A woeful lack of specialty and trauma care outside of the city. The reasons are obvious:
The reality also is, as we have stated here, that specialty surgeons (and trauma surgeons in particular) are in short supply. Besides that, due to the litigation climate and the demands on their time they would face being the one or two guys in town that do trauma, they absolutely do not want to practice in rural areas. Sometimes the best they can do outside a trauma center will not keep them out of court. Result? They leave for the big city. Go figure.
