To the Editor.
—Dr Weiner1 presents an exacting analysis of the likely effects of health system reform on physician workforce requirements. His market approach to forecasting is a careful projection of physicians needed in the year 2000. He uses health maintenance organization (HMO) plans as the prototype for the managed care environment likely to come out of current reform. However, he points out that "it is not very realistic to expect that managed care.. will ever serve a large proportion of rural Americans," and "it is not reasonable to expect that rural areas will ever be staffed with physicians at the same levels as urban locales...." We agree with this conclusion, but wish to point out that this conclusion might be because of his emphasis on the supply side of a market-based approach.From our perspective and experience with rural populations in North Carolina, Weiner has overlooked two important
Hallock J, Kobrinski E, Mansfield C. Forecasting Physician Workforce Requirements. JAMA. 1995;273(2):111. doi:10.1001/jama.1995.03520260031015