Managed care in North Carolina is evolving into two levels of service - rural and urban. In urban counties having employer-paid plans and multiple hospitals, HMO membership is highest. In rural counties, like Gates and Tyrrell, membership is insignificant. Counties are ranked by the number of physicians per 10,000 population served. Orange County ranks first with 86.4 physicians per 10,000 and Pitt third with 40.7. Twenty-five counties have 6.5 physicians or fewer per 10,000.