In Missouri its done by counties. Pretty much every county in my area is considered underserved. Some of the other factors include drive time to hospitals and availablities of physicians, etc. If you think rural I generally think of town vs small city. If it's a town then it's probably rural. I live in a city and we have two hospitals and we're still considered underserved because of the large portion of underserved (rural)areas all around us. When you count everyone who is coming to our docs & hospitals the ratios get a lot different. Plus our counties includes a lot more than just our city. Next hospital (that's not a sub of ours) is 1 1/2 hrs away S or W or 3 1/2-4 hrs N. Alot of people have to drive those distances to see specialists and stuff. If you think of driving from the outlying rural areas you can be putting in ALOT of mileage just to get an eval that can take months to get into and then months to get anything done about it. A lot of the out of town docs only see our folk once a month, so they fill up quickly. It's hard esp when it's a child with possible brain injury having to wait so long. We also have a lot of medicaid/medicare pts that go untreated bc docs who accept it are few & far between. Then add in HMO's and you're even more limited. It can be really frustrating esp at the Urgent Care bc we see a lot of pts w/o family docs or peds or who are waiting to get in.
Moral: D.O.s typically go into family medicine/pediatrics and many go into rural & underserved areas I think bc a lot of schools cater to students from those areas... like me! Also the philosophy helps gear towards the needy, I think.
