Successful Idaho remedies for America’s rural healthcare divide include Stanley’s clinic and ambulance.

Fifty years ago this summer, the Idaho Hospital Association both challenged and supported me to provide emergency services for the Sawtooths and upper Salmon River country. An RN and mother of five, I trained to become Idaho’s first Nurse Practitioner (“NP”). From 1972-1999 I was the sole licensed provider of primary-care and emergency services for 6,000-square-miles of wild Idaho.

Idaho was first in licensing NPs in 1971-1972, led by physician-legislator Dr. John Edwards of Council. Dr. Edwards built on work starting in 1965 in Colorado training NPs in caring for underserved communities.

On Father’s Day 1972, we opened the Salmon River Emergency Clinic in Stanley with support from Wood River Valley physicians. The Sawtooth National Recreation Area (SNRA) was dedicated in September. More visitors created more demands for emergency services.

Our first EMT class graduated in 1972. We purchased our first ambulance from Mountain Home Air Force Base for $300: a surplus 1958 Pontiac ambulance.

By the mid-1970s, we had a new clinic, new ambulance, new emergency radio system connecting to Idaho EMS “State Com,” Idaho’s first local 9-1-1 system, a vibrant volunteer EMT program, and a pre-med internship program through College of Idaho. In 1982, we added medical students and, later, NP training. Air ambulances came first from Mountain Home AFB and Forest Service, then LifeFlight.

Emergency calls in the Sawtooth country are rich with stories of incredible saves and horrific losses. Thank you to the many people who have supported Stanley’s clinic and ambulance. Our ability to respond often makes the difference between living and dying.

My being first NP and sole provider drove many decisions about roles and scope of practice for NPs who came later. My focus had to be on my patients: providing primary care and responding to emergency calls 24/7 for nearly 30 years. I loved my work.

Stanley’s clinic was in the crosshairs of policy battles whose outcomes defined NPs as a profession. Not all newer NPs did rural healthcare, creating tensions between urban versus rural NP roles and scope of practice. Proposals crippling rural NPs compelled frequent trips to Boise for meetings with legislators, Govs. Andrus and Evans, and Boards of Medicine, Pharmacy, and Nursing.

At pivotal moments, nearly the entire Stanley community testified at the State Legislature to protect the Stanley clinic and Stanley ambulance, and my ability to provide patient care.

Before we opened the Stanley clinic, emergency calls went to Forest Service staff. With an NP staffing Stanley’s new clinic and ambulance, Forest Service and Idaho Fish & Game staff were among our most dedicated volunteer EMTs.

In 2021, the Sawtooth NRA is projecting 3 million visitors. Yet the Stanley ambulance is struggling. EMTs able to respond to emergencies have dwindled to a few. For the Stanley clinic and ambulance, Forest Service and Idaho Fish and Game should recommit their support.

Bound together are 50-year anniversaries of the Stanley clinic, Sawtooth NRA, and NP as a new healthcare profession in Idaho. Stanley’s community impacted rural health care far beyond the Sawtooth country. Half-century anniversaries are an opportunity to look back— and look forward.


Marie Osborn, ARNP, provided emergency and primary care services in Stanley, Idaho, from 1972-1999. From 1999 until she retired at age 80, she saw patients in Idaho City, Horseshoe Bend, and Boise. Marie has a BSN from Ball State in 1953.

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