Indian Health Service must act to lower staff physician vacancies

To help retain and recruit physicians—and to mitigate severe staff shortages—the Indian Health Service (IHS) should create an office of academic affiliations to coordinate partnerships with accredited medical schools and residency programs. 

The IHS had a physician or health-professional vacancy rate of 25% in 2018, and the AMA is committed to identifying long-term strategies to mitigate the physician shortage within the IHS and ensuring that American Indians, Alaska Natives and Native Hawaiians are provided with the health care that they need. 

The vacancy rate among staff physician positions was 29% across the eight IHS geographic service areas, and ranged between 21% in the Oklahoma City service area to 46% in the Bemidji, Minnesota, and Billings, Montana, service areas, according to a 2018 report from the U.S. Government Accountability Office. 

“Working as a physician for a federally recognized AI/AN [American Indian or Alaska Native] tribe, or a nonprofit Indian health care organization is a critically important job with the potential to positively impact the health of a historically marginalized and underserved population,” AMA Executive Vice President and CEO James L. Madara, MD, wrote in a letter (PDF) to Health and Human Services Secretary Xavier Becerra and Indian Health Service Director Roselyn Tso. 

AMA policy supports efforts “to enable the Indian Health Service to meet its obligation to bring American Indian health up to the general population level.” 

The AMA policy recommendations for bolstering the IHS workforce include: 

• Raising IHS physician compensation to be competitive with other federal agencies. 
• Beginning a construction and modernization program to bring IHS facilities up to current standards. 
• Developing funding streams to promote rotations and learning opportunities at IHS, Tribal and Urban Indian Health Programs. 
• Establishing an office of academic affiliations to coordinate partnerships with the Liaison Committee on Medical Education, the Commission on Osteopathic College Accreditation, accredited medical schools and residency programs accredited by the Accreditation Council for Graduate Medical Education. 

The Indian Health Service “is the only large federal health system to lack formalized partnerships with academic medical centers,” physician researchers from Massachusetts General Hospital and the University of Minnesota noted last year in a JAMA Viewpoint column. 

“In comparison, the Veterans Health Administration has had 75 years of active partnership with teaching hospitals through its Office of Academic Affiliations,” the column says. “An annual budget of more than $1.4 billion in 2014 supports 120,000 annual trainees and 11,000 graduate medical education (GME) positions.” 

Additionally, the Military Health System operates more than 20 teaching hospitals and a medical school, the Uniformed Services University, that in 2020 received $169 million in funding, the authors noted, with another $315 million going to other Defense Department health education and training programs. 

“The AMA strongly encourages the IHS to create partnerships with medical schools and residency programs and to properly fund these partnerships once they are established,” says Dr. Madara’s letter. 

Teaching hospital staffing and GME programs can offer the IHS a foundation for clinical systems and workforce strengthening similar to the way the creation of an office of academic affiliations was created for the Veterans Health Service and the residency training program does for the Military Health System, Dr. Madara wrote. 

“Medical residents often continue to practice in locations where they complete GME training, which ultimately influences the distribution of the health care workforce,” Dr. Madara added. 

The AMA also encourages the IHS to evaluate existing regulatory and licensure opportunities and barriers that physicians face when seeking to provide health care to American Indians, Alaska Natives and Native Hawaiians. 

Physicians may need more help understanding the regulations surrounding the licensure requirements for these positions, says the AMA. The IHS should help create resources to ensure that physicians can easily transition into a position caring for American Indian, Alaska Native or Native Hawaiian communities. 

“The AMA is committed to identifying long-term strategies to mitigate the physician shortage within the IHS and ensuring that American Indians, Alaska Natives, and Native Hawaiians are provided with the health care that they need,” Dr. Madara wrote. 

Learn about the AMA’s strategic plan to embed racial justice and advance health equity.