Physician Diversity

Gaining trust through shared identity

The road from Anchorage to Fairbanks stretches more than 300 miles, carving a smooth and vital path between Alaska’s relatively populous Southcentral region and the huge, largely uninhabited Interior. About a third of it, right in the middle, hugs the eastern edge of Denali National Park and Preserve. The park’s centerpiece, Denali—recognized officially as Mount McKinley until reverting to its native Koyukon name in 2015—is the highest peak in North America, at more than 20,000 feet.

On a spring afternoon in 1995, Siobhan Wescott, MD, MPH, who until then had never considered becoming a physician, was making the drive after attending a public health conference in Anchorage. An Alaska Native living in Fairbanks, Dr. Wescott had long had a special fondness for Denali.

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Only a few spots on the drive have a view of the mountain, and most of the time its summit is obscured by clouds. On this day, though, as she came around a turn, the soaring massif came into view. This got her thinking.

“I had met so many people who waited their whole lives to see Denali,” she says. “I asked myself what I would wait my whole life for … and the answer was a medical degree.”

For decades, the number of Native Americans entering medical school in the U.S. has rarely topped 1 percent of the medical student population, according to Association of American Medical Colleges (AAMC) data. So even one more is a meaningful increase, especially in predominantly native areas.

Part of the shortage naturally has been attributable to Native Americans’ fraught experience with the U.S. government. Besides having been removed from their ancestral hunting lands and separated from their traditional nomadic way of life, they were subjected to forced sterilizations and other procedures performed in the name of medical research.

“The most common thing you can say of native patients is that there is often an initial, baseline distrust of Western medicine,” Dr. Wescott says. “There is a sense that their version of survival is not understood by people who are perceived as privileged.”

But Dr. Wescott’s desire to become a physician was about more than caring directly for native communities. Native Americans, she knew, also could contribute a unique worldview to medicine, so she wanted to see more of them in the profession.

“What amazes me about my ancestors is that they survived for thousands of years by being tough, adaptable, wise and, most importantly, looking out for each other,” she says. “We need more people like that in medicine.”

By the time of her revelation in the shadow of Denali, Dr. Wescott had been working in tribal health for years. After graduating from Dartmouth with a degree in government, she had gone to work for Sen. Tom Daschle, then the junior senator from South Dakota, and spent a year on the Senate Committee on Indian Affairs, as a Henry M. Jackson Leadership Fellow.

She wasn’t happy in D.C., though, so she moved back to Alaska, eventually getting married, relocating to Los Angeles and earning a master’s in public health, then ending up again in her home state. Like her ancestors, Dr. Wescott was constantly moving.

She was 35 and the oldest student in her class when she enrolled at Harvard Medical School. There she co-directed the Four Directions Summer Research Program, an opportunity for Native American undergraduates to explore careers in medicine under supervision of medical school faculty.

Dr. Wescott has been out of medical school for more than 10 years now, but she still rarely sees other Native American physicians. In fact, according to AAMC, faculty who report as American Indian or Alaska Native alone account for just 0.1 percent of the nationwide total.

But she also has been working to address the Native American physician shortage systemically. As a member of the board of directors of the Association of American Indian Physicians (AAIP), she has helped organize an annual summit with AAMC to expand national efforts to attract native students to medicine.

Read this story in its entirety as featured in our inaugural issue of AMA Moving Medicine.