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Rural hospital service trends.

Being a rural family physician, I am proud of what I do in rural practice. Necessity and temperament allow me to practise to the full extent of my training. I have even acquired additional skills that were not covered in my original training. I have a fulfilling job that gives me endless variety, from attending births to tending to the dying, and everywhere in between. I feel sad that urban family physicians are being pushed out of hospitals by low pay scales and resource limitations here in Canada, and by payor restrictions in the United States. Sociopolitical forces do not seem to place importance on having family doctors on staff in urban hospitals. One would think that, in rural areas, where no one else is available to do this socially important work, family doctors would be sheltered from those forces. In some ways rural family doctors continue to do and be their best. Rural family practice is still vibrant with greater family physician involvement in attending births, giving anesthetics, and doing surgery than is usually found in cities. The same trends that have limited our scope of practice in urban settings, however, are apparent in rural settings. Dr Rourke (pages 2107 and 2117) shows that the availability of these services in rural communities is decreasing in Ontario.