Oklahoma is facing a shortage of doctors, and University of Oklahoma and Oklahoma State University officials say things only will get worse unless steps are taken to address the problem.
Citing an aging physician workforce and a growing pool of Medicaid patients, officials from the OU School of Community Medicine and the OSU Center for Health Sciences say the state needs to ramp up efforts to recruit and train more doctors to meet the needs of underserved areas, particularly in rural Oklahoma.
A New England Journal of Medicine article ranks Oklahoma as the state that faces the most challenges in meeting medical needs. That ranking is based on the ratio of Medicaid expansion to primary care capacity.
Rising Medicaid need
According to the article, Oklahoma is expected to see a large expansion in the Medicaid population as the federal health care law takes effect. But Oklahoma doesn't have the primary care capacity to deal with those newly insured patients. Without outside efforts, the demand for medical care could outstrip the supply of providers in the state.
Oklahoma's health is already poor, said Gerry Clancy, president of OU-Tulsa and dean of the School of Community Medicine. As the increasing demand for care continues to put pressure on doctors, the state's overall health will continue to deteriorate, he said, particularly in areas with few or no doctors.
Residents in those underserved areas could see shorter life expectancies, Clancy said. Those residents also tend to delay seeking medical attention, he said, meaning they eventually wind up in emergency rooms. As a result, emergency rooms fill up, making it more difficult for trauma patients — such as patients who have been in a car accident — to get care quickly, he said.
A new health ranking appears to bear that warning out. America's Health Rankings for 2011 place Oklahoma at No. 48, two spots lower than the previous year's rankings. Only Mississippi and Louisiana fell behind Oklahoma in the rankings, which are released annually by the United Health Foundation.
The rankings cite a high prevalence of smoking and obesity, limited availability of primary care doctors and low use of prenatal care for the low ranking.
What's being done
Officials from both universities spoke to the Oklahoma State Regents for Higher Education last week about efforts to put more doctors in rural Oklahoma.
Clancy, along with OU President David Boren, told the board they're working to expand the Tulsa-based School of Community Medicine and build a partnership with the University of Tulsa. OU-Tulsa's physician's assistant program has collaborated with TU since 2009, Clancy said, and expanding that partnership to include the School of Community Medicine could be good for both parties.
TU brings a number of assets to the partnership, Clancy said, including established basic science programs that OU doesn't offer in Tulsa. The university also brings high-
OU officials began planning the School of Community Medicine in 2007, Clancy said, and began working with TU on the expansion in 2009. The school is different than the Oklahoma City-based OU Health Sciences Center in that the Tulsa school focuses specifically on meeting the needs of underserved populations and rethinking the way the health care system works.
One of the ways the system is changing is through the use of medical informatics, or computer software used to enhance care. Recently, Clancy said, a professor developed a program that uses secure Web connections to allow primary care doctors to reach specialists for consultations. The specialist may then simply answer a question or ask to see the patient in person.
Much of the time, Clancy said, doctors are finding that they avoid referring patients to specialists simply by talking to the specialist beforehand. That helps alleviate the strain on specialists, who tend to be in high demand, Clancy said.
During the meeting, Boren and Clancy asked the board to consider budgeting $500,000 annually for the school. In years past, the board has appropriated funding for the school on a one-time basis.
Boren said he had already met with foundations interested in making donations for the school's endowment. Private donations will make up the largest portion of the funding for the school, Boren said, but donors typically want some sign of commitment from the state before making a donation. Adding an annual allocation of $500,000 to the state regents' funding formula would signal such a commitment, he said.
Ben Hardcastle, a spokesman for the state regents, said the board will vote on all funding decisions in May, after the state budget appropriation process is completed.
Like their counterparts at OU, officials at OSU are looking for ways to train doctors to go to underserved areas across the state. Howard Barnett, president of OSU-Tulsa and the OSU Center for Health Sciences, said the university hopes to establish a pipeline for placing doctors in rural Oklahoma.
That idea is in keeping with the center's main mission, he said — the center's College of Osteopathic Medicine was founded in 1972 with the express purpose of sending primary care doctors to rural and underserved parts of Oklahoma.
That pipeline starts early, when the students are in high school, Barnett said. The center is trying to reach out to students at high schools in rural areas in the hope that some of those students might consider a career in medicine.
One of the challenges the school faces is that students who graduate from urban and suburban high schools are less likely to be interested in practicing medicine in rural areas, while bright students from rural areas who might otherwise consider medical school tend to be more interested in veterinary medicine, he said. That could be in part because there are fewer doctors in rural areas who might serve as mentors when the students are younger, he said.
“We need them to think about being a doctor, too,” he said.
The school is also working with OSU's College of Agriculture and College of Arts and Sciences to create a kind of accelerated track for undergrads to start medical school. Students could get early acceptance to medical school after their sophomore year, provided they keep their grades up and perform well enough on the Medical College Admission Test, or MCAT, Barnett said, and they could begin taking courses in Tulsa as early as their junior year.
The college would also like to create programs at small, regional universities around the state, such as Southeastern Oklahoma State University in Durant, that would feed students into the college, Barnett said.
Once students are in medical school, he said, the college hopes to have them do as much of their work as possible in rural areas. It's important that they get an idea of what it means to be a doctor in rural Oklahoma, he said, which has a culture that is vastly different than that of urban areas like Oklahoma City and Tulsa.
“House calls still happen in rural Oklahoma,” he said. “Patients drop by your house in rural Oklahoma.”
Once the student is recruited, finished with undergraduate work and into medical school, Barnett said, the school faces yet another problem — there aren't as many residency positions in Oklahoma hospitals as there are students competing for them, so many Oklahoma medical students end up doing residencies in nearby states.
Because most doctors end up settling in towns near where they did their residencies, Barnett said, that means Oklahoma is training young doctors, only to send them to work in other states.
“We are already a donor state, if you will,” he said.
This year, the college is increasing its class size from 96 students to 115. They hope to have their class size at 190 by 2016. The college is in the process of seeking funding from the Oklahoma Legislature for residency positions at hospitals in rural areas across the state. As class sizes at the university grow, it will become even more important to give those students the chance to complete their residencies and, ultimately, stay and practice medicine in Oklahoma.
“We don't want to graduate doctors just to go to other states,” he said. “We want to graduate doctors to go to Oklahoma.”