I’m writing today with a heavy heart but a clear purpose because I am tired and deeply concerned: our rural communities are facing a healthcare crisis, and we need help — especially when it comes to emergency medical care.
Our hospital in Pocahontas, Iowa, is a 10-bed critical access hospital, and it is a perfect example of what’s happening across rural America. For decades, this hospital has been a lifeline for families, farmers, small business owners, and elders. But today, it is in need. Not because of buildings or equipment as we have one of the most modern and up to date facilities in the state. We certainly have superb nurses and nursing assistants. We are fortunate to also have great therapists, paramedics, EMTs administrators, lab and x-ray technicians as well as ALL of the other support staff necessary to do our jobs well. But we are struggling to find enough doctors to staff the emergency room. Our staffing company Wapiti Medical Staffing does a great job, but I know for a fact it is getting harder and harder for them to come up with 24 hour coverage.
At this critical access hospital:
One physician who worked past the age of 70 recently retired. The next three most active doctors are 69, 68, and 65 years old — all nearing retirement themselves.
This isn’t just “numbers on a page” — this is real people’s lives and safety at stake. When the remaining physicians retire or cut back hours, what happens to you or your loved one in a medical emergency?
Rural hospitals like Pocahontas provide 24/7 emergency services — but they can’t function without doctors. Critical access hospitals are designed to ensure that people living far from big cities can access timely, lifesaving care. Without doctors, that promise falls apart. Critical access hospitals are federally designated facilities precisely because rural areas often lack the population base and financial resources of larger urban centers.
There is a broader, scary reality in Iowa and across the USA
This isn’t only happening in Pocahontas — it’s a statewide and national crisis:
Iowa’s doctor shortage is among the worst in the nation.
According to recent data, Iowa ranks 44th in the country for doctors per capita, with fewer physicians relative to population than most other states. Nearly two-thirds of Iowa’s counties lack enough primary care providers, and that shortage is even more severe in rural counties.
Rural hospitals in Iowa — like Keokuk County Hospital — are struggling to recruit and retain emergency physicians. In Sigourney, a 14-bed hospital has just two full-time doctors in its emergency department and desperately needs a third.
The workforce challenge is compounded by the aging physician population and burnout from the pandemic era, meaning many doctors are retiring early or leaving emergency care entirely.
More than 60% of federally designated Health Professional Shortage Areas are in rural communities nationwide — meaning too few clinicians to meet the needs of their populations.
What’s happening in rural emergency rooms now?
Across the United States, researchers estimate that about 1 in 13 emergency departments do not have 24/7 physician coverage — and most of those departments are in small rural or critical access hospitals.
In Iowa specifically:
Only a small minority of emergency departments are staffed exclusively by emergency-medicine trained physicians. Virtually all rural facilities rely on family doctors like me and are increasingly calling on advanced practice providers like nurse practitioners (NPs) and physician assistants (PAs) — to keep the doors open.
These clinicians are highly skilled and work hard to care for patients — but when complex emergencies arise, there is no substitute for experienced emergency physicians. And many hospitals are forced into using NPs and PAs as primary coverage because they cannot recruit enough doctors.
What this means for rural Iowans
When we don’t have enough doctors:
This isn’t fear-mongering — it’s the reality that health policy experts, hospital CEOs, and statewide healthcare data are showing us.
We cannot rely only on NPs and PAs
I don’t want anyone to think I am dismissing nurse practitioners or physician assistants — they are compassionate, competent, and often serve as the backbone of rural care. They are in fact indispensable to the system. But they are not doctors, and many emergency scenarios require the breadth of training only a physician can provide.
Relying on NPs and PAs to bridge these gaps — while necessary for survival right now — is not a long-term solution. We need to recruit and retain fully trained physicians in rural areas, not just patch the gaps. And to do that, we need real support — through policy, training incentives, loan forgiveness, recruitment programs, and community partnerships.
What you can do today?
Share this post — help rural Iowans raise awareness.
Reach out to policymakers — ask for support for rural healthcare funding and physician incentives.
Support local medical education efforts — doctors more often stay where they train, so investing in Iowa residency programs matters.
Our families and neighbors deserve emergency care close to home
People shouldn’t have to drive 30, 40, or 60+ minutes in a medical crisis because there aren’t enough doctors in town. We shouldn’t have community hospitals shrinking because they can’t find the next generation of emergency room physicians. And we MUST NOT wait until the last doctor retires to act.
If you believe healthcare is a right, not a privilege, then let’s stand together for rural Iowa. Our communities deserve safe, reliable emergency care — right here at home.
Thank you for reading. Thank you for sharing. And thank you for standing up for rural healthcare.
Darwin Schossow is EMS Medical Director of Pocahontas Community Hospital.
Comments
No comments on this item Please log in to comment by clicking here