Experts Say Rural Emergency Rooms Are Increasingly Run Without Doctors

There was no doctor on-site when a patient arrived in early June at the emergency room (ER) in the small hospital at the intersection of two dirt roads in this town of 400 residents.

There never is.

The three-bed emergency department in Dahl Memorial Hospital in Ekalaka, Montana -- a 2-hour drive from the closest hospital with more advanced services -- instead depends on physician assistants (PAs) and nurse practitioners (NPs).

Carla Dowdy, PA-C, the institution's chief medical officer, realized the patient needed treatment beyond what the ER could provide, even if it had had a doctor. So, she made a call for a medical plane to fly the patient to treatment at Montana's most advanced hospital. Dowdy also called out medications and doses needed to stabilize the patient as a paramedic and