The Indian Health Service must act to reduce the vacancies of doctors

To help retain and recruit physicians and alleviate severe staffing shortages, the Indian Health Service (IHS) should create an academic liaison office to coordinate partnerships with accredited medical schools and residency programs.

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

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

Working as a federally recognized AI/AN physician [American Indian or Alaska Native] tribe or nonprofit Indian health organization is critically important work with the potential to positively impact the health of historically marginalized and underserved populations, AMA Executive Vice President and CEO Dr. James L. 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 fulfill its obligation to raise the health of American Indians to the level of the general population.

AMA policy recommendations for strengthening the IHS workforce include:

• Increasing IHS physician reimbursement to be competitive with other federal agencies.
• Initiate a construction and modernization program to bring IHS facilities up to current standards.
• Developing funding streams to promote rotations and learning opportunities in IHS, tribal, and urban Indian health care programs.
• Establish an academic liaison office to coordinate partnerships with the Medical Education Liaison Committee, 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 major federal health system that lacks formalized partnerships with academic medical centers, physician researchers at Massachusetts General Hospital and the University of Minnesota noted last year in a JAMA Viewpoint column.

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

In addition, the Military Health System operates more than 20 teaching hospitals and a medical school, the Uniformed Services University, which received $169 million in 2020 funding, the authors noted, with another $315 million earmarked for other health education programs and Department of Defense training.

AMA strongly encourages IHS to create partnerships with medical schools and residency programs and to fund these partnerships accordingly once they are established, Dr. Madaras’ letter said.

Hospital faculty and GME programs can offer IHS a foundation for clinical systems and workforce development, similar to how the Office of Academic Liaison was created for the Veterans Health Service and the residency training program for the Military Health System , Dr. Madara wrote.

Medical residents often continue to practice at sites where they complete GME training, which ultimately affects the distribution of the health care workforce, Dr. Madara added.

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

Doctors may need more help understanding the regulations surrounding licensing requirements for these positions, the AMA says. 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 alleviate the physician shortage within the IHS and to ensure that American Indians, Alaska Natives and Native Hawaiians are provided with the health care they need, Dr. Madara wrote.

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