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21 Am. J.L. & Med. 111 (1995)
The Virtual Health Economy: Telemedicine and the Supply of Primary Care Physicians in Rural America

handle is hein.journals/amlmed21 and id is 113 raw text is: The Virtual Health Economy:
Telemedicine and the Supply of
Primary Care Physicians in Rural
Daniel McCarthy t
For years, people living in rural areas have struggled unsuccessfully to attract and
retain primary care physicians to supply basic medical care to their residents.' Rural
areas continue to suffer from chronic shortages of physicians and mid-level practitio-
ners,2 as well as high rates of hospital closures and increased levels of uninsurance and
underinsurance, reducing both the physical and financial health of these communi-
ties.3 Physical and economic barriers unique to rural areas block the adequate delivery
of health care and contribute to this shortage of health care personnel.4
Although Congress has made some progress in identifying where health care short-
ages occur, it has not adequately identified the source of the shortages, and thus, it has
not been able to find adequate solutions to rural health care ills.5 Past legislative
t B.M., Northwestern University; J.D., Boston University School of Law. The author thanks his
parents James and Linda McCarthy for their support and encouragement. The author also wishes to thank
Felecia Wein for her hard work, patience, and invaluable editing suggestions.
I Teri Randall, Rural Health Care Faces Reform Too; Providers Sow Seeds for Better Future, 270
JAMA 419 (1993). Twenty-five percent of the U.S. population lives in rural areas. Id. While the prob-
lems of rural health care delivery are numerous, solving the shortage of primary care physicians is the key
to providing basic care to rural areas. Therefore, this Note will focus on primary care physicians as a
surrogate for rural health services generally. See C. Everett Koop, Telemedicine Will Revolutionize Care,
USA TODAY, Aug. 23, 1993, at 9A.
2The Congressional Office of Technology Assessment gives examples of mid-level practitioners as
nurse practitioners, certified nurse-midwives, physician assistants and certified nurse anesthetists. U.S.
Congress, Office of Technology Assessment, OTA-H-434, Health Care in RuralAmerica: Summary 14
(U.S. Government Printing Office, 1990) [hereinafter OTA Summary].
3139 Cong. Rec. S7611-02, S7627 (daily ed. June 22, 1993) (statement of Sen. Baucus) (The Rural
Health Improvement Act) [hereinafter RHIA]; Lisa Belkin, New Wave in Health Care: Visits by Video,
N.Y. TIMES, July 15, 1993, at Al. See generally U.S. Congress, Office of Technology Assessment, OTA-
H-434, Health Care in RuralAmerica (U.S. Government Printing Office, 1990) [hereinafter HCRA].
 HCRA, supra note 3, at 6; David Holthaus, Rural America: A Hospital Fights the Economic
Odds, 63 Hosp. 42 (1989); Craig Thomas, Reformers: Don't Forget About Rural Care-Neither Pay or
Play Nor Managed Care Will Work for Us, Says Wyoming Rep. Thomas, ROLL CALL, July 19, 1993, at 1.
-See Randall, supra note 1, at 419. Generally, the federal government's role in addressing the short-
age of medical services, and in particular, general practice physicians, is limited by the scope of federal
power. OTA Summary, supra note 2, at 4. However, the federal government does have a role to play in
effecting changes in rural America's health care shortages. Id. While changes on a local level specifically
adapted to the situation in a particular state or community are better suited to the states themselves, rural
primary care shortages affect a significant part of the U.S population in 46 states. Connecticut, Rhode
Island, New Jersey and Hawaii did not have any rural primary care shortages in 1988. HCRA, supra note
3, at 297-98. Nearly 44% of state resources for rural health activities come from federal sources without
even including enormous federal health insurance programs like Medicare and Medicaid. Id. Therefore,

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