Economy, Energy, Natural Resources: Policy to People

The Cause and Cure of Oklahoma’s Rural Doctor Deficiency Might be Money

Joe Wertz / NPR StateImpact

Bob Abernathy, a family practice doctor in Cordell, says the lifestyle of a rural physician doesn't appeal to young medical students.

Bob Abernathy has been a physician for about 30 years. He grew up in the country, and enjoys his life and medical practice in Cordell, a town of about 3,000 in the western part of the state.

Two of his sons are in medical school, but neither wants to follow their father’s path.


The Abernathy’s are a case study. Rural Oklahoma suffers from a doctor deficiency, and medical officials say the cause and treatment are the same: money.

Click above to see an interactive map on primary care health shortages in Oklahoma counties. Nine entire counties have been designated primary care health shortage areas.

There are about 175 doctors for every 100,000 residents in Oklahoma, which is the second lowest ratio in the country, data from the U.S. Census Bureau show.

When it comes to primary medical care, all but six of the state’s 77 counties have “medically underserved” populations, according to the U.S. Department of Health and Human Services. Nine counties — in their entirety — have been designated Health Professional Shortage Areas.

The shortage hasn’t gone unnoticed by lawmakers.

State Aid

The Physician Manpower Training Commission is one of only a few state agencies Gov. Mary Fallin wants to give more money to.

Joe Wertz / NPR StateImpact

Donna Jones, an ex-nurse who now owns the Sunshine Cafe in Cordell, says healthcare options are limited for those in rural Oklahoma.

Despite an almost entirely flat 2013 budget proposal, Fallin and her administration have proposed spending more than $3 million to establish 40 new residency programs to train physicians in rural parts of the state.

Currently, Oklahoma has five such residency programs, says Rick Ernest, the commission’s executive director. The proposed funding would increase the commission’s budget by 70 percent, and allow it to double the number of rural residency programs to 10 from five.

Training location makes a big different in medicine, Ernest says.

“If you want a rural doctor, you have to train them in a rural area,” he says, citing research showing most doctors end up practicing within 50 miles of where they were trained.

Rural residency programs help train doctors who are already committed to the idea of working in a small-town practice. But the symptoms of Oklahoma’s rural doctor deficiency are worsened by medical trends seen throughout the country.

Cash for Commitment

Rural medicine is general medicine, but many young doctors are steering away from primary care and family practice.

Russell Kohl, a family practice doctor in Vinita, says state-funded incentives for rural doctors haven't kept up with the cost of medical school.

Pay is part of it, and specialists often have more earning potential than family care doctors. That’s a big deal, because the average medical student graduates with more than $140,000 in student loan debt. And most up-and-coming doctors won’t be able to make a dent in that during their years in relatively low-paying residency programs.

Oklahoma is so desperate for rural doctors that it’s subsidizing medical students, residents and doctors.

One of the programs helps medical students with their loans by giving them $15,000 a year for up to four years. Another gives $1,000-per-month stipends to family practice residents for up to three years.

In exchange for loan assistance and stipends, med students and residents must commit to working in rural medicine for as long as they were subsidized, Ernest says. For example, a med student who received two years of loan assistance must practice for at least two years once they become doctors.

For most, the obligated commitment becomes a permanent practice, Ernest says.

Dr. Russell Kohl says he received about $40,000 in state subsidies while he was in medical school. Those stipends brought his student debt down to about $130,000, but he says medical interns at his rural practice in Vinita often owe more than $200,000 in total undergraduate and medical school debt.

The funding for the incentive program has stayed relatively constant over the years, Kohl says. The cost of becoming a doctor has not. “While it is an incentive, it’s certainly not as strong of an incentive as in the old days,” he says.

Resident Effect

The course of most young doctors is established by the time their residency ends, says Robert Valentine, a medical resident at the University of Oklahoma College of Medicine in Oklahoma City.

If they aren’t committed to rural care by then, it’s too late, he says.

Valentine, a Texan who graduated from Ross University School of Medicine in the Caribbean, says it would have been easy to stay in OKC where he’s made friends and established personal and professional relationships.

“They got me early when I didn’t know anyone in Oklahoma City,” he says about the state’s physician training commission.

Valentine is receiving the state’s residency stipend, and has committed to working in Fairfax, a town of about 1,300 in north-central Oklahoma.

State-funded incentives probably won’t change the minds of new doctors, but they can convince those on the fence, Valentine says.

“I think the program locks in the people that wanted to do it, and it encourages the people in the undecided category to at least give it a try,” he says. And once they’re in rural Oklahoma, they build relationships. “They get friendships and a house out there and they don’t want to leave.”

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  • APRNStudent2012

    Nurse Practicioners can help with this provider shortage. It would be nice to be receiving help with my nurse Practitioner education as well.

    • BobBurnitt

      I have NEVER met a nurse practitioner that I like yet. So far every ONE of them I have MET had a HUGE EGO and did not know squat. Ask one of them to explain Ankylosing Spondylitis. I will bet you they cannot even SPELL it let alone tell you what it is or treat it. I have TRIED to do that, it is just ONE ailment I have, I REFUSE to see a NP based on the multiple experience I have had. BB

  • BobBurnitt

    The problem is INSURANCE OLIGARCHS have HIJACKED the whole racket same as everywhere else. The Insurance Fascist Oligarchs RUINED the system beginning in the 1970′s with the “concept” of the HMO. Also, INSURANCE COMPANIES make OBSCENE Profits, Med-Surge and Psych Hospitals make more money than EVER before. I lost my health Insurance in 1987 over a $1,250 claim on a GROUP POLICY for myself and my Employees. They CANCELLED me rather than pay $1,250 in a claim. Well, I live in TEXAS and once you are CANCELLED for any reason, even if the INSURANCE companies does it do defraud you, for the rest of you life you cannot buy Health Insurance becasue they ALL ASK on the application, “Have you EVER had you insurance denied or cancelled? If you check the YES box, they will NOT sell it to you.

    I went through YEARS of that in Texas trying to buy Insurance. Then I had a heart attack and NO HEALTH INSURANCE. So, that put me in BANKRUPTCY. A few years ago, in a momentary Burst of prosperity that is now gone, I signed up for the TEXAS RISK POOL administered by Blue Cross. I paid them over $42,000 bucks in four years, they DENIED every claim I sent them even AFTER I met the $8,000 deductible EVERY YEAR!! I was STILL CASH PAY AT EVERY DOCTOR I WENT TO!! Just like I had NO insurance at all!! When I dropped them, the premiums were $12,000 per year. That was about five years ago, I told them I had to QUIT. They STOLE MY MONEY!! *They had NO INTENTION of EVER paying any claims* They commit FRAUD AGAINST THE CITIZENS and the citizens lay down and TAKE IT.

    I will NEVER sign up for ANY Government Sanctioned Program Again. NEVER. That is what the RISK POOL IS, a Government sanctioned program like Obama Care except Obama Care has the IRS as their COLLECTION AGENT. And OH YEAH, Ted Cruz said HE was going to get RID of Obammiie Care. What sis he do?? He signed up for it HIMSELF!! Another DOUBLE TALKING DOUBLE DEALING Politician.

    I will NEVER sign up for ANYTHING like that again. They have destroyed my life more than anyone else. I am nearly 64 years old and I am a college degreed PAUPER. They have made my life IMPOSSIBLE. I have THREE incurable Diseases and TWO of them are CHRONIC PAIN Diseases. I MUST have medication for these diseases as the pain can be suicide level. I am DISABLED, yet I am NOT eligible for any “disability”. My body is getting so WEAK I cannot do anything.

    This will NEVER get better FOLKS until you get out the TAR AND FEATHERS and go to your STATE Houses and then ULTIMATELY WASHINGTON and start dipping Politicians. Until you do THAT it will never change, BB

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