FREDERICK — Gregory Howard didn't quite make it to Fredericksburg, Va.
He and his wife had lived in the Virginia town of 24,000, and they liked it.
And it was on the list of places that Howard was thinking of opening his chiropractic practice.
But while he was in his last year of chiropractic school in Dallas, his father-in-law, Altus chiropractor Carl Reed, made a suggestion.
“He said, ‘You know, you all are talking about moving back to the East Coast, but why don't you drive through Frederick on your way back to Dallas? You might just like that town, and you'd have patients right away.'”
It turns out Reed was right.
Howard has been a chiropractor in Frederick, a southwestern Oklahoma town of about 4,000, for the past 18 years.
He's among many chiropractors who choose to open their practices in rural Oklahoma.
Of about 830 actively practicing chiropractors in Oklahoma, about 300 of them have home addresses or practices outside the Oklahoma City and Tulsa metro areas and suburbs, according to data from the Oklahoma Board of Chiropractic Examiners. Specific data about chiropractors who work in rural Oklahoma was not available.
Meanwhile, many parts of rural Oklahoma face substantial shortages of medical doctors and doctors of osteopathic medicine.
Oklahoma has 67 medically underserved areas that include a county or group of adjoining counties or pieces of a county where residents have a shortage of personal health services.
Frederick sits on the western side of Tillman County, one of those medically underserved areas.
About 30 percent of adult residents in southwestern Oklahoma are obese. The region has the third-highest obesity rate, behind northwestern Oklahoma at 32 percent and southeastern Oklahoma at 32 percent.
Howard sees patients who need help controlling their weight, and he often helps them work through how they can live a healthier lifestyle.
He had a year of training in nutrition while in chiropractor school and has taken classes and researched to educate himself about how to best guide his patients.
Even though some patients only come once or twice, chiropractors typically see their patients multiple times over a number of weeks. This allows them multiple opportunities to discuss health and diet, Howard said. Medical doctors might not have the same opportunities, for their patients generally come in on a less regular basis, he said.
Howard tells patients — the American diet of white bread, a piece of meat and a chicken strip with a side of corn doesn't cut it. And often times, losing weight and strengthening core muscles would alleviate some of the back pain that people feel.
“Ask someone to carry 20 pounds around with them all day, they abandon it within the first hour, like ‘No way,'” he said. “But we'll carry it on our waist.”
Ruby Walker, who has lived in Frederick for 42 years, was Howard's first patient.
Walker has seen a chiropractor for most of her life, off and on for neck and back pain. She goes to Howard to keep her bones in line and avoid surgery, she said.
Walker has doctors outside of Frederick but appreciates the few minutes that it takes to get from her house to Howard's office.
“Couldn't do with him,” she said.
A study published in 2009 in the Journal of Rural Health showed that more rural residents than urban used chiropractors.
Claims data from 237,500 claimants from two large insurance companies in Washington state were analyzed.
The study found that about 44 percent of rural residents used chiropractors, versus 32 percent of urban residents.
“Lack of conventional providers in rural areas did not completely explain this difference, nor did differences in patient cost-sharing or demographics,” according to the study. “Among those who used chiropractors, those in urban areas had more chiropractic visits than users of chiropractic in rural areas.”
Howard has an appreciation and understanding for doctors outside of chiropractic.
He often talks with the other doctors in Frederick, such as the doctor of osteopathic medicine.
“I'm not curing your cancer,” he said. “My dad died with it nine months ago from it. I wish I could help. Can't.”
Howard said he, like doctors in other fields, understands what his scope is. He said he also understands where the misconceptions among medical doctors and chiropractors comes from.
Medical doctors and chiropractors see each other's failures, the people that the other doctor couldn't help, he said.
And the people Howard helps aren't setting up appointments with their medical doctors to brag about what he has done to them.
“Nor do they schedule an appointment with me to brag on their medical doctor,” he said. “We don't see each other's miracle patients. We see the stuff that's like, ‘OK, so that didn't help you.'”