@Brown Eyed Girl I think it's similar here: service is much more available in large, urban centers than in small cities and towns, and much better still than in rural areas. It's not unusual to have to travel 100 miles (140km) or more to the Seattle/Tacoma area to find adequate specialists in some fields. We're particularly short in dermatologists, endocrinologists, rheumatologists, allergists, and gerontologists. I don't know why those specialties are in particularly short supply, but that's just the way it is.
There is also inordinate difficulty getting a PCP; the waitlists are often 9+ months long, during which times peoples' only option is to rely on urgent care clinics, with no patient continuity. Far too many docs are opting out of networks altogether to work as "consierge physicians," eschewing ALL insurances because of the inordinate paperwork and bureaucracy involved. This leaves medical care ONLY adequately available to the very wealthy. And that's truly disgusting!