People with less than doctoral-level training can do a whole lot of health care. You ve got a community college system that s pretty well distributed across the country. You ve got a nursing workforce that s better distributed than most of the health care workforce. There are very bright, very able, ambitious people who don t want to leave their communities. It s still almost a cottage industry in terms of medical practitioners.
Most rural counties don t have community health centers.
Only two or three Appalachian counties have academic medical centers or a teaching hospital. It tapers off real quickly when you get away from the metropolitan areas. Students in the Community Partnerships for Health Professions Education Program get hands-on clinical training at a Mountain City health center. When somebody has a heart attack at one o clock in the morning, that system is not relevant to that emergency. The real safety net in Appalachia is pretty much the practitioners and the hospitals that are taking care of the needy because that s what they re supposed to do.