On a recent Wednesday morning, 10 women sat inside Glacier Maternity & Women’s Center describing in poignant detail, often through tears, the impact Pady Dusing has had on their lives.
Their emotions stemmed from North Valley Hospital’s recent decision to close Glacier Maternity & Women’s Center in Kalispell, affecting the clinic’s hundreds of patients — 800 by Dusing’s count but roughly half that by hospital administration figures — and five staff members, including its lone provider, Dusing, a certified nurse-midwife (CNM) who years ago shifted away from birthing to focus on general women’s health care. She is a primary care provider for all ages, although she specializes in menopausal care.
Patient after patient on Sept. 5 said Dusing, a pioneering midwife in the valley, is their sole primary care provider and the only practitioner they trust, describing women’s health care as particularly personal and private. A few have been with Dusing for nearly all 30 years she’s practiced in the valley, and they all said the relationship-driven care Dusing provides is irreplaceable. They also said there isn’t another local provider with her specific expertise in menopausal care, which includes training and extensive experience in certain hormone therapies.
“I don’t have another doctor,” LeAnn Noffsinger said. “I don’t have anywhere else to go. I don’t have anyone else I trust.”
“I don’t know what I’ll do, where I’ll go,” Carolyn Feldman added. “There’s nobody else who provides the services Pady does in the valley. There’s a rapport and relationship 800 of us have with Pady. There just isn’t that provider available in the valley for these 800 women.”
North Valley Hospital officials informed Dusing in late July that the center would be closed. The hospital then sent out letters to Dusing’s patients on Aug. 15 telling them the clinic would take appointments through the end of September. Patients expressed frustration over what they felt was a short window of time to find a new provider.
CEO Kevin Abel said the decision was based on the departure of the clinic’s other providers. In April, one of the two other certified nurse-midwives joined another practice, followed by the other moving in July to be closer to family in Idaho.
The other two CNMs delivered babies, while Dusey instead focused on general women’s health care. Dusing has been practicing in the valley for three decades, but has been with North Valley only since last year. Abel said it was not financially viable to maintain the clinic with a single part-time provider.
Although the hospital is affiliated with Kalispell Regional Healthcare after announcing a formal partnership in 2016, Abel said the decision to close the clinic was entirely North Valley Hospital’s.
“We do appreciate the year of service we’ve had with Ms. Dusing,” Abel said on Sept. 10. “We’d be happy to work with her if she’d like to work independently.”
Dusing, who doesn’t know what she’ll do next, acknowledges that her clinic doesn’t make comparatively large quantities of money, given the nature of her services, but said it’s a viable enterprise, and could be more so if given the chance to make changes. She added that she refers clients for laboratory work and to other providers, generating additional revenue for the hospital system.
Moreover, Dusing said her clinic has low overhead. Working three days a week, her salary is $60,000, and the center has only four other employees while working with hundreds of patients. Dusing said when administrators arrived at a far lower figure than 800 patients, they weren’t factoring in patients who haven’t seen her a while but still use her services.
In a July 15 meeting with hospital administration, following the departure of the second CNM, Dusing proposed searching for another provider to join the clinic but said she was surprised to be told 10 days later of the decision to shut down the clinic. Abel maintains the decision was thought out and not made in haste.
“We worked with her and looked at other options,” he said. “We didn’t come to an agreement on those options and made the decision to close the clinic because we had one part-time provider. The one part-time provider model wasn’t financially viable.”
Crystal Boyd, the clinic’s office manager, spoke highly of North Valley Hospital as an employer and said she understood the financial reasoning behind the closure, although she was hoping Dusing would be embedded into another clinic so she could continue practicing.
Boyd, who has worked with Dusing on and off since 1996, echoed patients in describing Dusing’s commitment to relationship-building and her thoughtful approach to patient care.
“She has been there for OB care, births, deaths in their family,” Boyd said. “She knows her patients in and out. She can tell you the whole life history of her patients. That’s what patients are afraid of, trying to go to another provider or clinic and trying to establish that with someone new.”
Dusing graduated from Baylor College of Medicine, one of the nation’s leading medical programs, in 1986 and briefly practiced in Salt Lake City before moving to the Flathead. She was the first non-MD to gain hospital privileges at Kalispell Regional Medical Center in 1988, making her a pioneer in the CNM field.
“That really paved the way for every mid-level practitioner to have privileges at the hospital,” she said.
Dusing then started the area’s first nurse midwife office with obstetrician and gynecologist Dr. Perry Birky. The two were in private practice together for 18 years until Birky’s retirement in 2008. Dusing opened the Flathead Valley Women’s Center in 2009 and then transitioned to Glacier Maternity & Women’s Center last year, becoming a North Valley Hospital employee.
Kiersten Alton, a pharmacist with Big Sky Specialty Compounding, said no provider in the valley rivals Dusing’s expertise and experience with bioidentical hormone replacement therapy for menopausal women, although some providers practice it. Alton said concerned patients are approaching the pharmacy with questions, with some saying they had tried multiple providers over years before finding Dusing. Alton noted that Dusing’s patients “love her.”
“As a pharmacist, my biggest concern is how are we going to take care of these 800 women?” she said. “My feeling is that the hospital made a financial decision on paper but they didn’t know all the impacts. I think they thought these women would just go somewhere else under their umbrella, but there isn’t anybody else with Pady’s knowledge and expertise. I really don’t know where to send these women.”
“I don’t think you’ll find any provider in town with a better reputation than Pady,” Alton added. “It just blows my mind that her practice is getting closed.”
Dusing points out that she brought her extensive patient base to North Valley Hospital, and she echoed Alton’s concerns about the patients’ future.
“I worked so hard to build that practice — it doesn’t happen overnight,” she said. “I’m very worried about where those patients are going to end up and how they’ll be served. I just love my patients dearly. This is all so sad.”