POTEAU — Dr. Dennis Carter's decision on where to practice medicine wasn't difficult.
Since 1988, he has been in Poteau — nearly 200 miles southeast of Oklahoma City; population 8,300.
“Home,” he said. “It's just home.”
Carter grew up in Heavener, a town of 3,400 that sits about 13 miles south of Poteau. He went to college in the area and left only for medical school.
He came back in 1988, worked at the Poteau hospital for about 12 years and opened up his own practice.
That's likely part of a resume among many small-town doctors.
Four things predict where doctors will practice midcareer — where they grew up, where they go to college, whether their medical school has a curriculum with an emphasis on primary care or rural and underserved populations, and where they do their residency, according to the Oklahoma State University Center for Health Sciences.
Offering ‘total care'
Carter starts each day about 6 a.m. at the Poteau hospital. He'll do his rounds there, seeing patients, writing orders and helping discharge patients.
Poteau's hospital and health care system is small enough at this point that the hospital doesn't have a hospitalist, a doctor who sees patients just in the hospital.
“So far, in this area, the physician takes care of the patient as long as the patient stays in the area and uses our local hospital, which is obviously not required,” Carter said. “We take care of them in the office setting, we take care of them in the hospital setting, if they're transferred to the nursing home, we take care of them. We still offer that total care.”
After about three hours at the hospital, he will go about one-third of a mile down Dewey Avenue to his private practice. From there, he will see patients throughout the day and hopefully have lunch with his wife.
He usually goes home about 6 p.m., unless he needs to go back to the hospital. At home, he'll answer pages through an app on his iPhone and also any calls he gets on his home phone.
“And do it all over again,” he said.
On a per capita basis, Oklahoma has one of the worst physician shortages in the nation, according to the OSU Center for Health Sciences. A lack of doctors in rural areas is a problem felt nationwide, though. About 18 percent of Americans live in a rural area. Only 9 percent of doctors are in rural areas.
“You could stand in one corner of Oklahoma City, throw a rock and hit no less than four hospitals,” said Brock Slabach, senior vice president for member services at the National Rural Health Association. “And nobody seems to ever question whether there are too many hospitals or too many services in an urban center, but you start talking about rural hospitals or rural clinics, and people start to talk about how there's too many hospitals or too many of this or that.”
Slabach said recent medical school graduates aren't generally trained to operate a business. This means communities either need a hospital, a federally qualified health center or a rural health clinic — some kind of structure — to pull in prospective doctors.
“Physicians go and get exceptional training in how to treat the human body,” Slabach said. “But they don't feel comfortable or capable in being an expert in billing and collections and medical records and space planning.”
In Carter's office, OSU medical student Tiffany Palmer helps with the steady stream of patients.
She started her stint at Carter's office in early June. Right now, she's considering being a pediatrician and looking at programs in larger cities, including Memphis, Tenn., and Oklahoma City.
But rural areas are appealing, one of the reasons being that there are medical school loan repayment plans for medical students who finish school and go to work in a rural setting. Palmer anticipates she will have about $160,000 in student loan debt.
Palmer, who grew up in Houston and Moore, has learned a lot during her time in Poteau. She didn't anticipate so much freedom, but that's how Carter runs his office.
She remembered treating a woman who came in with breathing problems. She and Carter discussed what the woman needed. Palmer asked about a medicine she had learned about in classes, but Carter pointed out the side effects.
They ended up sending the woman to the hospital to help regulate her breathing. Later that evening, they went to check on her.
“And that was my first day,” she said.