PUBLIC HEALTH BRIEFSrequires a minimum population of 1,500 who would see the provider an average of three times a year at an average fee of $10 per encounter and a collection rate of 100 per cent to generate $45,000 a year in revenue. This figure represents a bare minimum for the support of one mid-level practitioner, without considering the cost of capitalizing facilities or equipment. Thus, it could be predicted that remote areas with smaller populations would be unable to sustain an independent NHSC mid-level practice without continuing subsidy.The high expense ratio demonstrated by the sites reflect the fact that a modern curative medical practice requires an expensive plant and relatively high personnel costs. Fixed costs are high; variable costs relatively low. This is exemplified by the Alaskan sites in which extremely remote, small villages have low utilization, high need, and high operating costs. Perhaps good management and experience can reduce these costs. However, the major decision revolves around questions of equity. If we as a society decide to make curative health care readily available to remote populations, we will have to increase external subsidies to increasingly smaller communities. On the other hand, the data suggest that from an economic standpoint mid-level practitioner sites that are started and nurtured in communities of over 1,500-2,000 people can approach financial self-sufficiency.