In the country the situation follows one of two types. Assuming that a thousand people in an accessible area will support a competent physician, one of two things will happen if the district contains many less. In a growing country, like Canada or our own middle west, the young graduate will not hesitate to pitch his tent in a sparsely settled neighborhood, if it promises a future. A high-grade and comparatively expensive education will not alter his inclination to do this. The more exacting Canadian laws rouse no objection on this score. The graduates of McGill and Toronto have passed through a scientific and clinical discipline of high quality; but one finds them every year draining off into the freshly opened Northwest Territory. In truth, it is an old story. McDowell left the Kentucky backwoods to spend two years under Bell in Edinburgh; and when they were over, returned contentedly to the wilderness, where he originated the operation for ovarian tumor in the course of a surgical practice that carried him back and forth through Kentucky, Ohio, and Tennessee. Benjamin Dudley, son of a poor Baptist preacher, dissatisfied with the results first of his apprenticeship, then of his Philadelphia training, hoarded his first fees, and with them subsequently embarked temporarily in trade; he loaded a flat-boat with sundries, which he disposed of to good advantage at New Orleans, there investing in a cargo of flour, which he sold to the hungry soldiers of Wellington in the Spanish peninsula. The profits kept Dudley in the hospitals of Paris for four years, after which he came back to Lexington, and for a generation was the great surgeon and teacher of surgery in the rough country across the Alleghanies. The pioneer is not yet dead within us. The self-supporting students of Ann Arbor and Toronto prove this. For a region which holds out hope, there is no need to make poor doctors,— still less to make too many of them.
In the case of stranded small groups in an unpromising environment the thing works out differently. A century of reckless over-production of cheap doctors has resulted in general overcrowding; but it has not forced doctors into these hopeless spots. It has simply huddled them thickly at points on the extreme margin. Certain rural communities of New England may, for example, have no physician in their midst, though they are in most instances not inaccessible to one. But let never so many low-grade doctors be turned out, whether in Boston or in smaller places like Burlington or Brunswick, that are supposed not to spoil the young man for a country practice, these unpromising places, destined perhaps to disappear from the map, will not attract them. They prefer competition in some already over-occupied field. Thus, in Vermont, Burlington, the seat of the medical department of the University of Vermont, with a population of less than 21,000, has 60 physicians, one for every 383 inhabitants;[1] nor can these figures be explained away on the ground that the largest city in the state is a vortex which absorbs more than its proper share; for the state abounds in small towns in which several doctors compete in the service of less than a thousand persons: Post Mills, with 105 inhabitants, has two doctors;
- ↑ American Medical Directory; Polk (1908) gives 75 active physicians, a ratio of 1:280.
