Physicians and rural America

Many rural Americans have limited access to health care.This problem stems from 2 characteristics of the health care system: the many Americans without health care insurance and the tendency of health care professionals to locate and practice in relatively affluent urban and suburban areas.The relative shortage of physicians in rural areas of the United States is 1 of the few constants in any description of the US medical care system.About 20% of the US population-more than 50 million people-live in rural areas, but only 9% of the nation's physicians practice in rural communities. 1rude comparisons of the physician-to-population ratio in rural versus urban areas can be extremely misleading and provide almost no information about whether shortages or surpluses exist in either location. 2In 1995-the latest year for which data are available-gaps existed between the supply of active physicians in counties of different size (figure 1).As can be seen in this figure, major differences persist between the aggregate supply in urban and rural areas, with the larger counties having many more physicians per 100,000 population.But this information obscures the fact that the physician supply has grown in rural areas in the past 20 years, although the growth has not been uniform.The supply of rural physicians has increased modestly in the past few decades, with most of the increase in the larger rural communities adjacent to metropolitan areas (figure 2).Rural supply lags far behind the current urban supply of physicians, but the urban supply of physicians is, in the opinion of many, excessive.