Whilst historically medicine has maintained a position of dominance and power within the health care system there are suggestions that contemporary social trends such as managerialism, proletarianisation and the corporatisation of the health care system are resulting in challenges to medicine's traditional power. In some countries, declining medical power has been attributed to increased interest in alternative health management, intraprofessional competition, and medical oversupply. In Australia, these emerging social trends are having some impact on the dominant position of the medical profession. However, many of these trends are 'metrocentric'. In rural Australia, most doctors are neither corporatised workers nor publicly employed. They retain significant independence as fee-for- service providers whose medical power is strengthened by medical shortages and professional autonomy. The Australian Health Care Agreement provides for equitable access for public health care irrespective of geographic location. However in Victoria, it would appear that rural doctors' economic autonomy creates a significant disparity between rural and metropolitan constituents' access to public health services, especially public hospitals.