As the second member of the San Carlos Apache tribe to graduate medical school, and the first one to earn a dual degree, Sylvestor A. Moses, MD, PhD, is aware of the barriers Native Americans face in navigating a career in medicine.
Less than 0.5% of the current physician workforce identifies as American Indians and Alaska Natives. Dr. Moses hopes his career path—which recently involved him accepting a position as an inpatient hospitalist at the San Carlos Healthcare Hospital in Peridot, Ariz.—will serve as an inspiration for others. An active AMA member who is the AMA Young Physicians Section representative on the AMA Minority Affairs Section Governing Council, Dr. Moses recently sat down for a conversation on the state of Native American representation in the physician workforce and his journey in the field.
AMA: What was your path to a career in medicine?
Dr. Moses: My pathway to medicine was a little bit different than most people. I actually went into a PhD program before going to medical school. I was doing cancer drug research and discovery at the University of Arizona. I got to work a little bit, as well, at MD Anderson in Houston. While there I saw what people can do as physician scientists working in a lab, while also having a clinical practice. That got me really interested in that pathway.
After I finished my PhD, I was trying to look for a postdoc position somewhere close in Arizona. At that time there were major funding cuts at the NIH, and basically overnight, a lot of the postdoc positions that I was applying for evaporated.
So I decided, well, you know what, let me just see what happens and I'll just go work for my Tribe for a little bit. I decided to go into the education department on the reservation that allowed me to mentor our students going into college and help them out with that whole process. And then at that very exact time, they were building the hospital on the reservation, and they wanted to have this initiative to get more students, more Apache tribal members into the health care system, as well as nurses, medical assistants, dentists, pharmacists, doctors, everything from top to bottom.
I wasn’t getting any younger, and I've always wanted to go into medicine, so I decided to just go and try to apply to medical school and get in. I actually went through a pathway program called the Pre-Medical Admissions Pathway, P-MAP, at the University of Arizona, and I got into that. My cohort had about 10 or 11 students, many of them were Native American. Then right after that, you go directly to medical school.
AMA: Why did you opt for a primary care specialty?
Dr. Moses: I wanted to go into a specialty that, well, not only interested me, but is also something that we can use on the reservation. Something like dermatology or the heavy surgical fields, we don’t have that capability at our reservation hospital, so I decided to go into internal medicine. I also had the ability to do outpatient clinic if I wanted to, but then also the inpatient hospitalist stuff. I decided that that’s what I was going to do, so now I’m a hospitalist here at the San Carlos Apache Hospital.
AMA: What are your ties to the San Carlos Apache reservation?
Dr. Moses: My family, on my dad’s side, is all from a small town called Bylas. He grew up there and then he went into the army. I was actually born in Cleveland, because he was stationed there, and we came back after I was born. I lived briefly on the reservation, but we moved to a place that was just off the reservation in a small town called Morenci. It’s a mining town here in Arizona, and it’s pretty close to the reservation, so we frequently came back to see the family.
AMA: Did you always plan to focus on working with Native American people?
Dr. Moses: My goal was always to come back to the reservation. And I’ve said that since day one. When I decided to apply to medical school, it was like, “I’ll be back, just hold a spot for me open when I graduate in a residency." That was always my goal to come back. And we only had, prior to me, only one previous San Carlos Apache physician who's ever done it.
It's always been important for me to come back and help mentor our students and hopefully have a new generation of doctors come in. It's a long process, obviously with medical school and schooling in general. But, again, I just wanted to go with that initiative of Apaches healing Apaches. I think it’s very important for our community.
Many of the Native American communities are very distrusting of outside medicine, if you will, especially with the stories that they hear from our elders. So it's been hard for some of these smaller tribes and other tribal nations to get what they feel is proper health care and a good patient-doctor relationship. And with me being there, I see how happy they are when they find out, "Oh, your family is from Bylas. I used to know your dad. I used to know your grandma. I know your aunt!"
AMA: Working in organized medicine, what are your advocacy priorities?
Dr. Moses: Certainly, we are trying to get more Native representation, not only within the AMA, but just in health care in general. The biggest issue that we have right now is with the new Supreme Court [SCOTUS] ruling on affirmative action, it's unfortunate for us that we already have a low representation in health care and we're very concerned that this would push it down even lower.
One of the ways we're trying to improve representation is to really push these pathway admissions programs, kind of like the one that I did. I think that will help increase representation.
We're having these problems on our reservation, and I know a lot of other reservations are having that problem, as well. It's necessary and for us to get involved at a national level so that things like this SCOTUS opinion and other problems that will happen in the future don't derail our efforts to get Native Americans into medicine.
AMA: When it comes to increasing Native American representation in the physician workforce, what does success look like to you?
Dr. Moses: There's nothing better you can do than to have one of your own in there and help mentor students. A lot of people just don't know how to navigate the whole education system. It can be confusing at times, especially if you grew up in that environment with all the poverty and all the alcohol and drugs that are happening around here. It's easy to get lost down a very bad pathway, even though you are very intelligent.
Working with the education department, I would see really smart people in high school and say, "Hey, how come you're getting such bad grades? That doesn't make any sense to me because I can see your homework and you know how to do all this stuff. I don't understand what's going on."
Maybe it's the family situation. Things happen at home where they can't control it, and maybe mom or dad or aunt or uncle or somebody is just out partying all the time and the student has to stay home and take care of the kids, cook for their brothers and sisters and whatnot. They get out of high school and instead of going to college, they just try to find a job or something, which is unfortunate because they could go a lot higher.
That transition to college can be a struggle. It's just a really strange place to them because they don't have their friends, they don't have other Native Americans, really, to be around who really understand where they come from. So, a lot of them get disheartened and come back after a semester or two at college. I see that all the time, and I don't know how to change that other than to encourage them as much as possible.
AMA: Coming from a background in which you weren’t surrounded by Native American physicians, how did you navigate the education system?
Dr. Moses: My own mentoring experience came in high school, through a program at the University of Arizona. It was called the Medical Student Research Program, or MSRP. It's been ongoing since the '80s, run by Dr. Marlys Witte. It’s a summer program that brings you into the academic environment where you get to get paired with either a researcher, a scientist or a physician, and you get to work in the lab, you get to do research. You get the experience of what it is like to be a physician scientist. And that was the point where I really wanted to become either a physician or actually a physician scientist.
AMA: How are you working to mentor Native American students?
Dr. Moses: I keep in touch with some of these students that are going through college, to see if they need any help or if there's anything that they need to talk about. They have my phone number so they can always reach out to me.
We also run a summer program exposing Native American students to health professions careers, which has been pretty successful so far, so we’re just trying to ride with that and see what happens in the future. The really encouraging news is that we do have a couple of our tribal members who are currently in medical school now or in pathway programs. So, yeah, there’s some success in that respect. I think that mentoring is really helping.