What new leader of Idaho’s medical association says about state’s maternal care

A little over a year ago, a new report revealed that more than one in five obstetricians had stopped practicing in Idaho since the state’s near-total abortion ban took effect in August 2022.

Health care leaders said the law had a chilling effect and prompted some doctors to retire or flee the state. But others stayed, including Dr. Megan Kasper, an OB-GYN in Nampa.

Kasper told an audience of legislators in April 2024 that she practiced in a “maternity care desert” in Southwest Idaho, which had recently seen the closure of two labor and delivery units, at West Valley Medical Center in Caldwell and Valor Health in Emmett.

Around the same time, the medical group she had worked at for nearly a decade, Saltzer Health, suddenly closed. Kasper decided to start her own practice. Three days after Saltzer shuttered for good, she was unpacking boxes of paperwork and medical equipment in her new clinic, Grace Women’s Health, at 5826 E. Franklin Road. In early June, she celebrated the clinic’s one-year anniversary.

Kasper told the Idaho Statesman that she’s been managing more patients with high-risk pregnancies. In an interview, she talked about the benefits of operating her own clinic, the challenges facing maternal health care in the Treasure Valley, and the flight of OB-GYN’s from the state.

The interview has been edited for length and clarity.

What has the last year been like since you opened the clinic?It’s been a lot, but it’s been really rewarding as well. There’s a lot of problems to solve that now I have to solve. But I can solve them versus before it could be hours of conversations and meetings, trying to convince someone else to solve a problem because I didn’t have the ability to do it myself.

So there’s pros and cons to everything, and it’s not for everybody, but it has been very fun. We’ve created a practice environment that fits how we want to deliver care to patients.

I think that knowing my patients at Saltzer needed care, and that there weren’t really other practices that had the capacity to absorb all of them, pushed me over the edge to take the risk and do it. Like my husband said, “You can’t just make pregnant women be not pregnant for a few months while you get your act together.”

What makes it so rewarding?

I think a lot of it is the autonomy. You see something that needs to be fixed and you just go fix it.

I remember, at Saltzer, we needed a fetal monitoring machine so we could do fetal monitoring in the office. And it took like six to nine months from the point of getting the purchase approved, not even including the time it took to just approve the purchase. At one point I was thinking, I will write a check. Like, we need this piece of equipment, I will just write the check.

Here, one of our ultrasound transducers needed to be replaced, and it took a little bit of time because we’re a new practice and I didn’t have an account established with the ultrasound manufacturer, but we got that ordered and it came a week later.

How many patients do you see now? Has your workload increased?Between the office and surgery and hospital, I’m probably having 70 to 80 patient encounters a week, but not every week, since some of my volumes are a little bit different because it’s me and four nurse midwives. I found, with my clinic schedule here, that I can’t see quite as many patients in a day, because overall the complexity of the patients is higher than what it was at Saltzer, where I had more a mix of low-risk and high-risk pregnancies.

The midwives are seeing as much of the simple stuff as possible. And so, just on average, my patient complexity has gone up a bit.

What are some examples of the more complex pregnancies that you deal with?It’s all kinds of things. We have pre-existing diabetes, chronic hypertension, twins. Those are probably the most common ones. Then there’s all the other random little things, like, we have a few patients right now with different types of bleeding disorders or clotting disorders.

In the last year since you opened the clinic, you became chair of the OB-GYN department at St Luke’s hospital in Nampa and the president-elect of the Idaho Medical Association’s board of trustees. Can you talk about how those roles came about and how you’re managing it all?With the department chair role, I was literally the only person on the medical staff of St. Luke’s Nampa that’s been here long enough to fulfill the requirements for that role. So that was a little bit of a last-man-standing situation.

Now, with the IMA, I’ve been on the board for most of the last seven years in a couple of different roles. The board of directors has representation from different regions in Idaho, and the board presidency rotates around to the different districts, with the idea being that they want leadership representation from around the state. They don’t just want, you know, a whole bunch of Boise people being in the president role all the time, because they’re the people that get the most votes. So it’s a good system to rotate around the state.

What are some of the challenges that you see facing maternal health care in the area?Idaho women’s health care in the last several years has been challenging with the political changes.

There’s been a lot of fear, and our overall workforce has decreased pretty significantly, not necessarily because physicians were leaving because of the changes in the laws, but because physicians leave and retire for all kinds of normal reasons. You know, they move to another state to be closer to aging parents, or they’re retiring, and it’s been very difficult to recruit the normal number of physicians to replace them, and certainly difficult to recruit physicians to grow as the Idaho population is growing very significantly. That’s created an imbalance.

In Ada County, where there are a lot of attractions for physicians to move to with all of the resources, opportunities, specialty schools and all the things, that’s been one thing to recruit physicians. Even in the west end of the Treasure Valley, in Canyon County – Caldwell, Nampa – that’s a different dynamic. And then certainly in rural parts of the state, that’s been very challenging.

There was a report that came out about a year or so ago from the Idaho Physician Well-Being Action Collaborative that found that 22% of the state’s obstetricians had stopped practicing in Idaho. I was wondering, from what you’ve seen, whether that shortage has eased or gotten worse?

For Ada County, it’s certainly gotten a little bit better. St Luke’s has been able to hire several OB-GYNs from out of the state. That’s helped a little bit. In Canyon County, we have one new doc that has been hired.

But there have been some other things that have happened in the last year where groups have shifted to consolidate in Ada County. Right now, at this moment, I would say the net change in Canyon County has been pretty even to maybe just a little bit tighter.

It’s headed in the right direction. But it’s still pretty tight right now for all of us that are currently working at the St. Luke’s Nampa OB-GYN group.

Have you had to turn anyone away?I have not had to turn anyone away. Well, there have been … we have started to get picky. We haven’t had to turn anyone away that really needed to be seen and didn’t have other good options. But there have been a few situations, like transfers of care, where we’ve looked at it and said, “Hey, we’re stretched fully thin and there are other options. Like, this is somebody who can go get seen in Boise. Let’s do that.”

But I haven’t had to close my practice to new patients. We have had conversations about it, though.

You work with women during some of the most important, and perhaps uncertain, times in their lives. What is it like to help your patients navigate those situations?Being able to come alongside someone who is going through something difficult or scary, whatever it might be, and helping them navigate it is very rewarding. It’s not that I’m coming in and rescuing something, because ultimately our own bodies have to walk that path. You know, your body has to heal.

But providing them the things that they can’t do, whether it’s surgery or catching their baby or ordering lab tests or prescribing medications, those things that the individuals cannot do themselves but that I can provide for them, and the empowerment that can come from that, from women successfully navigating those experiences in their lives, has the potential to be huge.

What would you say to people who are looking to start a family or have another child and are worried about the availability and quality of maternal health care in Idaho?I hear occasionally that women are concerned about getting pregnant. Will I be able to find someone to take care of me if I have a problem in pregnancy? Will I be able to get the appropriate care?

And I would say the answer is yes. You can find someone to take care of you. We can intervene if there is a medical complication in your pregnancy. You might have to be a little more flexible about the timing of your appointments. You might find that it works better to schedule your prenatal appointments in advance rather than waiting until a week before.

Just have an awareness of some of the squishy things and medically, know that there are a few things that we do need to transport women out of the state for. Generally, those things are not the time sensitive life-threatening things. The time sensitive life-threatening things we can take care of, and it ends up being a pretty small number.