Rural Health Care Faces Reform Too; Providers Sow Seeds for Better Future

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Abstract
THE VOICE of rural America, scarcely audible to organized medicine and policymakers in past decades, is demanding to be heard in the debate over health care reform in the United States. Almost one fourth of all Americans, or 55 million people, are rural residents, and during the last decade they have seen their already tenuous access to primary care services decline even further. Ten percent of all rural hospitals closed during the 1980s. Numerous disincentives have caused physicians and surgeons to leave rural practices. And many rural residents have contributed to the problem by driving past rural providers to obtain their care in urban centers. The outlook for the future is also disconcerting. In a recent survey, 23% of physicians with practices in rural communities said they were dissatisfied and plan to leave within 5 years. Many experts are predicting that these physicians will pursue practices in urban areas as

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