Measures must be taken to alleviate severe physician shortages in Indian Health Service (IHS) facilities and address the health inequities in American Indian and Alaska Native communities, the AMA says in a letter supporting the IHS Workforce Parity Act (PDF) that was reintroduced earlier this year.
The letter points out that the physician shortages are “partially linked to the financial barriers that American Indian and Alaska Native students face when they consider pursuing or staying in medical school. As such, it is imperative to strengthen the IHS programs that …help to provide much needed medical care to our underserved American Indian and Alaska Native populations.”
The IHS, which was established in 1955, provides federal health services to about 2.8 million American Indians and Alaska Natives. The IHS includes 605 facilities and hospitals on or near Indian reservations in 12 area offices and 37 states, and employs more than 15,000 physicians, nurses, and other health professionals.
High physician vacancy rates
According to a 2018 report from the U.S. Government Accountability Office, the average vacancy rate in the IHS was roughly 25% for physicians, nurses, and other health professionals. The report also showed that in the eight areas where the IHS has substantial direct-care responsibilities, 29% of physician positions were vacant, ranging from 21% in the Oklahoma City area to 46% in the Bemidji, Minnesota, and Billings, Montana, areas.
The report noted that American Indian and Alaska Native people “have a life expectancy that is 5.5 years less than all races in the United States, and they die at higher rates than other Americans from many preventable causes, including diabetes, suicide, chronic liver disease and cirrhosis, and chronic lower respiratory diseases.”
American Indian and Alaska Native people are 1.5 times more likely than white people to be diagnosed with diabetes “and about three times as likely to receive late or no prenatal care,” says the AMA’s letter, which was written by James L. Madara, MD, who retired in June from his post as the organization’s CEO and executive vice president.
A JAMA® Viewpoint column from 2022 points out that the IHS is the “only large federal health system to lack formalized partnerships with academic medical centers,” which it says “hinders the agency's ability to recruit and retain physicians and may contribute to regional physician vacancy rates.”
Learn more with the AMA about why the IHS must act to lower staff vacancies.
More flexibility can help
The IHS Workforce Parity Act of 2025, S. 632, was reintroduced this year by Sens. Catherine Cortez Masto (D-Nev.) and Markwayne Mullin (R-Okla.). The first version passed unanimously in the Senate during the last Congress but did not pass through the House of Representatives.
The bill would amend the Indian Health Care Improvement Act, which was permanently reauthorized in 2010 as part of the Affordable Care Act, to allow IHS scholarship and loan recipients to fulfill their service obligations through half-time clinical practice in addition to full-time service.
The IHS loan program provides $50,000 to physicians who agree to work for two years in health facilities that serve American Indian and Alaska Native communities, and physicians can extend their contracts until their student debt is paid off.
“By expanding the program to include physicians who are willing to practice within the IHS part-time, it will likely encourage more practitioners to engage with this vital program, thereby increasing access to care for American Indians and Alaska Natives,” Dr. Madara wrote.
The AMA has policy supporting a variety of measures that would help the IHS meet its obligations to eliminate the inequities in health outcomes for American Indian and Alaska Native people.
These include support for this bill’s provisions as well as for making IHS physician payment competitive with other federal agencies and considering an increase in payment for specialty and primary care physicians in remote areas.
