Sir.—I read with interest the May 1991 issue of AJDC devoted to the desperate plight of health care for poor children in the United States. As a pediatrician serving a low-income rural population, with 75% of my patients receiving Medicaid, 20% being uninsured, and 5% being insured (figures reflecting the area's pediatric population as a whole), I concur with Fulginiti's editorial statement, "The reasons for the lack of medical care are legion; the most often cited... are financial."1 However, one aspect of the pediatric care crisis not addressed is the impact on providers of care outside of metropolitan areas.
In his article, Nelson2 overlooks the problem in rural areas, stating that "the most serious deficits are,... to a great extent, concentrated in our large metropolitan areas." It is an oversight to ignore poor children in rural areas who face enormous obstacles in obtaining access to medical care.