Programs, funding aim to ease Indian Health Service provider shortage

The Indian Health Service (IHS) has pulled together bipartisan support from Congress to recruit and hire more health care workers for understaffed clinics and hospitals in tribal nations.

A quarter of all positions for physicians, nurses and other care providers at IHS facilities are vacant, according to the Government Accountability Office (GAO), meaning more than 1,300 positions need to be filled.

In the IHS Phoenix health service area, which includes all of Nevada and most of Utah and Colorado, 21% of physician/nurse positions are vacant, along with about 14% of positions for dentists.

Those vacancies limit service availability for the 140,000 American Indians and Alaska Natives in the multi-state region who receive healthcare and community health services from IHS, including 14 tribal and urban Indian health centers in Nevada.

This week, Democratic U.S. Sen. Catherine Cortez Masto introduced legislation with Alaska Republican Sen. Lisa Murkowski to provide students preparing for work in healthcare fields with fully tax-exempt scholarships and loan repayment programs in an effort to close those vacancies.

“As Indian Country deals with dire doctor and nurse shortages, expanding the IHS’s capacity to provide financial aid to medical students and new health workers is just common sense,” said Cortez Masto. “This legislation will allow IHS facilities in Nevada to recruit and hire more doctors, nurses, and other clinicians to help save lives and keep Native American communities healthy.”

The majority of federal health scholarships and repayment programs are already tax exempt. However, IHS scholarship programs are not. Cortez Masto’s bill, the IHS Health Professions Tax Fairness Act, would ensure IHS programs receive the same tax exemptions applied to programs in the Department of Defense and the National Health Service Corps.  

Cortez Masto has also pushed legislation designed to address health disparities for Native Americans in urban areas by securing provisions in the American Rescue Plan that allow programs funded under the Office of Urban Indian Health Programs to receive 100% reimbursement for Medicaid services, according to a spokesperson.

Cortez Masto is working to make the change permanent and looking at all avenues to do so, including the reconciliation package that Democrats are trying to iron out in Congress, said a spokesperson.

Funding from the American Rescue Plan provided $500 million to support health services in Indian Country. IHS hopes the investment will strengthen care over the long term by investing in high-quality provider salaries and services.

Another $2 billion for health infrastructure to serve tribal members is included in the reconciliation package.

Resources for federally and tribally operated facilities have increased in recent years overall. However, both the IHS and tribal leaders say funding is still insufficient, according to a GAO report.

In 2018, IHS estimated that federally operated and tribally operated facilities were only able to fund, on average, 49% of the needed health care for tribes.

Officials from the Phoenix Area office told federal officials the Nevada Skies Youth Wellness Center, an adolescent substance abuse treatment center, had to decrease the number of beds available due to staffing vacancies in 2018.

Part of the larger issue is that IHS can’t offer salaries that are competitive with other federal health agencies like the Veterans Health Administration (VHA).

In 2018, a nurse just starting a career in the IHS Phoenix service area could make about $63,871 at VHA, versus $44,835 at IHS.

The high cost of school for healthcare professionals makes working for lower pay unattractive, especially while they are paying back student loans.

Historically, Native Americans have poorer health outcomes than the general U.S. population, including shorter average life spans and higher incidence of certain medical conditions. Barriers in accessing health care services only exacerbate health disparities, many of which can be mitigated, at least in part, through access to effective preventive primary care services.

“High vacancy rates for doctors, nurses, and other health care providers in our Native communities continues to be a hindrance in providing adequate care. Unfortunately, the existing inequities Native communities face were compounded by the COVID-19 pandemic,” said Murkowski in a statement.