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WORKFORCE
ISSUE
Federal, tribal, and urban Indian health programs have difficulty recruiting and retaining health professionals in a competitive hiring market.
BACKGROUND
Most Indian health facilities are located in isolated rural areas on or near reservations. As a result of this isolation, many Indian health programs have historically been extremely difficult to staff. Most health professionals are from urban areas or have at least spent the last several years of their lives in urban areas. They are concerned about conditions commonly encountered on Indian reservations such as insufficient housing, educational systems that are frequently not up to urban standards, lack of jobs for spouses, and few community activities for youth.
SITUATION
The Indian Health Service (IHS) has been successful in recent years with physician recruitment overall, although there are still some places that pose signifi
cant problems. These difficulties are primarily the result of the geographic and professional isolation of the sites. The physician vacancy rate now stands at approximately 18%, and the average length of service of the approximately 900 federally employed physicians in Indian health is 10 years.
The dental vacancy rate of 32% is much higher than it has been in many years. Pharmacy vacancy rates have increased to 11% from 8% in FY 2002 and nursing vacancies are up to 19% nationwide. Of particular concern is the shortage of registered nurses nationwide in both the inpatient and outpatient settings. These are the nurses most needed throughout Indian health. The agency expects the shortage of registered nurses will increase markedly over the coming years due to the increasing age of the U.S. nurse population (the average age of nurses in the U.S. is 47 years) and decreasing numbers of nursing schools, graduates, and new students. Pharmacy is facing similar issues in that fewer people are entering pharmacy schools at a time when the need for pharmacists is projected to grow considerably over the next 8 - 10 years. Other professions are either experiencing similar problems or anticipating problems in the coming years.
OPTIONS/PLANS
Historically, the salaries of Indian health professionals have not been competitive with those offered by the private sector. Recent legislative actions have helped reduce the pay disparity for physicians and dentists and should help in other professions as new salary rates are approved. Additionally, the IHS Loan Repayment Program has been helpful in attracting professionals and retaining them. The IHS Scholarship Program contributes to the recruitment and retention effort by supporting the education of Indian health professionals. Its success is indicated in several ways; since 1981, the number of federally employed health professionals who are Indian has increased by 272% and the proportion of the professional staff that is Indian has increased by 138%, while the total professional staff has grown by 61%. Many scholarship recipients have gone on to work in tribal and urban Indian health programs after completing their service obligations, thus increasing the overall positive impact of the program.
ADDITIONAL INFORMATION
For referral to the appropriate spokesperson, contact the IHS Public Affairs Staff at 301-443-3593.
June 2008