Back in 1998, when I was a fourth year medical student at Penn State, I did a “rural medicine” rotation in Williamsburg, PA. The only thing keeping this town alive was an envelope factory. There were roughly 1,300 people living in the town composed of 98.4% white people making roughly $30,000 per year per household.

My rotation was with the Williamsburg Family Practice run out of a large house in the main part of town. Just a few months prior to my arrival, the practice had been taken over by a thirty-something year old family practice doctor. I found out on my first day that the 80-something year old doctor who had made it his life’s work to be the Williamsburg town doctor passed away just a few months prior where he lived in the second floor of the house. And guess where I was supposed to stay for this month-long rotation? In the second floor of the house. There was an empty third floor, but I was told it was off-limits. Just outside the bedroom window was an old Civil War graveyard. I lasted a night and a half in that place by myself. But that’s another story.

The young doctor who took over the practice was taken aback by two things. First, the doctor had been practicing out of that house for a little over 50 years and had delivered babies that were then 50 years old or so. Each person’s entire life’s medical records were on a few 3×5 index cards. It was that simple. And, second, and most surprising, was that most of the adults, especially the little old ladies of the town, were being prescribed an anti-anxiety medication that went out of vogue in the 1970s. It was a “nerve pill.” Essentially this old doctor had the entire town all chilled out and dependent on him. Not a great policy at all, but I’m sure something that happens all over the country in rural areas. Literally entire counties, if they have doctors, are at the mercy of how that one doctor practices. It’s easy to forget that living in NYC. But roughly 20% of people in America live in rural areas where doctors are scarce. Thirty-five counties in Texas have no physicians at all. There really are two Americas.