Nonetheless, Victory - a typical small-town hospital that just happens to be in New York - is a near perfect partner from the perspective of Manhattan's medical giants.

In the third McInnes mystery, a young woman asks Tom to investigate the death of her mother in a small-town hospital.

It can work for neighborhood clinics, small-town hospitals, hospital systems, or, well, the Department of Veterans Affairs.

To all intents and purposes, it was a small-town hospital.

Faced with the prospect of spending taxpayer money to subsidize a small-town hospital, city officials are wondering: If they have come, must we build it?

"I am hearing from small-town hospitals all across Iowa that they are getting close to bankruptcy," Mr. Ganske said.

My large family is spread out now, with in-law obligations, and my sister had to work at a small-town hospital in Arkansas all Christmas weekend.

Doctors applying to a small-town hospital, by contrast, usually have their license and medical-school record examined by a credentials committee.

Indeed, many small-town hospitals are adapting, beefing up their marketing, converting to ambulatory care, sharing services with other hospitals and cutting overhead costs.