The difficulties of meeting the medical and psychological needs of individuals living in rural areas have long been recognized. In Pre-Colonial days, a network of native healers attempted to meet the needs of rural populations, and when the Colonists arrived from England, the first formally trained physicians arrived in America as well. As the colonists moved westward, physicians followed, facing difficulties and hardships they had not encountered previously. In 1910, the Flexner report was released, which suggested revamping medical education and moving toward a formalized 4-year medical education system. Less than 20 years after this report was implemented, publications started to appear in the literature discussing the lack of healthcare providers in rural areas—an unintended consequence of the Flexner report. Recognizing this problem, in the 1960s and 1970s, the federal government established Area Health Education Centers (AHECs) primarily to directly serve the medical and behavioral needs of rural individuals. Although the office of Rural Health Policy at the U.S. Department of Health and Human Services was not formally established until 1987, it was seen as a final major step forward in improving the health of rural Americans.
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