Several counties in Oklahoma are at the front lines of a demographic shift that's playing out across the nation as the population ages and rural areas continue to depopulate.
Nowhere is it more evident than the far western reaches of the state in Cimarron County. In the past decade, its population fell 21 percent to 2,475 people. That marked the state's largest county decline in population.
Cimarron County also shares another distinction: It now has the state's highest proportion of seniors compared to working-age residents, according to an analysis of data released last month by the U.S. Census Bureau.
Demographers call this measure the old-age dependency ratio. It takes the number of people older than 65 in an area and divides it by the number of people between 20 and 64.
The old-age dependency ratio is used at the national level to study future needs in Social Security and Medicare
“Having an older population in rural Oklahoma is particularly challenging because this same population is generally sicker and poorer,” said Chad Landgraf at the Oklahoma State University Center for Rural Health. “Further compounding the problem is the chronic shortage of physicians.”
Doctors who practice in rural areas tend to be older than their peers in urban areas. A recent study by OSU's Center for Rural Health found more than half of the primary-care physicians in rural areas were older than 55. That compared to about one-third of urban primary-care doctors in the same age group.
In Cimarron County, father-son doctors J.L. Wheeler, 90, and Paul E. Wheeler, 51, practice medicine at Cimarron Memorial Rural Health Clinic in Boise City. The clinic also has an osteopathic doctor and a part-time physician's assistant.
J.L. Wheeler graduated from the University of Oklahoma medical school and moved to Boise City in 1956.
He's the oldest practicing doctor in the state, said officials at the Oklahoma Board of Medical Licensure and Supervision.
Paul Wheeler grew up in Boise City and also attended OU's medical school. He practiced medicine in Shawnee before returning to Boise City in 1998.
J.L. Wheeler said in medical school he was trained in a broad range of skills that are more specialized today. He used to perform surgeries, set bones and deliver babies. Now, access to diagnostic equipment and other medical specialists are constant concerns for rural patients and their doctors. Because of malpractice insurance costs, the hospital no longer delivers babies, J.L. Wheeler said.
“In a rural area, it's a bad deal when you've got to send somebody 120 miles (to Amarillo, Texas) for any surgery,” J.L. Wheeler said. “These small country hospitals are in big trouble. If you can't deliver babies, there goes a lot of your practice because that would bring in the rest of the family.”
Paul Wheeler said one of the biggest challenges is stabilizing patients with serious conditions so they can be transported.
“We have a lot of heart attacks and strokes, and it can take up to two hours to get these patients transported,” Paul Wheeler said.
Still, Paul Wheeler likes the pace of a country practice. In Shawnee, he'd work long hours and average nine patients a day at his old practice, he said. He would take care of as many as 30 patients in an emergency room shift. In Boise City, he has more time to spend with patients.
“When they come in, you've got a really good idea of what's going on,” Paul Wheeler said. “As far as the physician-patient relationship, I don't think it gets any better.”