Reversing the Doctor Drain

How innovative partnership models may help slow the erosion of medical care in America’s rural and Indigenous tribal areas

Nearly 1 out of 2 Americans – 121 million of us – live with some form of cardiovascular disease. It’s a shocking figure that exemplifies the severity of our national health crisis. However, there is another dimension to this growing issue that most Americans never experience.

The majority of patients suffering from coronary heart disease, stroke, hypertension or heart failure, and life-saving health services live in highly populated urban areas. But imagine having to drive five hours to see a physician, knowing there is a high likelihood that the doctor will not be there when you arrive.

That scenario is a frequent reality among American Indian and Alaska Native patients living in one of the 574 Federally recognized tribal areas in the U.S. Many of these reservations represent the most medically underserved areas in the country, where the quality of healthcare varies widely and significant physician shortages are chronic issues, eroding the level of trust and participation that patients have in their available health resources.

As part of a new podcast series exploring innovative technologies, partnerships and processes that could lead to breakthroughs in public health, I recently spoke with Rear Admiral (ret.) Jim Galloway, MD, a former Assistant U.S. Surgeon General to two presidents and currently the Chief Medical Officer of Native Arc, a Native American, woman-owned public benefit company developing novel, sustainable partnerships to reduce critical physician shortages and improve healthcare in Indigenous tribal areas.

From his decades of experience working as a cardiologist in some of the largest tribal areas in the southwest and across the nation, Dr. Galloway has witnessed the discrepancies in care provided to Indigenous populations, where congressional studies have found health provider vacancy rates approaching 50 percent in some areas, an issue that adversely affects the availability of services, waiting times and quality of care that patients experience.  

The pandemic underscored the state of health available to Indigenous populations relative to patients in the rest of the country. While New York City received headlines for its COVID-19 infection rate, the Navajo Nation—which covers parts of Arizona, Utah, and New Mexico—surpassed New York and New Jersey combined in mid-2020 for the number of cases it endured.

The result of the pandemic and years of neglect is an erosion of trust between patients and health providers. In certain specialized services, such as obstetrics, the impact of this loss of services and confidence is connected to disproportionately higher rates of mortality. For example, American Indian and Alaska Native women are twice as likely to die of pregnancy-related complications than White women and less likely to trust physicians.

To reverse this trend, Native Arc and its partner company, Arc Health, have developed and expanded a novel partnership model that fills physician vacancies with high-quality, mission-driven doctors and academic fellows from among the country’s leading medical institutions in a model to enhance tribal, Indian health and academic collaborations that improve health care services and facilities.

Medical staff take a collaborative approach to addressing health challenges unique to Indigenous tribal communities, weaving together the latest medical practices with a deep understanding of the cultural issues and social determinants impacting patient health in these areas.

The results of this partnership model are remarkable: A decline in physician vacancies, greater collaboration between tribal, Indian health systems and academic centers to drive improved quality, increased services and educational support, as well as improved professional development among doctors and other medical staff. Importantly, the academic institutions and incoming providers also better understand the culture and underlying socioeconomic issues that can be applied to understanding patient health in underserved areas.

One of the program’s most impressive outcomes points to the heart of its potential as a sustainable force for good: Many physicians and providers serving at these sites choose to stay on as full-time physicians for Indigenous tribal areas. These numbers are additive to the number of residents and students from academic institutions who return to serve tribal communities.

That’s a powerful testament and offers a possible path forward for improving the state of healthcare within tribal and rural populations, both in the U.S. and around the world. The more we can replicate partnership programs that place mission-driven physicians and fellows in areas of need and build meaningful collaborations between tribal and Indian health systems, the more likely physicians are to stay in those communities. This model also increases the opportunities to leverage the expertise, connections, and resources of both the physicians and academic centers to deliver long-term improvements to patient care.

Listen to the full podcast here to get the full picture of Native Arc’s innovative approach and Dr. Galloway’s powerful insights from his decades of service.


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Richard Hatzfeld
Richard Hatzfeld
Richard Hatzfeld is a global communications leader and public health champion who has led campaigns in Africa, Asia, Europe and the Americas to confront many of the most urgent health issues of our time. Richard is a senior partner at Finn Partners, leading the firm's global public health group from Washington, DC. He was previously a senior leader at Ogilvy, where he advised multinational companies, foundations and NGOs on global health issues, including infectious and parasitic diseases, maternal and child health, immunization, pandemic preparedness, and antimicrobial resistance. Before Ogilvy, Richard was communications director at the Sabin Vaccine Institute and led communications activities for their vaccine development, infectious disease and advocacy efforts, as well as the Global Network for Neglected Tropical Diseases and its award-winning END7 Campaign. Richard began his global public health career pioneering the development of the first reproductive health product line and a nationwide network of maternal/child clinics in the Democratic Republic of the Congo on behalf of USAID.
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