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The physician's assistant.

THE CONCEPT OF REMOTE CLINICS manned by new health practitioners has recently held great promise in the United States. Educators, clinicians, planners, and researchers have been intrigued with the idea that a remote, or satellite, physician's assistant (PA) or nurse practitioner by consulting regularly with a nearby physician could provide all of the primary care needed by residents of rural physicianless communities-becoming a kind of "barefoot doctor," American style (1-7). Such clinics have been seen as one solution to the maldistribution of physicians. Other proposed solutions are training more and more physicians, thus changing the supply to demand ratio and forcing physicians out of the overserved cities; selecting from small rural towns more medical students, who presumably would be willing to return to these towns after training (8); obligating physicians to work in underserved areas on the selective service model, or to repay aid for medical education (9); and creating better linkages in the health delivery system and providing access to care for everyone through transport-focused or regionalized outreach programs (10). We offer evidence, based on 2 years of evaluative research, that remote clinics operated by new health practitioners may not solve the problem. In fact, these clinics may be overly dependent on public subsidy for economic survival, a development which is detrimental to a satisfying professional relationship between the new health practitioner and the employing physician, and they may prove over time to be a frustrating