Sosrh 2008 Edition

�

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


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%


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


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)


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)


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


�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


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


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


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



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


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


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


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.


Center for Rural Health

1111 West 17th Street

Tulsa, OK 74107-1898

(918) 584-4310

ruralhealth.okstate.edu

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