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BOZEMAN (AP) – Access to doctors is the biggest medical problem facing rural residents in both the United States and Japan, those attending a conference on rural health care agreed Saturday.

“There are 220 rural counties in this country where there are no doctors,” said Thomas Ricketts, who studies national rural health trends from the University of North Carolina. “You see other counties where there is one doctor and 10,000 or more people.”

Ricketts was one of the panelists at a seminar on rural health organized by the Mansfield Center for Pacific Affairs. A similar meeting was held last month in Japan.

Rural areas lack the patients, profits and prestige that draws doctors to cities, panelists said.

Rural areas have decreasing populations, and many residents are aging. Studies show rural residents tend to be poorer and in worse physical shape, said Andrew Coburn, director of the Maine Rural Health Research Center.

If rural medicine were more profitable, access might not be a problem, one panelist suggested.

“We’re willing to spend money on quality care, but not willing to spend money on access,” said Naoki Ikegami, chairman of health policy and management at Keio University in Tokyo.

He suggested nationally fixed prices for medical services in rural and urban areas as a way to lure doctors to small towns.

Many medical school graduates also want to focus on some specialty, panelists said.

Kenjiro Narato, a family doctor, said there would be more rural doctors if universities and colleges pointed students in that direction. He said schools in both the United States and Japan need to teach obligation.

“It is doubtful whether they actually educate students with a real awareness that they will be responsible for the nation’s health and security,” Narato said.

Rural medicine can be demanding, making it difficult for a rural doctor to take a day off or leave town, panelists noted.

“The thing that troubled me the worst was the professional isolation,” said Walker Wallace, Big Timber’s only doctor. “It’s important to visit with peers frequently. We have to develop a system so doctors interact daily.”

One solution emerging in rural America is telemedicine, which allows face-to-face medical consultation through video connection, noted John Zauher of St. Vincent Healthcare in Billings.

He said the technology might be a viable connection between rural health centers and urban hospitals, if the cost comes down.

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