Despite efforts to increase the number of doctors in rural areas, many Oklahoma counties are still sorely lacking physicians to provide sufficient care to their residents, according to health experts.
Seventy-two of the state's 77 counties are designated as primary health-professional shortage areas by the federal government: 30 of them have 10 or fewer doctors of any type. The five counties not considered shortage areas are Oklahoma, Johnston, Canadian, Rogers and Wagoner, according to the U.S. Health Resources and Services Administration.
Oklahoma has 76 doctors per 100,000 residents, far fewer than the 220 doctors per capita nationally, according to the Association of American Medical Colleges. The state ranks 43rd in doctors per capita and 41st in primary-care physicians.
The shortage of primary-care doctors plays a large role in the poorer health outcomes of rural residents, health experts say. Rural counties have a significantly higher residents-to-doctor ratio than urban ones, according to data obtained by Oklahoma Watch from the Oklahoma Board of Medical Licensure and Supervision and the State Board of Osteopathic Examiners.
Since the 1970s, Oklahoma has been creating incentives for doctors to set up shop in rural areas and in recent years has tried some new methods, but shortages remain a significant problem.
Many large urban hospitals and medical groups have different sets of doctors for emergency rooms, clinics, and inpatient and outpatient care.
That is a luxury physicians in small rural communities do not have, said Dr. Maha Sultan, who practices in Frederick in southwest Oklahoma.
Sultan said her duties consist of working in a clinic; the hospital, including the emergency room; home health care, and nursing homes.
“Most new graduates want to get a job where it is 9-to-5, no responsibility after hours, nobody to call them and nobody to bother them, so they are not interested,” Sultan said.
“In a small town, you have to do everything. Some new doctors, they just don't want that life.”
Sultan came to Frederick about 20 years ago after emigrating from Syria and receiving medical training in Canada.
A friend referred her to Frederick.
“After four months, I was going to leave like everybody else,” Sultan said.
But the hospital, which was having difficulty with finances and a lack of doctors, pleaded with her to stay.
“I have been here for 20 years,” she said. “You don't see too many people like me.”
According to licensure records, Sultan is one of only three licensed physicians — two MDs and one osteopathic doctor — in Tillman County.
Sultan said she often misses the amenities that urban areas offer, but she has enjoyed working in a tight-knit community.
“I love the patients. I care for them; they care for me,” Sultan said. “They're very loyal, and I'm loyal to them.”
Lure of the city
It is the big-city amenities and educational and professional resources that draw many physicians away from rural areas, said Rick Ernest, executive director of the Oklahoma Physician Manpower Training Commission, a state agency responsible for encouraging physicians to locate in underserved areas.
“When you're in a rural community with one or two doctors, you spend every other night or every third night on call. That get's pretty old,” Ernest said.
More new physicians are choosing specialty practice, Ernest said, because they can earn more and pay off their sizable debt from medical school more quickly. Most of the specialty practices are located in urban areas, he said.