A growing number of rural emergency rooms across the U.S. are operating without doctors present around the clock, according to a new study cited by KFF Health News. In 2022, at least 7.4% of U.S. emergency departments had no on-site attending physician 24/7 — with over 90% located in small, low-volume or critical access hospitals like Dahl Memorial in Montana.
Critics argue that replacing doctors with physician assistants (PAs) and nurse practitioners (NPs) compromises care. States like Virginia and Indiana have passed laws requiring ERs to have physicians on-site. But rural providers warn that such mandates could force hospitals to close, citing a lack of physicians and resources.
Supporters of expanded use of PAs and NPs emphasize the importance of experience, consultation systems, and remote oversight. Dahl Memorial, for example, uses virtual tools and physician review while averaging one to two patients per day.
Montana, Wyoming, and other rural states have some of the nation’s highest rates of ERs without 24/7 doctors — and no in-state training programs for emergency physicians.
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