By Alex Strauss
Monument Health’s Recruitment Surge Expands Subspecialty Care in Western South Dakota
Keely Ulmer was loading cattle trucks in Winner, South Dakota, when her parents called to say that the letter she’d been waiting for from the University of South Dakota School of Medicine had arrived.
“They asked me if I wanted them to open it and I said ‘Sure, go ahead’,” recalls Ulmer, now a gynecologic oncologist at Monument Health’s Cancer Care Institute. “I was sitting there with a couple of truckers and when I told them I had just gotten into med school and they said ‘If you don’t go, we’re going to be really mad at you!'”
It’s a fitting origin story for someone who has spent her career defying expectations—from the Pine Ridge Indian Reservation ranch where she grew up to a prestigious fellowship at the University of Iowa, and now back home to western South Dakota.
But Ulmer isn’t the only physician with an unconventional path who has recently chosen Rapid City as a destination rather than a stepping stone. Between July 1 and October 1 last year, Monument Health added 31 new physicians representing 15 specialties—part of an aggressive expansion that brought 107 new providers over 27 months.
Among them are three bringing subspecialty services previously unavailable or inconsistently available in the Black Hills: In addition to Keely Ulmer, MD, in gynecologic oncology, they include dual-trained cardiothoracic/vascular surgeon Tommaso Cambiaghi, MD, and colorectal surgeon Steven Donahue, MD.
For patients in western South Dakota, the implications are potentially huge – especially for those fighting heart and lung diseases or cancer.
From the Alps to the Black Hills
ommaso Cambiaghi, MD, had his pick of locations after completing dual fellowships in vascular surgery and cardiothoracic surgery. The Italian-born physician earned his medical degree at the Università Vita-Salute San Raffaele in Milan. He completed his vascular surgery residency and fellowship at McGovern Medical School at the University of Texas, followed by a cardiothoracic surgery fellowship at Houston Methodist Hospital.
After years in Houston, Dr. Cambiaghi says he was ready for a place that felt more like home.
“I am from a small town so, honestly, it was a bigger change to move from Italy to Houston than from Houston to here,” says Campbiaghi, who grew up skiing in the Alps. “The Black Hills aren’t quite the Alps, but it is better than skiing in Houston!”
But his decision to join the Monument Health Heart and Vascular Institute was about much more than the landscape.
“I was also looking for a place that would allow me to practice both of the areas I’m trained in,” says Cambiaghi, who has been here since September. “So I was focusing on smaller hospitals that might want to have a ‘two-in-one’ physician like me.”
In larger hospitals, cardiothoracic and vascular surgery are typically covered by separate teams. At Monument Health, Cambiaghi’s expertise means patients can get a comprehensive and tailored care plan without having to see multiple surgeons.
“The fact that I am trained in both cardiothoracic and vascular surgery means that I can customize the treatment for each patient—whether it is minimally or maximally invasive or a combination,” he explains.
His training also means he can offer new and potentially safer ways of doing older procedures, such as endovascular treatment of complex abdominal aortic aneurysm. “These were historically treated with big open surgeries that required a long recovery time,” he says. “But now we can do them in a minimally invasive way.”
Another procedure becoming less risky under Dr. Cambiaghi’s direction is Thoracoabdominal Branch Endoprosthesis (TAMBE). Monument Health recently became the first facility in the world to perform this procedure through a vein instead of an artery, further minimizing surgical risk.
Coming Home
For Keely Ulmer, MD, the decision to return to western South Dakota was never really in question, even though others tried to recruit her.
“I always planned to come back here,” she says simply.
But her path into medicine was anything but straight. Before she got that letter from USD, Ulmer had spent time as a forest firefighter, worked as a livestock manager at a sale barn, and waited tables—never imagining she was “smart enough” for medical school, even when others suggested it.
“I didn’t really think of myself in that vein,” she says. “But I took the MCAT and did decently, so I thought I would give it a shot.”
A graduate of Black Hills State University, Ulmer excelled at USD School of Medicine, graduating summa cum laude before starting a residency at the University of Iowa. She fell in love with gynecologic oncology during her training, which meant three additional years of fellowship. Despite the extended stay, Ulmer says she made sure South Dakota programs knew she was still coming back.
“I was always reaching out to people saying, ‘Don’t forget me!’,” she says. “But after I went into my fellowship, it was the other way around.”
She joined Monument Health this fall. As a member of the Oglala Lakota Sioux Nation, Dr. Ulmer is especially passionate about Native women’s health and has worked with Dr. Dan Petereit’s long-standing Walking Forward initiative. The program focuses on cancer screening in Native American communities.
“I also think that representation matters,” says Ulmer. “Lack of representation was a big part of why I thought I couldn’t do this job. I’d never seen people like me do it.”
The need for gynecologic oncology services in this population is greater than ever. American Indian women in the Northern Plains have twice the incidence and four times the mortality from cervical cancer. They’re also more likely to have HPV strains not covered by current vaccines. Before Dr. Ulmer’s arrival, many patients with gynecologic cancers had to travel to Sioux Falls, Denver, or Billings for care.
“One of the most exciting things is not only the fact that we can now offer more consistent gynecologic oncology services here, but that we have more treatment options than we did before, especially for recurrence,” says Ulmer.
“There are new treatments such as immunotherapy for uterine cancer and antibody drug conjugates for advanced cervical disease that are showing promise in overall survival. It is an exciting time to be in this field.”
The Missing Specialty
The arrival at Monument of Steven Donahue, MD, filled a gap that most people didn’t realize existed until they needed it.
“Some of the things I do can be done by a general surgeon, but there are a specific few that haven’t been done here at any volume,” says Donahue, who also joined Monument Health in September as the first fellowship-trained colorectal surgeon in Rapid City.
While general surgeons have long performed colon resections in the region, Dr. Donahue brings specialized expertise in managing inflammatory bowel diseases such as ulcerative colitis, Krohn’s disease, and IBS. For patients with severe ulcerative colitis, he can offer J-pouch total colectomies—a procedure that wasn’t previously available locally.
Other new procedures Dr. Donahue has brought to the region include minimally invasive trans-anal surgery for rectal cancer or polyps and minimally invasive ultra low anterior resection (ULAR) for very low rectal tumors.
“This is a technically complex procedure but it can preserve bowel function and allow patients to avoid having to have a permanent colostomy,” he says.
Looking ahead, Dr. Donahue hopes he’ll soon be trained to offer single site robotic surgery for colorectal cancer, an approach that recently won FDA approval.
Dr. Donahue completed his fellowship at Creighton University in Omaha after earning his medical degree at USD and completing his residency at the University of Nebraska Medical Center. The move to Rapid City had been in the works for years.
“We always knew that we wanted to end up here,” says Donahue, who grew up in Minneapolis. “My wife is from this area and we have family here. I don’t see us going anywhere after this.”
A Different Kind of System
All three physicians say there was something more than professional opportunity that drew them to Monument Health. They say that the organization itself is changing for the better.
“Coming from a major academic medical center, Monument Health is very impressive,” says Dr. Ulmer. who grew up knowing the hospital by its former name, Regional Health. “I feel like I have, arguably, an even better facility here than I did there.”
“I’ve been happy with all the changes in leadership,” says Donahue, adding that Monument Health was the only hospital system in western South Dakota that could support the specialized work he wanted to do.
For Cambiaghi, who interviewed at facilities across the country, Rapid City Hospital stood out. “I interviewed here almost by chance, but it turned out that I loved the area, loved the group, loved Monument,” he says.
And just as “a rising tide lifts all boats”, the addition of new subspecialties and the expansion of others gives all providers more opportunities to consult and collaborate on complex cases.
“As someone doing advanced ovarian cancer surgeries, I often lean heavily on other specialties like colorectal or general surgeons,” says Ulmer. “It’s important that they are there for support.”
As they represent the newest subspecialties in the region, Ulmer, Cambiaghi, and Donahue are building their programs from the ground up, establishing standards of care, and paving the way for new providers in their fields. For Dr. Ulmer, in particular, for whom the Black Hills are home, the circle is now complete. She’s back where she wanted to be, practicing at the highest level of her field, and serving the communities that shaped her.
“The Monument Health that we have now is a completely different system than the health system of old,” says Ulmer. “This cancer facility is state of the art. We have a beautiful infusion center and a dedicated chemo-pharmacist. It’s as good as anything you’d find in much bigger medical centers.”
