active Allopathic (M.D.) Physicians, 2007
OSAGE
TEXAS
ELLIS
KAYBEAVER
Le FLORE
CADDO
CIMARRON
WOODS
GRADY
McCURTAIN
CREEK
ATOKA
KIOWA
GRANT
BRYAN
DEWEY
CUSTER
BLAINE
MAJOR
HARPER
PITTSBURG
CRAIG
LINCOLN
NOBLE
PAYNE
WASHITA
GARFIELD
CARTER
ALFALFA
LOGAN
LOVE
GARVIN
PUSHMATAHA
MAYES
COAL
GREER
TILLMAN
HUGHES
WOODWARD
TULSA
ADAIR
COMANCHE
BECKHAM
JACKSON
STEPHENS
ROGERS
ROGER MILLS
LATIMER
CANADIAN
CHOCTAW
COTTON
KINGFISHER CHEROKEE
MUSKOGEE
HASKELL
DELAWARE
JEFFERSON
PAWNEE
McINTOSH
NOWATA
PONTOTOC
SEQUOYAH
McCLAIN
OKMULGEE
OKFUSKEE
JOHNSTON
OKLAHOMA
HARMON
OTTAWA
WAGONER
CLEVELAND
MURRAY
MARSHALL
POTT
AWAT
OMIE
WAS
HIN
GTON
SEM
INOL
E
Active Osteopathic Physicians
Source: Oklahoma Board of Osteopathic Examiners (01/2007)
1 dot represents 1 physician
OSAGE
TEXAS
ELLIS
KAYBEAVER
Le FLORE
CADDO
CIMARRONWOODS
GRADY
McCURTAIN
CREEK
ATOKA
KIOWA
GRANT
BRYAN
DEWEY
CUSTER
BLAINE
MAJOR
HARPER
PITTSBURG
CRAIG
LINCOLN
NOBLE
PAYNE
WASHITA
GARFIELD
CARTER
ALFALFA
LOGAN
LOVE
GARVIN
PUSHMATAHA
MAYES
COAL
GREER
TILLMAN
HUGHES
WOODWARD
TULSA
ADAIR
COMANCHE
BECKHAM
JACKSON
STEPHENS
ROGERS
ROGER MILLS
LATIMER
CANADIAN
CHOCTAW
COTTON
KINGFISHER CHEROKEE
MUSKOGEE
HASKELL
DELAWARE
JEFFERSON
PAWNEE
McINTOSH
NOWATA
PONTOTOC
SEQUOYAH
McCLAIN
OKMULGEE
OKFUSKEE
JOHNSTON
OKLAHOMA
HARMON
OTTAWA
WAGONER
CLEVELAND
MURRAY
MARSHALL
POTT
AWAT
OMIE
WAS
HIN
GTON
SEM
INOL
E
Active Allopathic Physicians
Source: Oklahoma Board of Medical Licensure and Supervision (02/2007)
1 dot represents 1 physician
Urban95466%
Rural45631%
Mixed443%
Osteopathic Physiciansby Rural, Urban, or Mixed
Urban4,24474%
Rural1,33924%
Mixed1172%
Allopathic Physiciansby Rural, Urban, or Mixed
�0
Primary care is the most fundamental element of healthcare. Research by Starfield, Shi, and Macinko (2005) shows that access to
primary care physicians and a functioning primary care delivery system both result in more equitable 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% (�,��2) specialize in primary care. For the purposes of the State of the State’s Rural Health, we classified any physician as “primary care” who had a primary specialty of family medicine/general practice, internal medicine, pediatrics, and obstetrics/gynecology. Like the larger universe of physicians, most primary care physicians practice in Urban Oklahoma (64%), followed by Rural (��%), and Mixed (�%). One county, Alfalfa, has no primary care physicians in active practice. The table on pages �2 and �� shows a county-by-county breakdown of the various primary care specialties. As a state, Oklahoma ranks last in the nation in access to primary care physicians.
0 20 40 60 80 100 120
U.S.
Texas
Oklahoma
New Mexico
Missouri
Kansas
Colorado
Arkansas 98.7
116.6
101.6
106.2
113.6
79.7
95.5
119.9
Source: American Medical Association (2007)
Primary Care Physicians per 100,000 Population
Number of Primary Care Physicians in Oklahoma and Neighboring States per 100,000 Population, 2005
Primary Care Physiciansin Oklahoma
��
Primary Care Physicians, 2007
Primary Care Physicians per 10,000 Population, 2007
OSAGE
TEXAS
ELLIS
KAYBEAVER
Le FLORE
CADDO
CIMARRON
WOODS
GRADY
McCURTAIN
CREEK
ATOKA
KIOWA
GRANT
BRYAN
DEWEY
CUSTER
BLAINE
MAJOR
HARPER
PITTSBURG
CRAIG
LINCOLN
NOBLE
PAYNE
WASHITA
GARFIELD
CARTER
ALFALFA
LOGAN
LOVE
GARVIN
PUSHMATAHA
MAYES
COAL
GREER
TILLMAN
HUGHES
WOODWARD
TULSA
ADAIR
COMANCHE
BECKHAM
JACKSON
STEPHENS
ROGERS
ROGER MILLS
LATIMER
CANADIAN
CHOCTAW
COTTON
KINGFISHER CHEROKEE
MUSKOGEE
HASKELL
DELAWARE
JEFFERSON
PAWNEE
McINTOSH
NOWATA
PONTOTOC
SEQUOYAHMcCLAIN
OKMULGEE
OKFUSKEE
JOHNSTON
OKLAHOMA
HARMON
OTTAWA
WAGONER
CLEVELAND
MURRAY
MARSHALL
POTT
AWAT
OMIE
WAS
HIN
GTON
SEM
INOL
E
Active Primary Care Physicians
Source: Oklahoma Board of Osteopathic Examiners (01/2007)Oklahoma Board of Medical Licensure & Supervision (02/2007)
1 dot represents 1 physician
Urban2,12564%
Rural1,09033%
Mixed1173%
Primary Care Physiciansby Rural, Urban, or Mixed
OSAGE
TEXAS
ELLIS
KAYBEAVER
Le FLORE
CADDO
CIMARRON
WOODS
GRADY
McCURTAIN
CREEK
ATOKA
KIOWA
GRANT
BRYAN
DEWEY
CUSTER
BLAINE
MAJOR
HARPER
PITTSBURG
CRAIG
LINCOLN
NOBLE
PAYNE
WASHITA
GARFIELD
CARTER
ALFALFA
LOGAN
LOVE
GARVIN
PUSHMATAHA
MAYES
COAL
GREER
TILLMAN
HUGHES
WOODWARD
TULSA
ADAIR
COMANCHE
BECKHAM
JACKSON
STEPHENS
ROGERS
ROGER MILLS
LATIMER
CANADIAN
CHOCTAW
COTTON
KINGFISHERCHEROKEE
MUSKOGEE
HASKELL
DELAWARE
JEFFERSON
PAWNEE
McINTOSH
NOWATA
PONTOTOC
SEQUOYAH
McCLAIN
OKMULGEE
SEM
INOL
E
OKFUSKEE
JOHNSTON
OKLAHOMA
HARMON
OTTAWA
WAGONER
CLEVELAND
MURRAY
MARSHALL
POTT
AWAT
OMIE
WAS
HIN
GTON
Primary Care Physiciansper 10,000 Population
12.6 to 16.5
7.6 to 12.5
5.1 to 7.5
3.3 to 5.0
1.4 to 3.2
No Primary Care Physicians
Source: Oklahoma Board of Osteopathic Examiners (01/2007)Oklahoma Board of Medical Licensure & Supervision (02/2007)
�2
CountyTotal
PhysiciansPrimary CarePhysicians
Family Medicine/General Practice
InternalMedicine
Pediatrics OB/GYN
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 2�7 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
��
CountyTotal
PhysiciansPrimary CarePhysicians
Family Medicine/General Practice
InternalMedicine
Pediatrics OB/GYN
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 9�5 �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)
�4
Population Pyramid of All Active Physicians in Oklahoma, 2007
Population Pyramid of All Active Primary Care Physicians in Oklahoma, 2007
Mimicking 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 20�8, 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.
The Aging Physician Workforce
�5
Population Pyramid of All Active Physicians in Oklahoma, 2007
Rural PhysiciansUrban Physicians
4.7%
10.3%
11.4%
13.0%
18.0%
15.8%
11.4%
6.8%
4.7%
2.2%
1.1%
0.5%
9.8%
12.8%
12.4%
14.1%
14.8%
13.0%
8.8%
5.2%
3.9%
2.1%
0.9%
0.4%
20.0% 15.0% 10.0% 5.0% 0.0% 5.0% 10.0% 15.0% 20.0%
30 to 34
35 to 39
40 to 44
45 to 49
50 to 54
55 to 59
60 to 64
65 to 69
70 to 74
75 to 79
80 to 84
Over 85
Age
Rang
e (Y
ears
)
% of Physicians in Urban or Rural
Source: Oklahoma Board of Osteopathic Examiners (01/2007)Oklahoma Board of Medical Licensure & Supervision (02/2007)
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
Rural PhysiciansUrban Physicians
6.0%
12.4%
10.8%
13.2%
18.3%
14.8%
10.5%
5.2%
4.4%
2.4%
1.0%
0.6%
12%
14.8%
12.7%
13.7%
14.8%
12%
7.2%
3.7%
3.4%
1.8%
0.9%
0.3%
20.0% 15.0% 10.0% 5.0% 0.0% 5.0% 10.0% 15.0% 20.0%
30 to 34
35 to 39
40 to 44
45 to 49
50 to 54
55 to 59
60 to 64
65 to 69
70 to 74
75 to 79
80 to 84
Over 85
Age
Rang
e (Y
ears
)
% of Physicians in Urban or Rural
Source: Oklahoma Board of Osteopathic Examiners (01/2007)Oklahoma Board of Medical Licensure & Supervision (02/2007)
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.
�6
Rural Physicians by Medical School (five largest alumni base), 2007
0
100
200
300
400
500
600
700
University ofOklahoma
Oklahoma StateUniversity
Kansas City Universityof Medicine & Biosciences
University ofKansas
A.T. S ll University(Kirksville, Mo.)
613
RuralPrimary Care
367 RuralPrimary Care
253
35 24 25
328
4732
47
Source: Oklahoma Board of Osteopathic Examiners (01/2007)Oklahoma Board of Medical Licensure & Supervision (02/2007)
Of 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. According to the Association of American Medical Colleges, Oklahoma ranks ��th in the nation in physician retention. Oklahoma’s two medical schools are in Tulsa (Oklahoma State University College of Osteopathic Medicine) and in Oklahoma City (University of Oklahoma College of Medicine). The combined enrollment of the schools during the 2007-2008 Academic year was 99� students.
Oklahoma also ranks ��th in the nation in retaining physicians who complete their graduate medical education in the state. Graduate medical education in Oklahoma occurs in only six counties. There are 88 residency programs in the state (2� osteopathic and 65 allopathic) with four osteopathic internship programs. The relatively high retention rates among medical students and GME graduates means that Oklahoma does a good job of retaining the physicians that it trains in-state.
Physician Education and Training in Oklahoma
�7
Physicians Graduating from an Oklahoma Medical School, 2007
OSAGE
TEXAS
ELLIS
KAYBEAVER
Le FLORE
CADDO
CIMARRON
WOODS
GRADY
McCURTAIN
CREEK
ATOKA
KIOWA
GRANT
BRYAN
DEWEY
CUSTER
BLAINE
MAJOR
HARPER
PITTSBURG
CRAIG
LINCOLN
NOBLE
PAYNE
WASHITA
GARFIELD
CARTER
ALFALFA
LOGAN
LOVE
GARVIN
PUSHMATAHA
MAYES
COAL
GREER
TILLMAN
HUGHES
WOODWARD
TULSA
ADAIR
COMANCHE
BECKHAM
JACKSON
STEPHENS
ROGERS
ROGER MILLS
LATIMER
CANADIAN
CHOCTAW
COTTON
KINGFISHER CHEROKEE
MUSKOGEE
HASKELL
DELAWARE
JEFFERSON
PAWNEE
McINTOSH
NOWATA
PONTOTOC
SEQUOYAH
McCLAIN
OKMULGEE
OKFUSKEE
JOHNSTON
OKLAHOMA
HARMON
OTTAWA
WAGONERCLEVELAND
MURRAY
MARSHALL
POTT
AWAT
OMIE
WAS
HIN
GTON
SEM
INOL
E
Active Graduates of OklahomaMedical Schools
Source: Oklahoma Board of Osteopathic Examiners (01/2007)Oklahoma Board of Medical Licensure & Supervision (02/2007)
1 dot represents 1 physician
Primary Care
Non-Primary Care
Graduate Medical Education Program Locations, 2008
OSAGE
TEXAS
ELLIS
KAYBEAVER
Le FLORE
CADDO
CIMARRONWOODS
GRADY
McCURTAIN
CREEK
ATOKA
KIOWA
GRANT
BRYAN
DEWEY
CUSTER
BLAINE
MAJOR
HARPER
PITTSBURG
CRAIG
LINCOLN
NOBLE
PAYNE
WASHITA
GARFIELD
CARTER
ALFALFA
LOGAN
LOVE
GARVIN
PUSHMATAHA
MAYES
COAL
GREER
TILLMAN
HUGHES
WOODWARD
TULSA
ADAIR
COMANCHE
BECKHAM
JACKSON
STEPHENS
ROGERS
ROGER MILLS
LATIMER
CANADIAN
CHOCTAW
COTTON
KINGFISHER CHEROKEE
MUSKOGEE
HASKELL
DELAWARE
JEFFERSON
PAWNEE
McINTOSH
NOWATA
PONTOTOC
SEQUOYAH
McCLAIN
OKMULGEE
OKFUSKEE
JOHNSTON
OKLAHOMA
HARMON
OTTAWA
WAGONER
CLEVELAND
MURRAY
MARSHALL
POTT
AWAT
OMIE
WAS
HIN
GTON
SEM
INOL
E
Graduate Medical Education Programs
Source: American Osteopathic Association (2008)Accreditation Council for Graduate Medical Education (2008)
Osteopathic Residency Program Location
Allopathic Residency Program Location
Osteopathic Internship Program Location
Oklahoma City
Tulsa
Enid
Lawton
Ramona
Durant
�8
Top Ten Current Out-of-State Practice Locations of Oklahoma Medical School Graduates, 2007
Top Ten Out-of-State Sources of Active Physicians Practicing in Oklahoma, 2007
Texas594
New Mexico44
Arizona97
Colorado138
Washington102
California320
Missouri182
Arkansas124
Kansas139
North Carolina98
Florida157Alaska
Hawai’i
Source: American Medical Association (2007);American Osteopathic Association (2007)
Oklahoma
Texas489
California80
Missouri387
Kansas134
Alaska
Hawai’i
Arkansas84
Pennsylvania118
Illinois115
Louisiana96
New York93
Nebraska72
Source: American Medical Association (2007);American Osteopathic Association (2007)
Oklahoma
Ho
spita
ls
20
A rural hospital is more than bricks-and-mortar. In rural communities across Oklahoma the local hospital is often a primary driver of the local
economy. Typically, the healthcare infrastructure in rural 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 is served by 82 hospitals providing 5,�90 certified beds. Three counties, Alfalfa, Cotton, and Grant do not have hospitals.
This section explores the characteristics of rural hospitals in Oklahoma and provides an overview of the two primary federal grant programs that support many rural hospitals, the Medicare Rural Hospital Flexibility Program and the Small Hospital Improvement Program.
Oklahoma 3.8
United States 2.7
Rural Oklahoma 3.1
Mixed 1.1
Urban Oklahoma 5.1
0 1 2 3 4 5 6
Sources: Oklahoma State Department of Health (2006);U.S. Health Resources and Services Administration (2007)
Number of Hospital Beds per 1,000 Population, 2007
Hospitals in Rural Oklahoma
2�
Licensed Hospitals, 2007
Number of Hospital Beds per 1,000 Population, 2007
OSAGE
TEXAS
ELLIS
KAY
BEAVER
Le FLORE
CADDO
CIMARRONWOODS
GRADY
McCURTAIN
CREEK
ATOKA
KIOWA
GRANT
BRYAN
DEWEY
CUSTER
BLAINE
MAJOR
HARPER
PITTSBURG
CRAIG
LINCOLN
NOBLE
PAYNE
WASHITA
GARFIELD
CARTER
ALFALFA
LOGAN
LOVE
GARVIN
PUSHMATAHA
MAYES
COAL
GREER
TILLMAN
HUGHES
WOODWARD
TULSA
ADAIR
COMANCHE
BECKHAM
JACKSON
STEPHENS
ROGERS
ROGER MILLS
LATIMER
CANADIAN
CHOCTAW
COTTON
KINGFISHERCHEROKEE
MUSKOGEE
HASKELL
DELAWARE
JEFFERSON
PAWNEE
McINTOSH
NOWATA
PONTOTOC
SEQUOYAHMcCLAIN
OKMULGEEOKFUSKEE
JOHNSTON
OKLAHOMA
HARMON
OTTAWA
WAGONER
CLEVELAND
MURRAY
MARSHALL
POTT
AWAT
OMIE
WAS
HIN
GTON
SEM
INOL
E
Licensed Hospitals by Bed Size
Sources: Oklahoma State Department of Health (2006);U.S. Health Resources and Services Administration (2007)
50 Beds or Fewer
51 to 150 Beds
151 to 250 Beds
251 to 500 Beds
More than 501 Beds
OSAGE
TEXAS
ELLIS
KAYBEAVER
Le FLORE
CADDO
CIMARRON
WOODS
GRADY
McCURTAIN
CREEK
ATOKA
KIOWA
GRANT
BRYAN
DEWEY
CUSTER
BLAINE
MAJOR
HARPER
PITTSBURG
CRAIG
LINCOLN
NOBLE
PAYNE
WASHITA
GARFIELD
CARTER
ALFALFA
LOGAN
LOVE
GARVIN
PUSHMATAHA
MAYES
COAL
GREER
TILLMAN
HUGHES
WOODWARD
TULSA
ADAIR
COMANCHE
BECKHAM
JACKSON
STEPHENS
ROGERS
ROGER MILLS
LATIMER
CANADIAN
CHOCTAW
COTTON
KINGFISHERCHEROKEE
MUSKOGEE
HASKELL
DELAWARE
JEFFERSON
PAWNEE
McINTOSH
NOWATA
PONTOTOC
SEQUOYAH
McCLAIN
OKMULGEE
SEM
INOL
E
OKFUSKEE
JOHNSTON
OKLAHOMA
HARMON
OTTAWA
WAGONER
CLEVELAND
MURRAY
MARSHALL
POTT
AWAT
OMIE
WAS
HIN
GTON
Certified Hospital Bedsper 1,000 Population
10.2 to 20.2
5.3 to 10.1
3.7 to 5.2
2.3 to 3.6
0.7 to 2.2
No Hospital Beds
Sources: Oklahoma State Department of Health (2006);U.S. Health Resources and Services Administration (2007)
22
CountyLicensedHospitals
CertifiedBeds
Beds/1,000Population
Discharges by County Residents
(2005)
AverageL.O.S. (Days)
(2005)
Discharges LeavingCnty. for Treatment
(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 �2,2�2 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.� 2�7 4.26 �00%
Cleveland 5 528 2.� 26,28� 4.97 54%
Coal � 20 �.5 �,2�5 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 8�5 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�%
2�
CountyLicensedHospitals
CertifiedBeds
Beds/1,000Population
Discharges by County Residents
(2005)
AverageL.O.S. (Days)
(2005)
Discharges LeavingCnty. for Treatment
(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 2�9 �.0 8,�5� 4.76 25%
Pittsburg � �82 4.0 7,�48 5.46 27%
Pontotoc � �52 4.� �,6�7 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%
Source: Oklahoma State Department of Health (2005; 2007); U.S. Health Resources and Services Administration (2007)
24
The �� Critical Access Hospitals in Oklahoma are a vital component of the health and well-being of rural Oklahoma. Certified by the Centers for
Medicare and Medicaid Services and the state, these hospitals receive �0�% cost-based reimbursement for their Medicare patients. For CAH designation the hospitals must meet the following criteria:
Be a rural public, non-profit or for-profit hospital;Be located more than a �5-mile drive from any other hospital (other mileage rules apply in mountainous terrain or in areas served by secondary roads);
••
Make available 24/7 emergency care services;Provide no more than 25 beds for acute inpatient care (some exceptions apply to swing bed facilities); andProvide an annual average length of stay of less than 96 hours per patient for acute care patients.
Aside from the enhanced Medicare reimbursement, other advantages of CAH status include cost report deductions that allow for many expenses to be covered by Medicare and patient-based staffing for payroll flexibility.
••
•
The Small Hospital Improvement Program (SHIP) is an annual grant program administered by the Office of Rural Health Policy in the Health
Resources and Services Administration of the U.S. Department of Health and Human Services. The SHIP grant provides approximately $8,500 annually for every hospital in the country that meets the following criteria:
Is located in a rural area (outside of a Metropolitan Statistical Area); andHas fewer than 50 beds on its most recently filed Medicare Cost Report.
•
•
Hospitals may expend their grant funding on any of the following expenses:
Complying with provisions of Health Insurance Portability and Accountability Act;Implementing Prospective Payment System; andReducing medical errors and supporting quality improvement.
In 2007, the OSU Center for Rural Health distributed SHIP grant funding to 60 rural hospitals.
•
••
Critical Access Hospitals
SHIP Hospitals
25
Critical Access Hospitals, 2007
Hospitals Qualifying for the Small Hospital Improvement Program (SHIP), 2007
OSAGE
TEXAS
ELLIS
KAYBEAVER
Le FLORE
CADDO
CIMARRON WOODS
GRADY
McCURTAIN
CREEK
ATOKA
KIOWA
GRANT
BRYAN
DEWEY
CUSTER
BLAINE
MAJOR
HARPER
PITTSBURG
CRAIG
LINCOLN
NOBLE
PAYNE
WASHITA
GARFIELD
CARTER
ALFALFA
LOGAN
LOVE
GARVIN
PUSHMATAHA
MAYES
COAL
GREER
TILLMAN
HUGHES
WOODWARD
TULSA
ADAIR
COMANCHE
BECKHAM
JACKSON
STEPHENS
ROGERS
ROGER MILLS
LATIMER
CANADIAN
CHOCTAW
COTTON
KINGFISHER
CHEROKEE
MUSKOGEE
HASKELL
DELAWARE
JEFFERSON
PAWNEE
McINTOSH
NOWATA
PONTOTOC
SEQUOYAH
McCLAIN
OKMULGEEOKFUSKEE
JOHNSTON
OKLAHOMA
HARMON
OTTAWA
WAGONER
CLEVELAND
MURRAY
MARSHALL
POTT
AWAT
OMIE
WAS
HIN
GTON
SEM
INOL
E
Source: Flex Monitoring Team (2007)Oklahoma Office of Rural Health (2007)
Critical Access Hospital
Atoka
Mangum
Okeene
Madill
Beaver
Stroud
Prague
Nowata
Sulphur
Cordell
Buffalo
Fairfax
Guthrie
Sapulpa
Waurika
Watonga
Fairview
Coalgate
Healdton
Anadarko
Pawhuska
Marietta
Cheyenne
Cleveland
DrumrightKingfisher
Boise City
Tishomingo
Weatherford
HoldenvilleCarnegieOkemah
Seiling
OSAGE
TEXAS
ELLIS
KAYBEAVER
Le FLORE
CADDO
CIMARRONWOODS
GRADY
McCURTAIN
CREEK
ATOKA
KIOWA
GRANT
BRYAN
DEWEY
CUSTER
BLAINE
MAJOR
HARPER
PITTSBURG
CRAIG
LINCOLN
NOBLE
PAYNE
WASHITA
GARFIELD
CARTER
ALFALFA
LOGAN
LOVE
GARVIN
PUSHMATAHA
MAYES
COAL
GREER
TILLMAN
HUGHES
WOODWARD
TULSA
ADAIR
COMANCHE
BECKHAM
JACKSON
STEPHENS
ROGERS
ROGER MILLS
LATIMER
CANADIAN
CHOCTAW
COTTON
KINGFISHER
CHEROKEE
MUSKOGEE
HASKELL
DELAWARE
JEFFERSON
PAWNEE
McINTOSH
NOWATA
PONTOTOC
SEQUOYAH
McCLAIN
OKMULGEE
OKFUSKEE
JOHNSTON
OKLAHOMA
HARMON
OTTAWA
WAGONER
CLEVELAND
MURRAY
MARSHALL
POTT
AWAT
OMIE
WAS
HIN
GTON
SEM
INOL
E
Source: Oklahoma Office of Rural Health (2007)
SHIP Qualifying Hospital
Atoka
Mangum
Okeene
Madill
Beaver
Stroud
Prague
Nowata
Sulphur
Cordell
Buffalo
Fairfax
Guthrie
Sapulpa
Waurika
Watonga
Fairview
Coalgate
Healdton
Anadarko
Pawhuska
Marietta
Cheyenne
Cleveland
DrumrightKingfisher
Boise City
Tishomingo
Weatherford
HoldenvilleCarnegieOkemahSeminole
Seiling
Stigler
Hollis
Guymon
Shattuck
SayreElk City
Clinton El Reno
Hobart
Frederick
Lindsay
Purcell
Alva Blackwell
Perry
Vinita
Pryor
Bristow
Henryetta Sallisaw
Stilwell
Eufaula
Wilburton
Talihina
Antlers
Hugo
26
MetadataThe 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.
27
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
28
About the OSU Center for Rural Health
Photo by Terry Drenner
The Center was founded in 200� by the Oklahoma legislature as the Oklahoma Rural Health Policy and Research Center, but its name was changed in 2006 to better fit within the OSU family. With offices in Tulsa and Oklahoma City, the Center is able to meet the health advocacy needs of all rural Oklahomans. The map below shows the footprint of the Center’s health services and activities through November 2007. The Center is home to the Oklahoma Office of Rural Health, the OSU Center for Health Sciences Division of Rural Medical Education, and the Oklahoma Area Health Education Center (OkAHEC).
The mission of the Center is to improve health care in Oklahoma through residency training, research, program applications, advocacy and alliances 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 through the time they are practicing in rural communities by �) training osteopathic medical students, 2) providing support services to osteopathic physicians and their rural practices, and �) strengthening the broader health care delivery system in the rural communities where they practice.
For more information about the OSU Center for Rural Health, please visit our web site. It contains current information about the various programs administered by the Center, our research activities, and our educational endeavors. Our web site can be found at:
http://ruralhealth.okstate.edu
OSU
OSU
OSU
Boise CityGuymon Beaver Buffalo
Shattuck
Woodward
Cheyenne
Seiling
ClintonElk City
Sayre
Mangum
Hollis
Altus
Hobart
Cordell
Weatherford
Hydro
Watonga
Okeene
Fairview
Caldwell, Ks.
ENID
LAWTON
Carnegie
Anadarko
El Reno
Kingfisher
Hennessey
Guthrie
Oklahoma City
Harrah
Purcell
StillwaterDrumright
ClevelandPerry
Blackwell
LindsayPauls Valley
Waurika
FrederickSulphur
Healdton
Ada
Tishomingo
Ardmore
Marietta MadillDurant
Coalgate
Atoka
Prague
StroudBristow
Okemah
Seminole
Holdenville McAlester
Okmulgee
Henryetta
Sapulpa
Mannford
Jenks
Broken ArrowTULSA
SandSprings
Skiatook
Pawhuska
Fairfax
OologahClaremore
Chelsea
NowataVinita
Miami
Grove
Tahlequah
Stillwell
SW City,Mo.
Joplin, Mo.
Eufaula Stigler
Wilburton
POTEAU
Vian Salisaw
Talihina
Hugo
Antlers
Idabel
Broken Bow
FeltBalko
Cushing
Owasso
Bartlesville
Hartshorne
Porter
Alva
Legend
NoteDistance learning sites and telemedicine sitesin Oklahoma City and Tulsa are omitted forclarity.
Rural Medical Education SiteCritical Access & SHIP Eligible HospitalSHIP Eligible HospitalTelemedicine SiteDistance Learning SiteFuture Telemedicine Site
Northwest AHEC (Enid)
Northeast AHEC (Tulsa)
Southwest AHEC (Lawton)
Southeast AHEC (Poteau)AH
ECRe
gion
s
OSU Mobile Telemedicine Clinic Visit Site
This annual report is published
by the Center for Rural Health,
Oklahoma State University
Center for Health Sciences,
���� West �7th Street,
Tulsa, Oklahoma 74�07-�898.
OSU is an equal
opportunity/affirmative
action institution.
Chad Landgraf & Jeff Hackler
Editors
Ellen Stockton
Art Director
Angela Byers
Designer
Terry Drenner
Photographer (cover photo and page 28)
This publication, issued by
Oklahoma State University
Center for Health Sciences,
as authorized by John
Fernandes, D.O., M.B.A.,
president and dean, was
printed by Spectra Press, Inc.,
at a cost of $4,989.
Advisement
The OSU Center for Rural Health, to the best of its ability, provides the most accurate information possible. Readers should be aware that the data used to compile the State of the State’s Rural Health is constantly changing. The data 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.
Oklahoma State University
Center for Rural Health
1111 West 17th Street
Tulsa, OK 74107-1898
(918) 584-4310
ruralhealth.okstate.edu
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