Medical EducationORIGINAL ARTICLE
Abstract
Context: The United States is facing a persistent physician shortage, particularly in rural and tribal regions. Oklahoma ranks 43rd nationally for primary care provider (PCP) availability, with rural and tribal communities experiencing some of the most severe health workforce shortages. The Indian Health Service (IHS) Oklahoma City service area reports a 16 % physician vacancy rate, with national IHS vacancy rates reaching 38 %. Rural and tribal healthcare systems are especially impacted by recruitment and retention challenges. Evidence suggests that physicians are more likely to practice near their residency training site, highlighting the importance of location-specific training programs to alleviate workforce disparities.
Objectives: This study aimed to evaluate the geographic distribution and practice outcomes of graduates from three family medicine residency programs located in tribal healthcare systems in Oklahoma and to assess their contributions to addressing physician shortages in rural and underserved areas.
Methods: A retrospective cohort analysis was conducted on 87 graduates (2013–2024) from three Accreditation Council for Graduate Medical Education (ACGME)-accredited family medicine residency programs: Cherokee Nation, Choctaw Nation, and Chickasaw Nation. Program rosters were utilized to identify participants and reported initial practice location. Practice locations were verified utilizing National Provider Identification (NPI) data and cross-checked against the Federation of State Medical Boards (FSMB) Licensure database. Practice sites were classified by Medically Underserved Area/Population (MUA/P) status, Primary Care Health Professional Shortage Area (HPSA) score, and Rural Location utilizing the Federal Office of Rural Health Policy (FORHP) designation, IHS, or Tribal Healthcare Setting. Statistical analysis examined associations between medical school location and postresidency practice location.
Results: Among 87 graduates included in the final analysis, 64.4 % completed medical school at Oklahoma State University College of Osteopathic Medicine (OSU-COM) in Tulsa, Oklahoma. A total of 66.7 % of graduates remained in Oklahoma, 79.3 % practiced in Primary Care HPSAs, 65.5 % practiced in rural areas, and 57.5 % had initial practice locations in MUAs. OSU-COM graduates were significantly more likely to remain in Oklahoma postresidency (78.6 % vs. 45.2 %, p<0.01). Additionally, 55.4 % of OSU-COM alumni continued to work within tribal healthcare systems, compared to 41.9 % of graduates from other schools. Graduates represented 23 different medical schools with 9 graduates pursuing fellowships, most commonly sports medicine and emergency medicine.
Conclusions: Residency programs located in rural tribal healthcare systems in Oklahoma are effective in producing physicians who remain in rural and medical shortage areas. These programs support balanced physician distribution, particularly within tribal healthcare systems, and represent a replicable model for addressing national workforce shortages through location-targeted graduate medical education (GME). Further research is needed to evaluate long-term retention.