This scoring system is similar to that proposed by Leduc. The estimated population for 69 NIA communities are summarized in Table 4 . The problem appears to be compounded by the fact that there is also a relative shortage of specialists working in these areas. There are problems associated with using the physicianpopulation ratio to determine how many doctors are needed. The assumption that physicians in a community are used only by the residents in that community is not always valid.
People can, and do, travel to other communities to access medical care.
Some physicians travel to other communities to provide medical care. Geographic, economic and demographic disparities dictate that an ideal ratio for one region may not meet the needs of another. This gives a misleading impression of the number of general practitioners for those communities. 2,6 Similar conclusions could perhaps be drawn from our data. A high density of physicians would allow for a relatively infrequent on-call schedule as compared to that in rural areas.