08/15/2025
About 7% of tiny, rural emergency departments nationwide don't have an attending physician on site 24/7. The reason, of course: Cost pressures.
In Virginia, while many rural emergency departments are covered by NPs and PAs, VACEP passed a law that went into effect in July requiring an on-site physician 24/7 in every one. Indiana and South Carolina have the same law, built on model legislation from the American College of Emergency Physicians - ACEP.
This piece from KFF Health News explores the issue and quotes none other than Leon C. Adelman, MD, MBA, FACEP, a former VACEP member now practicing in Wyoming. A longtime analyst of our specialty, Dr. Adelman shares his views on onsite physician requirements, as does ACEP president Alison Haddock, MD, FACEP.
Questions to consider:
> Are rural communities receiving the level of emergency care they deserve?
> How can we better support advanced-practice providers facing extraordinary responsibility?
> What steps can we take to ensure universal physician coverage in ERs, regardless of location?
> How do we bridge the gap and make emergency care fair and reliable for every community?
There was no doctor on-site when a patient arrived in early June at the emergency room in the small hospital at the intersection of two dirt roads in this town of 400 residents. There never is.