Increasing Physician-Access for American Indian Communities

Across the country, nearly 9 million people identify as American Indian or Alaska Native, and many call the Washington, Wyoming, Alaska, Montana and Idaho (WWAMI) region home. According to Indian Health Services, there’s a physician shortage ― a health-professional vacancy rate of 25% ― among doctors who care for this population.

The UW School of Medicine and the UW Medicine Office of Graduate Medical Education are working to improve those statistics and increase the number of physicians in American Indian and Alaska Native communities.

Medical School experiences

For the past 15 years, the UW School of Medicine Targeted Rural Underserved Track (TRUST) program has provided medical students with the opportunity to experience what it’s like to practice medicine in rural locations. In Montana, students in the Targeted Rural Underserved Track participate in the American Indian Medical Experience: a three-day immersive training at local reservations.

Engagement opportunities that integrate first-year medical students into underserved communities can spark their interest early, says Jay Erickson, MD, assistant clinical dean, Montana WWAMI, UW School of Medicine.

Learning about culture to improve health

The American Indian Medical Experience prepares medical students to better address community health needs by engaging them in American Indian culture, says Lisa Benzel, director of Montana’s WWAMI Targeted Rural Underserved Track. Currently, 14 of the 30-member first-year medical school class in Montana are enrolled in the program. It’s the first time many students experience life on a reservation.

Students rotate through several reservations — Blackfeet, Crow, Northern Cheyenne, and the Confederated Salish and Kootenai tribes — to learn about traditional American Indian healing.

During the week, the students meet with tribal elders to learn about Native healing practices, such as the Sun Dance and sweat lodges. Tribal leaders also share their knowledge about traditional herbs, teas, plants, grasses and medicines used to improve wellness. This learning is part of creating connections with patients and practicing culturally responsive and humble healthcare. Working with the community to understand and honor Native practices is a means of reducing bias and inequity in care.

It’s also an opportunity for students to learn about the health disparities Native communities face. American Indian and Alaska Native people have a lower life expectancy — 5.5 years less — than the general U.S. population and are disproportionately burdened with higher rates of disease and poverty. In Montana, the rates of inequity are even higher. Students also meet with reservation law enforcement officers to discuss domestic violence and missing persons reports. The training is especially important in the context of the Missing and Murdered Indigenous Women movement and bringing awareness to the high rates of disappearances and murders of Native women and girls.

There are many factors that influence health for Indigenous populations, and learning from the community is part of providing culturally appropriate care.

Continued impact and community commitment

During each immersion experience, students impact community health in concrete ways, says LeeAnna Muzquiz, MD, associate dean for Admissions at the UW School of Medicine and a physician at the Tribal Health Clinic in Polson, Montana. For example, last year, 20 students prepared seven community gardens for the Confederated Salish and Kootenai Food Sovereignty program.

“Students learned about our gardens that produce thousands of pounds of fresh fruits and vegetables for our communities. Grocery store access is limited, so this program provides fresh foods and teaches people in our community how to take better care of their health with traditional and nontraditional foods,” Muzquiz says. “By preparing the garden for fall, our students were an incredible help to a program that creates meals and food baskets for our elders and other people in the community.”

Many students in the program choose to augment their training through the Indian Health Pathway, an additional elective pathway at the UW School of Medicine.

“The pathway provides a primer for nascent physicians to adequately meet the healthcare needs of the Native communities they serve by focusing not only on their physical ailments, but their spiritual, mental and emotional sides as well,” says Jason Deen, MD, professor (Cardiology) and director of the Indian Health Pathway and the UW Medicine Center for Indigenous Health. “Students receive instruction from Native UW School of Medicine faculty and our community partners in Indian country throughout WWAMI.”

The program offers advanced courses and clerkships and allows students to launch scholarly public health projects, such as harm reduction and needle exchange programs or collaborate with established projects like the FAST Blackfeet food pantry.

“We’ve found that once students start in these early training programs, they become more interested in American Indian health and want to engage with this population,” Erickson says. “It’s really planting the seeds for a potential future career as a physician serving these communities.”

Expanding graduate medical education

Efforts are now underway to expand graduate medical education opportunities for residents and fellows interested in working with Indigenous communities. The Network of Underrepresented Residents and Fellows is actively recruiting trainees through outreach events and recently attended the Association of American Indian Physicians Annual Meeting & Health Conference. UW Medicine is also part of a national effort to create more opportunities for trainees to be of service to Native communities.

Through an advocacy group called the American Indian Medical Education Strategy Alliance, regional stakeholders plan to lobby U.S. Congress for the creation of graduate medical education curricula in reservation health facilities. The goal is twofold, Muzquiz says.

“We envision an environment where physicians have ample chances to further their education and training in urban and rural Indian Health Services, tribal and other indigenous clinics,” she says. “The hope is that Native communities will one day benefit from increased health equity and reduced health disparities by having access to medical facilities that are fully staffed with physicians who can provide expert, culturally appropriate care.”

Few graduate medical education opportunities of this nature currently exist, and this programming will increase the number of residents and fellows who have firsthand experience working with Indigenous communities. The alliance is actively recruiting partners, including the UW School of Medicine, who can help design training opportunities that will be modeled after the Veterans Affairs Health System.

As an inaugural member of the Alliance and vested partner in expanding medical education, Erickson says, UW Medicine is uniquely positioned to fill the physician pathway with well-trained providers who can meet American Indian healthcare needs in a culturally knowledgeable and appropriate way.

“We are committed to understanding underserved communities and the health issues and health disparities they face,” Erickson says. “We are dedicated to creating a workforce to serve these patient populations throughout the WWAMI region.”