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moving_mountains

See also:  Taking Action Together – America’s Rural Healthcare Crisis, scheduled Sept. 12, 2026

America’s  Rural Healthcare Crisis: 

Lessons from Idaho’s Sawtooth – Salmon River country

Page Contents:

  • Overview
  • Articles and Reviews
  • Slides: Idaho Capitol Rotunda:  book launch
  • Slides: 50th anniversary of Pre-Med Rural Internship

Overview

Boise — America’s first state-licensed nurse practitioner (NP), Marie Osborn ARNP, stood in the Idaho Capitol Rotunda on February 11, 2025, to release a community memoir Moving Mountains (Caxton Press), celebrate the NP profession, and call attention to the growing crisis in rural healthcare. Marie was joined by former healthcare leaders, volunteer EMTs, and her former student interns-turned-physicians.

In 1971, Marie Osborn, an RN, married with five kids, set out to provide healthcare to a place that had none. For the next 30 years, she ran the Stanley Idaho emergency clinic and trained volunteer EMTs, establishing Emergency Medical Services (EMS) for 6,000 square miles including the Sawtooth National Recreation Area and Frank Church River of No Return Wilderness. Idaho was the first state to license NPs, and Marie was the first licensed NP in Idaho. Today in the U.S., licensed NPs number over 300,000 and the NP profession has expanded internationally.

Emergency services in many small communities such as Stanley, Idaho, remain volunteer-based. But, America’s EMS volunteers are aging and retiring.

“Our EMS safety net is fraying,” said Paul Anderson, who served as the first director of Idaho EMS for nineteen years. “A system built on volunteers must sustain itself. This is not an urban versus rural problem. Anyone traveling outside a city will depend on the kindness of strangers to answer their emergency call if they or a loved one is injured.”

The book calls on state and federal leaders to step up support and encourage agency staff to train and serve as volunteer EMT first responders.

“Colleges and universities should team with rural clinics to give students hands-on experiences in healthcare realities,” said Doug Brigham, President of the College of Idaho. In 2025, the College celebrates the 50th year of its premed internship program at the Salmon River Clinic. “Many of our students have gone on to become doctors, more clear-eyed about rural realities thanks to the Clinic,” said Brigham. In 2022, the College awarded Marie an honorary doctorate for her contributions to rural healthcare (link)

Articles and Reviews

Slide Show #1  From the Idaho Capitol Rotunda to Ball State University in Muncie, Indiana:  book events in photos.

A special thanks to Roland Miller, Stanley EMT emeritus and photographer, for photos from the Idaho Capitol Rotunda and (further below) the 50th celebration of College of Idaho’s rural healthcare internship program. 

(1) BOOK LAUNCH
After 10 years of interviews, writing, and editing, on February 11, 2025 -- on the coldest day of the year -- we launched our community memoir about creating the nurse practitioner profession and rural EMS. "Thank you" to all who helped with this book: this is your story. A special thanks to our publisher, Scott Gipson/Caxton Press in Caldwell, Idaho.
Marie Osborn ARNP
Idaho's first NP and America's first state-licensed nurse practitioner. Marie covered 6,000 square miles of Idaho's Sawtooth Salmon River country as a sole healthcare provider for nearly 30 years. She broke trail for rural healthcare that others might follow.
Marie Osborn ARNP and son, John Osborn MD: authors of "Moving Mountains: Creating the Nurse Practitioner and Rural EMS"
Why launch "Moving Mountains" in the Idaho Capitol Rotunda?
Healthcare and politics are inseparable. In the early 1970s, the Idaho legislature revolutionized rural healthcare by becoming the first state to license nurse practitioners and creating Idaho EMS. The legislature funded programs through the University of Washington (WWAMI) and the University of Utah to train doctors. “Idahoans should be proud of their state government's commitment to rural healthcare,” said Marie. “More is needed.”
EMS Director: Paul Anderson
Paul Anderson was Idaho's first EMS Bureau Chief, serving from 1973 to 1992. He is credited with building the foundation for Idaho's statewide emergency medical services, establishing EMT training across the state, and founding the "StateComm" emergency communications system. The book recounts Paul's lifelong commitment to EMS interwoven with EMS's history.
Steve Lipus, Stanley EMT
Steve Lipus was a Law Enforcement Supervisor and Officer for the U.S. Forest Service based in Idaho. Operating primarily out of the Boise and Sawtooth National Recreation Area regions, his multifaceted career bridged law enforcement, environmental regulation, and emergency medical services. Along with Gary Gadwa, Steve Lipus was the Stanley EMT "goat patrol" whose stories are told in the book.
Jim Everett, C of I President
Since 1975, the College of Idaho has supported the Stanley Clinic rural healthcare internship program.
Catherine Reynolds MD with Marie's #1 son, Calvin Osborn
Dr. Reynolds, once a pre-med intern at the Stanley Clinic and one of Marie's students, is now Marie's physician. Calvin now helps provide care for his mother, now 95.
Legacy: Idaho events that changed medical history
A gathering of friends, Left to right: Teresa & Steve Lipus, Steve Richardson & Allison McClintick.
Premeds (long ago)
Kelly Mutch MD (left), Craig Pierce (right), with John (middle). All three were premeds at the Stanley Clinic. "Moving Mountains" recounts how Kelly prompted the clinic board to build living quarters for the students, and Craig's Sunday-morning emergency childbirth.
Deputy Sheriff Jim Parkhouse
We who provide emergency care, from first responders to ER staff, depend on law enforcement to help us with bringing control out of chaos. "Moving Mountains" tells the stories of Stanley's Deputy Sheriff Jim Parkhouse.
Jim Everett and Ken Harris MD
Ken (right) was a premed when the Stanley Clinic launched the internship program in 1975. As a physician, Dr. Harris later served as a physician for the Challis community before locating to Twin Falls. His chapter in "Moving Mountains" recounts his personal journey and the challenges of being a physician in a rural, isloated community.
Ingrid & Dave Burica
David Burica MD (right) served the McCall community for 40 years as a physician doing primary care internal medicine. Marie asked the young Dr. Burica, vacationing in the Stanley area, for help responding to a boating accident on the Middle Fork, a nighttime rescue story told in "Moving Mountains".
Family and Community
Marie's daughter, Melinda (left) and daughter-in-law Dia. We do nothing of consequence alone. "Moving Mountains" started out as Marie's story, but eventually became the story of family and the greater community who helped make possible the revolutionary changes in rural healthcare that centered in Stanley, Idaho.
(2) MUNCIE, INDIANA
In 1953, Marie Clark graduated from Ball State University in Muncie, Indiana. In 2025, the university honored Marie Osborn with the Lifetime Achievement Award.
Ball State University, where Marie delivered a heartfelt and tearful message about dedicating ourselves to the care of our patients.
(3) Grace Independent Living (Boise)
John Hutchison, Idaho Hospital Assoc.
In 1971, the Idaho Hospital Association under John Hutchison opened doors for Marie and the Stanley community to start the clinic and ambulance service. That changed the course of medical history. Years later, with Marie's eyesight failing forcing her to move, living across the hall from her at Grace Independent Living was . . . John Hutchison.
(4) Idaho NPs' annual meeting
(5) Emmett, Idaho
Bryan Stone, MD (left) served as Marie's physician preceptor for nearly 20 years, making the trips over Galena Summit from Ketchum Medical Clinic. Bryan and Ann Stone (1939-2020) settled in Emmett after serving a second time in Africa through their church. The Emmett Public Library marked its 100th year with events that included readings and story telling from "Moving Mountains".
(6) Ketchum, Idaho
Ketchum Community Library
Carole King (right), who contributed a chapter to "Moving Mountains," joined over a hundred friends, retired nurses, former EMTs and patients for a heartwarming evening together. Dr. Stone brought over 1,300 babies into the world during the 20 years he and Ann lived in Ketchum.
(7) Gonzaga University
National Nurse Practitioner Week
This event honors the nearly 400,000 nurse practitioners in the United States. Marie, a 4' 11" woman and mother of five, set out to provide healthcare to a community that had none, becoming America's first state-licensed NP. Gonzaga hosted a "Moving Mountains" event, recounting creation of the NP profession. Helping tell the stories of revolutionary change in healthcare were John Roskelley (right) and Dr. KT Fisher, both with chapters in the book.

 

Slide Show #2  50th Anniversary of the College of Idaho’s Rural Healthcare Internship Program, 1975-2025

In Stanley, Idaho at the the Stanley Museum on July 19, 2025, the College of Idaho and Sawtooth Interpretive and Historical Association hosted a 50-year celebration of the Rural Healthcare Internship Program for the Salmon River Clinic.

On the origins of this rural healthcare education program, from Marie Osborn NP in Moving Mountains:

The College of Idaho was and is successful in placing premed students into medical schools. We needed help at the Stanley Clinic, but we had no funding. My third son, John, who helped opened the first clinic, spoke with our Shaw Mesa neighbor, College of Idaho professor Dr. Lyle Standford, about creating a clinic internship for premeds. . . . In what would become the college’s longest and most successful student internship program . . . [they] created the premed internship to start in the summer of 1975.

Amy Klingler, PA-C
Dave Kimpton
Bernie Hartz
Jack Cafferty, Vice President, College of Idaho
Just off rafting the Middle Fork . . .
Marilyn, Kate, and Jake Clendenon. Sitting behind is Grant Porter (Middle Fork Rapid Transit).
Jake Clendenon, MD
Noah Carter
Steve Lipus
Teresa Lipus
KT Fisher, DO
Mike Nowling
Ken Harris, MD
1975: 1st pre-med interns from College of Idaho at the Stanley Clinic
John Osborn MD, Mike Nowling, Ken Harris MD
2025: Celebrating 50 years of rural healthcare interns
Fawn Hoffman & Abigail Hyland
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