Problems in rural medicine
Rural and especially rural, poor communities in the United States have always been under-served by medical professionals. Physicians cannot earn the living in rural areas that they can earn in urban areas, and practicing a specialty in urban areas has always been more lucrative than practicing general medicine. This problem is compounded by the high cost of higher education: a physician who graduates with substantial debt has even less flexbility regarding where he will commence practice.
As a result, many small towns either no longer have a hospital, or their hospital is staffed in a manner that would not be considered "standard of care" in larger metropolitan areas. Emergency Rooms may frequently be staffed by physician assistants rather than medical specialists, and doctors have to address and manage a wider variety of medical problems. A consultant may not be available in sub-specialty areas and expensive testing resources (such as CT scans or MRIs) may not be readily available.
The New York Times reported last week that this problem of under-served rural areas is becoming more acute, nationwide, and that the Governor of New York was recommending a higher Medicare payout for rural doctors to help address the problem. Other proposals have included the creation of a medical "peace corps" system providing two years of low-cost service by young doctor volunteers, and a grant system to support it.
In our experience, rural northern Michigan residents fully understand that they cannot expect the same quality of care that would be provided in metropolitan areas. A u.p. juror once told us, after a mediocre trial outcome, that "If it weren't for poor medical care, we wouldn't have any."