This is exactly what forced Canada to a national health system. Canada only has a handful of large cities and ended up with over 90% of the medical personnel and facilities in those handful of cities. The physicians rationalized that this was to "centralize care" and it actually improved care because of the extensive use (except in Quebec) of air ambulance services. Health economists said this was nonsense --- why would a $USD2,500 transportation bill for an annual checkup make sense. Canada had one of the lowest accident and heart attack survivability rates in the world. And over 90% of the area and 82% of the people had NO health care --- no hospitals, no clinics, no nurses, no physicians.

Careful analysis showed that "market forces" had created a situation where physicians and hospitals wanted only to practice in areas where patient wealth and concentration would meet their "target income." They had no interest in rural clinics and rural patients and especially no interest in the Inuit people. This was a system that was broken even worse than that in the U.S. And it HAD to change --- there was no choice. And change was painful because it required the imposition of a VAT (known here as a "Fair Tax.")

Canada is still struggling to train enough medical personnel and to get clinics and other medical delivery systems built in rural areas. Canadian health economists believe that it will take at least two generations before the health care in rural areas reaches "acceptable" levels. And they are quite aware that rural health care will NEVER equal urban health care.

But Canadians are very happy with their system (despite all the mis-information and falsehoods spread around this country by right-wing opponents of healthcare delivery systems) with all polls showing over 80% support for the system and that is still slowly rising. Physicians are not all that happy, but they are not starving either. The part that seems to have resonated with Canadians that I personally know is that thye poorest person in Canada gets the same access to health care that the wealthiest person gets ---- this has meant that the wealthy have thrown their weight behind improving the OVERALL system so they benefit as well. In this country the wealthy are against any improvements in the OVERALL system because they fear "dilution" of the services that they can afford that others cannot.

Canadian businesses, especially small businesses are thrilled with their "government" health care. Small businesses no longer have to fear that good people will be lured away by large corporations by health care benefits they cannot afford. And all businesses see the tremendous benefit to their bottom line that health equity provides, making them much more competitive with countries like the United States. This is just one burden that they no longer have to worry about --- even the owner gets health coverage.

I already buy most of my prescription drugs illegally from Canada because many brand-name drugs cost less from Canada (including shipping) that the co-pay for the same drug here. I actually use three sources for my drugs. Some drugs I get from Walmart on their $4 play (I do not tell them about my Blue Cross insurance.) Some I buy from Canada if the price is less than the co-pay (this one surprised me when I first started finding it to be true.) And the remainder I buy at my local drug store using my Blue Cross coverage. My HSP will pay for the Walmart and Canadian drugs as well as covering the Blue Cross co-pay, so the amount is even smaller (by about 1/3.)

Since the inception of Canadian national health care, only about .5% (1 in 200 people) have received any health care in the United States. Of those, 75% were already in this country on business, vacation, or cross-border commuting. That means that in over a decade fewer than 1 in 600 people have come to this country and received medical treatment and virtually all of this was for one of two reasons --- either it was a service not covered by Canadian health care (such as cosmetic breast implants) and more easily or cheaply available here or sociological reasons (mental illness or drug abuse treatment, abortions, or treatment of HIV or STD's.)

It is true that with some very rare forms of cancer and diseases Canadians are treated in the U.S. But this is by pre-arrangement. There are simply some diseases and conditions that are so rare that it is cheaper for the Canadian government to pay for transportation, housing, and treatment in the U.S. rather than try to maintain the necessary expertise and/or facilities in Canada. There is no equivalent treatment for treatment in Medicare or VA or similar government-run health plans because the GOP has blocked them for years. This is one example of health care waste in this country (since McGill University Medical School is a leading treatment center for a number of rare ailments.)

Can even the most Pollyanna Democrat claim the USA has been gearing up our healthcare providing system for millions more Americans? "Coverage" means zero without "Providers".

The point of the story was that there is NOT a lack of providers, but a disparity of coverage. It was even in the title.

The point of the story was that there is NOT a lack of providers, but a disparity of coverage. It was even in the title.

If a doctor doesn't live in your area and there are fifty doctors fifty miles away I think it is fair to say lack of providers is the issue. Even in the cities where the article says the doctors are, the government is not expanding healthcare access for millions of new people. City and suburban hospitals are also being cut and closed.

Many doctors liability insurance premiums are six figures. To pay that you have to see a lot of patients. Blame a lawyer if you don't see a doctor. Tort laws are needed.. Oh I forgot, the politicians are all lawyers...

You must have the bed side manor of a toad...........

Agreed, Pepster! I wouldn't take my kids to Blaine if you paid me! And Blaine, I would love to go to my church 7 days a week. It rocks! As a matter of fact , there are activities to attend practically every day of the week. Not boring things like pot luck dinners. I mean hiking, biking, concerts, art classes, etc. Don't knock church until you've tried it!

Oh, and by the way, Blaine, Katie Dias, the young doctor in the story, disagrees with you.

Just because Katie Dias, and you, disagree, doesn't mean that it isn't a valid point. Rural areas often don't appeal to people who did not grow up there, and often have a culture that is alienating to outsiders.

Unfortunately for people hoping to recruit rural physicians, doctors are far more likely to be from urban or suburban backgrounds than rural ones, simply as a matter of probability. By definition, rural areas have less people. And poor areas are even less likely to produce doctors, unless specific efforts are made to do so.

Yes, you may be right about the culture being alienating, and if only Dr. Blaine was as eloquent as you in stating his point, I wouldn't feel upset about it. I was born and raised in New York City, but I object to Blaine's callous characterization of rural people, as if they are all ignorant. I also object to his demeaning comment about religion. He needs a good dose of his own medicine!

Oh yeah. It was an offensive post.

Blaine isn't that far off and if anyone gave an objective assessment they would agree. I lived in a small rural town and visit Mom a few times a year and IT IS BORING LIVING THERE. Blane is right there is usually not a damned thing to do in most rural towns and cities. Not much more than cruising, fast food, watching TV and eating. Most don't even have a movie theater and you have to drive a long distance to see a new movie. THAT is a HIGHLIGHT of living in a rural community. There is not a damned thing to do for entertainment. Heck as I was growing up my family had to drive over 60 miles just to SHOP for different things or just to get away from how dull the life was. My mom still does that.

And yes many rural people ARE ignorant of most things outside their area. I mean the truth hurts. Most young kids want to get OUT of the rural areas as fast as they can because of terminal boredom and nothing to to. Why would anyone think that doctors would want to live in them when so many young people want to get out? All you end up with are elderly people set in their ways. I know I was raised there and still see it every time I visit my rural family.

talheure = thank you for that insight. Rural communities have a diversity of interests and intellect, just like urban. There are lazy, boring, and bigoted people in the big city and there are stylish, bright, critical thinkers in rural communities. Rural folks who ARE interested in more than TV and cruising do have to be more resourceful to get entertainment without driving an hour or two. But, then again those who don't have a WalMart, Starbucks, or movie theaters on every corner have to be resourceful to survive every day, not just the day they need entertainment. I have lived in both rural and urban communities....they both have their pluses and minuses. The cultures are different....but the daily concerns are the same. Jobs, education, and healthy children. If you hope to continue having affordable food in your future, you better damn well care about all three of those for the rural communities as well as for the urban.

I have agree with Blaine. Sure both rural and urban communities have their share of backwoods unpleasant hillbillies but since there are many more people in urban areas it is easy to find people that share your interests. Doctors often are schooled, educated and socialized in urban communities. Many aren't all the excited about a lifetime of being isolated in a sparsely populated area. Perhaps their family members might also have some issues with being stuck in a backwater. The Walmart and the Fundamentalist Church only can amuse a person for so long.

There are ignorant people in every population density.

That said, having grown up in a very rural farming community, and later moving to medium-sized city (pop. about 500,000 including all the suburbs), I would NEVER want to go back to a small town.

Having to drive 45 minutes through country roads and farmland, just to see a concert, see a movie, shop at a mall, or eat at a restaurant that has any beer other than Bud/Miller/Coors--well it's not something that I miss one bit. Plus, tell people you're an atheist and they look at you like you're from outer space.

I can completely understand why somebody would NEVER EVER want to live in a rural area.

Not, it's not religious hillbillies, it's because rich people pay whatever you ask and/or have great insurance. Rural folks are poorer and/or have no insurance so if you're a doctor helping these people you'll make a lot less money. If we had a reasonable single payer system in this countty (like every other modern, civilized nation on the planet) then this wouldn't be an issue. This is simply another unintended consequence of making healthcare a profit driven business.

You are an idiot. So glad I won't have to worry about going to an IGNORANT @!$%# Dr. like you!

Rural folks are poorer and/or have no insurance

That's not true. The cities have more poor people per capita.

Pepster,

You have it backwards. In 2005, 15% of people in rural areas were below the poverty line. This is compared to 12.5% of urban areas. Rural populations are also less likely to have health insurance.

Theres just more money in cities, especially in the suburban areas around cities.

Topic, your rant doesn't, in any way, address the disparity of pediatricians between wealthy and poor areas. How is this a result of Medicare and Medicaid? Do you honestly believe that if individuals had to carry the full cost of health care, if 'people paid for doctors, not government', there would be a rush of physicians to poorer areas from richer ones?

Really, I'd like to hear how you think this would work.

I don't know about you, but although we work, we couldn't remotely cover the cost of several routine doctor's visits a year without any insurance coverage. A kid's yearly physical is HUNDREDS of dollars; my last physical was several hundred dollars. My child was attacked by a neighbor's animal and the charges for emergency care and then extended follow up would have literally caused us to file for bankruptcy if we did not have private health insurance.

Cash for medical care might work if the charges for medical care were in line with what average working people could afford, but how many of us can walk in and pay $2,000 for an ER visit or $650 for a specialist visit?

Blaine brings up a valid point, if in an inflammatory way. Poor, rural areas are often less desirable places to live than wealthier areas, even if the pay were to be the same.

This is especially true in a system, where doctors are far more likely to be the children of wealthy urbanites than poor farmers or miners.

I live in a rural area and I don't know any "poor farmers" that would be because at minimal farm sizes of 2000+ acres at $5000/acre would make them not so poor. However, I do see lots of unemployed poor people in rural areas living in HUD houses and minute manufacturing job opportunities (more leaving yearly). So I guess I am trying to address two points made in this thread #1 "farmers" are not so poor (they are some of the few wealth holders in the rural community), and #2 the loss of the manufacturing base is really the impetus of our economic woes on the "people level" in rural areas thus why money/services (including health care for kids, elderly, etc...) is lacking there.

talheure:

I think you are missing a key statement in your much-more-nicely-worded slam of rural areas.

"To me."

Actually "to very many", especially those who did not grow up there. It is not a slam to observe that rural areas, although appealing to many who live there, are decidedly NOT appealing to a greatly higher percentage.

To Salt River, I also know more rich farmers than poor ones - a function of the great soil in this area. However, most of their children grow up to take over the farm, becoming rich farmers themselves, not doctors. And there are large areas of the country where the soil, and thus the farmers, are indeed poor.

Rural areas, and especially poor rural areas, produce less doctors than urban and suburban ones (somewhat a function, simply, of a lower population). Doctors who do not grow up in rural areas are unlikely to want to relocate to them. It is a combination that leads to a shortage of practicioners in rural areas.

If you want the 'best and brightest students and people' as doctors, you are going to have to allow the truly best and brightest, not just the richest and most connected, to actually become doctors.

Assisting qualified students from poor areas to become physicians, with grants, scholorships, and debt forgiveness, would do far more to address the disparity than simply paying more and more. There aren't many financially poor doctors, no matter where they live.

I would have to agree that doctors are not poor no matter their local. Starting off doctors right out of residency can actually make more in rural areas. The most common reason for choosing a practice location is family, the second is hobby intrests that the area can supply. I don't think that the pay issue is going to attract and keep physicians in rural areas.

Doctors already have a financial reason to practice medicine. What they do not have is incentive to practice in poor and rural areas.

This has nothing to do with administrative reasons.

Getting rid of some of the administartive overhead would improve medicine, but not in the the ways desired by this article.

You can make improvements to rural areas, but they are still rural. Most people want money, convenience, and a secure lifestyle, something cities offer.

While it is good that there are people out there that want to be rural doctors, there is really little that can be done to bring many ambitious urbanites to rural areas.

The poster speaks the truth - this has only been getting worse in some areas of the country. For many of you city dwellers, if you were to move some of our rural areas, you'd swear you were in a third world country.

drmom: That is the most succinct, articulate description of what practice in a small town is like. I'm a retired nurse retired to hubby's small town & loving it. We have a small hospital that gets its MRI once a wk. too in a mobile van. Hubby & I volunteer there also to help it make ends meet & to keep their doors open. They have a speciality clinic where specialists come in once a wk. & it helps a lot for older people & some indigent ones also. My family doctor, who was original from N.J., is so hard to get away from that both my husband & I laugh on the rare occasions we do see him. We think he's lonely for the "bigger city mentality," but we are happy being able to drive 65 miles for anything "big city" we want: Art, theatre, football, symphony, restaurants, etc. So, it is the best of both worlds & was why we decided to retire here 5 yrs. ago now & I STILL can't get used to doctors stopping, calling patients/friends by their first names & chatting for a moment in a busy day. Where we lived on the East Coast it was always a coldly detached, functionally polite relationship. How much nicer here!

YOU MADE THE RIGHT CHOICE!

And just how many of us are already doing that now? Just so we can have health insurance, because some of us are too old to risk an employment move and too young to retire and are praying we make it to retirement before the richies take THAT from us too. Why health care is tied to employment be traced back to post WWII benefits to attract young returning GI's. This is something that should have gone the way of the Corvaire. The fact that there is profit in healthcare is absurd. We already have death panels - they're called by the names of United Healthcare and Humana. And while I'm at it, Jan Brewer.

I've worked for one you mention, they hire the brightest and the best to figure out ways NOT to pay claims. Paying out is the LAST thing they want to do. They have entire programs dedicated to finding a niche that won't keep on their backs (endless hours on hold with a machine answering service) to pay their rightful claims.

Pregnancy claims were one of those niches. Women who were getting no sleep who had to be back to work in 6 weeks have little time to force a company to pay their due. THIS was exactly one of those niches that they could cheat out of their rights and who were too week to fight back. The NY attorney general has them up for other violations.

Stockholders all: rich media moguls - why do were hear only the promises and not the truth about insurance companies right now? Politicians, who by their very nature keep no promises and insurance company executives.

Wealth transfer will be all you get in exchange for their vision of utopia.

I liked the comment about "to serve a people who will make little effort of change in their lives themselves." It seems the politicians like to confuse "health care," "health care coverage" and "health."

The last in line takes personal habits and responsibility to achieve, and is why a national health care system will cost too much and fail to better the population's health. This cry for coverage is a convient scapegoating of personal responsibility that is echoed in the financial sector.

Same with everyone else.

There's a reason why scientists, engineers, doctors, lawyers, do not live in rural areas.

The jobs aren't there. The services aren't there. The money isn't there. Plus, no one else is there as well. How can you spend all the money you make when there is nothing to buy?

If you want doctors and money to go to rural areas, turn them in to urban areas.

Hey Endo,

Are you saying that people in rural areas don't deserve adequate healthcare? You NEED rural areas. You want the wood to build that fancy McMansion? Organic or not, food? You need the rural areas. You want a nice vacation in the country/National park. All of that is supported by the rural people. I am university educated, gainfully employed at an engineering company and I am fine with having to drive 2hrs to a metropolitan area. My town has a population of about 18,000 people. Not large. We have a community orchestra, theater, choir & several festivals. There are other towns and communities around with significantly less. They have their own ways of enjoying themselves. Not everyone has to got out for entertainment every day or week. Some people have enough work to keep ther busy. I like living here. It's cheaper to live here than in a larger city. You can make a better living from less pay.

To me it's the it's the idiot urbanites that crowd themselves like sardines just because they think they have more.

I like how you denegrate urbanites for their elitist views while sharing many of your own rural elitist views.

Anyway, all people deserve adequate health care. However, most people do not want to drive 2 hours for work, let alone entertainment. If your area is not hospitable to health care workers, expect to have a shortage. Most doctors grew up in urban or suburban areas, and, as such, that is the lifestyle they expect and want (something they cannot get from rural areas).

I recognize the need for rural areas, but at the same time, people in rural areas need to realize they cannot have urban conveniences without being in urban areas.

If doctors do not want to practice in rural areas, that is their right. All the incentives in the world will not bring doctors to rural areas, as most would rather live and practice in urban areas.

They already have programs like that.

They simply will not draw enough doctors to rural areas, especially once doctors find out what it is like to live and work in rural areas.

Loans are paid off, doctors leave; new doctors come-loans are paid off, doctors leave. (I can keep typing this, but I think you get the picture)

If doctors don['t go where the money is please tell me how they are going to pay off the loans that paid for their medical schooling. You people that keep complaining about Doctors only thinking about money make me sick. We are the ones that hve forced them into that attitude. If doctors could have more help with the cost of the education they most likely could afford to be more humanitarian in nature.

Sorry overextended i accidentally put my post in the wrong response area. It's just this whole Obamacare thing has me so upset i can't see straight.

And the patients want a prescription, are not satisfied with not knowing a cause... even after realizing a fix.

People cannot expect docs to be God, and anyone can say "no thanks, a script is NOT what I am looking for. Refer me to someone else. Thanks"

I don't understand how the requirements to practice medicine keep going up (years of training, specialty requirements, re-certification requirements) but the race to give "extenders" equal privileges is a blur. Example a physician assistant can be an orthopedic PA quit her job and next week be an emergency PA and a month later a urology PA, these PA's work with essentially no supervision and more or less act as that specialist (with the training of a medical student, not a boarded specialized doctor).

Further CRNA's have been given equal practice rights to them despite the fact their initial boarding is less rigorous and the re-certification process to show competency has followed the progression of the field is nonexistent. The AMA has been greedy in limiting the sizes of classes of medical graduates and has created a shortage so that pay stays elevated for physicians and now has mandated that a sub-physician provider group be created to care for the growing population.

What is saddest about the whole scenario is that many "doctors" don't even practice medicine themselves but manage a troop of extenders. Because of a mere management role, the extenders are better care providers than the M.D. supervisors are in many urban and rural centers.

I understand the frustration of the PA, NP, CRNA, etc... that feel they are better than the "physicians" that oversee them and have no respect and feel belittled at the term "extender". However, a decision needs to be made what are the standards of training to provide care... The divergence needs to stop!

Have you ever even left the city?

I've listened to Car Talk lots of times, where does that come from? And what's wrong with a gravel road if there are only 3 houses on it?

I can't see why military medics should be subjected to life in Mississippi, Arkansas, or Oklahoma.

There is more reason than poverty that these places have no docs.

As a military physician, I sit around and work about 60 hours/week, excluding call/deployments or any other side event. I don't have time to volunteer to go to the underserved areas. PAs/NPs/Corpsmen/medics all work under the supervision of a licensed physician, and to do otherwise would open them up to huge liability which isn't fair to them.

Many physicians don't want to go to the underserved areas because of the location. These areas don't have a reputation for good schools, after work activities, or the other luxuries offered in the "big city" areas. Many people want educational after school activities for their children, and if they aren't available, then why would they want move there. It would be like telling a person in an underserved area to move closer to a physician.

Personally, I will likely go to a smalll city when I am done with the service, to get out of the hustle of urban living.

I do not know where you were stationed Dr Rob but I was with the 82d AbnDiv. Our battalion medics spent most of the time they weren't in the field cleaning gear as much as us poor grunts did. I've seen our medics doing things, including minor surgery, in the field under "supervision" not in person by a physician but via radio which could be done even easier today with satellite communication. As far as Liability goes it would rest on the government through the Military. The military would just have to make sure that they only sent out ones who Were well trained & capable, not the common practice that exists of sending out the ones they could spare the most.