By James Neal, Staff Writer
Enid News and Eagle
Health care providers and stakeholders across the nation today will pause to observe National Rural Health Day, billed as a day to “showcase the good works of health care providers who serve Oklahoma’s 1.35 million and America’s 59.5 million rural citizens.”
Even as the health care profession celebrates its rural providers today, it also faces a continued shortage of physicians, nurses and other medical staff who want to live and work in rural communities.
Turnover often is high at rural hospitals and clinics as younger practitioners gravitate toward urban centers, and in some rural communities open medical staff positions remain unfilled for months, or even years.
Andy Fosmire, executive director of Rural Health Projects, works with area hospitals to educate the next generation of medical practitioners in northwest Oklahoma, and hopefully to keep some of them working in rural communities.
He said shortages in rural primary care providers have developed over time because of disparities, both perceived and real, between practicing medicine in urban and rural areas.
“There is a stigma associated with payment for rural providers, because the rural providers do get reimbursed at a lower rate than their urban counterparts,” Fosmire said.
Medicare and Medicaid reimbursements are calculated on a variety of factors, including economic factors from the community where care was delivered. That means rural doctors get paid less for the same procedure than their peers in the city.
Due to the small staff at rural hospitals, doctors there usually are primary-care physicians, specializing in family medicine, internal medicine, pediatrics or obstetrics and gynecology.
Fosmire said the primary-care fields often are perceived as being less prestigious than other specialties, and they usually draw less pay.
And, Fosmire said, rural practitioners usually end up working longer hours and taking on more responsibilities than doctors at larger hospitals.
“If you’re working in a small hospital or a clinic, there isn’t someone to come in and take calls for you, there’s no one to fill in for you, and you really end up being married to your practice,” Fosmire said.
Area hospital administrators know from experience how hard it can be to recruit a trained staff member, and how fast new recruits can leave for jobs in larger hospitals with higher pay, shorter hours and less responsibility.
“It’s continuing to be very tough, and probably will get tougher in the future to recruit physicians into rural practice,” said Roger Knak, Fairview Regional Medical Center CEO and administrator. The Fairview hospital is the primary-care facility for a majority of residents in Major and parts of Woodward, Woods, Alfalfa, Blaine and Dewey counties.
Knak said he has been trying to recruit a physician’s assistant or nurse practitioner “for almost a year, with very limited success.”
He said the biggest hurdle in recruiting new staff members is finding someone who embraces the increased responsibility and work load that comes with rural practice.
“I think the biggest thing for a lot of physicians, when they look at rural areas, is most rural areas require some sort of on-call schedule, so you have responsibilities to the hospital even after you go home from work,” Knak said. “That becomes quite unattractive when it’s compared to a larger hospital or practice where they know they’re going to have less or no on-call.”
Tim Starkey, CEO of Great Salt Plains Health Center, said perceived quality-of-life issues are his greatest challenge in recruiting doctors. Great Salt Plains Health Center operates a clinic in Cherokee, serving about 5,600 people in Alfalfa County, and soon will open a second clinic in Medford to serve the approximately 4,500 people in rural Grant County.
“Our greatest challenge in recruiting providers has been finding qualified physicians who want to live and work in northern Oklahoma,” Starkey said.
That challenge is made worse by the ongoing housing shortage in north central Oklahoma.
“At this time the oil boom in the area has created a significant housing shortage,” Starkey said. “I have recruited very qualified staff only to find that affordable housing is not available. The oil field is driving rent prices to an amount that creates significant hardship for health care workers at all levels. We really need a solution to the housing shortage as soon as possible.”
Fosmire said the long-term solution to the primary care shortage lies in recruiting rural residents to be trained and serve in rural communities, rather than trying to entice urbanites to move into rural practice.
“The key is growing our own rural providers,” Fosmire said. “You’re not going to recruit a kid from Dallas to come and practice in Cherokee or Medford. You need to recruit people from northwest Oklahoma who are going to know and love this region. They’re the ones who are going to come back and stay in northwest Oklahoma after they graduate.”
Recruiting early from rural communities is the focus of a new program at Oklahoma State University.
“If you can get someone from rural, the likelihood they’ll go back rural is higher,” said Dr. Bill Pettit, D.O., dean of the OSU Center for Rural Health.
The university has launched a rural physician program that begins with kids in middle school and high school, identifies likely candidates, and follows them all the way through their residency.
“There are a lot of kids out in the rural areas who don’t have any idea they could have a career in the medical field,” Pettit said. “Sometimes, it just takes someone telling them they’re bright enough, they have the aptitude, and this is a possibility for them.”
OSU launched a new medical school curriculum this year specifically tailored to rural health care. Pettit said the curriculum is the same as traditional medical school training until the latter stages of clinical work, when it focuses on the cultural differences doctors face in rural practice.
“The expectations are different and the culture is different in rural settings,” Pettit said. “What you expect of a doctor who is practicing solo or who is one of only two or three doctors in a town of 15,000, is very different than what you would expect of a doctor in a more urban setting.
“In addition to your normal duties, you may be expected to cover the emergency room, you may be expected to deliver babies, you may have to perform an emergency procedure.”
Pettit said the “final piece in the puzzle” is in creating residency programs at hospitals and clinics in rural communities. There already is such a residency program established through Integris Bass Baptist Health Center in Enid.
“One of the keys to getting doctors to select a career in rural medicine is to provide them with a residency in a rural setting,” Pettit said. “We look for young men and women from rural settings with great academic backgrounds who would like to go back to live in a rural setting, then we nurture them all the way through medical school to a rural residency program.”