Indian Health Service still seeing high vacancy rates

Wednesday, August 22, 2018  

The Indian Health Service doesn't have enough doctors or nurses to meet its trust and treaty obligations, according to a new Government Accountability Office report.

Despite efforts to recruit more professionals, vacancy rates across Indian Country remain "sizable," the report stated. A majority of regions -- including the Great Plains, where quality of care issues have contributed to patient deaths and losses in critical certifications -- saw vacancy rates above 20 percent, with a handful approaching highs of 30 percent.

"IHS data demonstrate large percentages of vacancies for providers in the 8 areas in which IHS has substantial direct care responsibilities," the GAO wrote.

"As of November 2017, the overall percentage of vacancies for physicians, nurses, nurse practitioners, CRNAs, certified nurse midwives, physician assistants, dentists, and pharmacists in these areas was 25 percent, ranging from 13 to 31 percent across the areas," the report stated.

When broken down by type of service provider, the vacancy rates were actually much worse. Nearly half of the physician positions in the Billings Area, a region that serves tribal citizens in Montana and Wyoming, and in the Bemidji Area, serving tribes in five states, were vacant, according to the GAO data.

Nurse vacancies were also high. Three of the eight regions where the IHS is most responsible for direct care saw rates greater than 30 percent, the report stated.

Nurse practitioners also went missing in extremely high rates across Indian Country. In the Albuquerque Area, which serves tribal citizens in New Mexico and Colorado, 47 percent of positions were unfilled, according to the GAO.

Such vacancies affect how the IHS provides care for more than 2.2 million American Indians and Alaska Natives, who suffer from numerous health disparities, the report noted.

"According to IHS, AI/AN people born today have a life expectancy that is 5.5 years less than all races in the United States, and they die at higher rates than other Americans from preventable causes," the GAO said. "The ability to recruit and retain a stable clinical workforce capable of providing quality and timely care is critical for IHS."

Throughout the years, the IHS has attempted to beef up recruitment efforts through scholarship programs, financial incentives and other benefits. But with hospitals, clinics and other facilities often located in rural areas, where housing, educational and other opportunities can be scarce, it's hard for the agency to compete with other employers.

The report notes that the IHS has attempted to make up for shortfalls in staffing by contracting with temporary providers, a practice that has been carried out repeatedly in the Great Plains over the last few years. But those efforts might actually end up costing more money and contribute to interruptions in patient care, the GAO said.

According to William Bear Shield, the chairman of Unified Health Board of Rapid City in South Dakota, that's been the case with the hospital which serves the Rosebud Sioux Tribe. Programs have seen restrictions off and on for nearly three years, with a seven-month shutdown of the emergency room leading to at least nine patient deaths.

“Since 2015, the Rosebud Sioux Tribe’s IHS hospital has seen a decrease in vital services like surgery and OB/GYN, and remains critically understaffed,” Bear Shield said after lawmakers took action on a bill to reform the agency. “The IHS continues to excessively rely on expensive contracts and non-IHS medical providers to furnish these services."

H.R.5874, the Restoring Accountability in the Indian Health Service Act (RAISE Act), includes provisions aimed at improving hiring and staffing at the IHS. The bill took a key step forward when it was approved by the House Committee on Natural Resources in June. It has not yet been cleared for action on the House floor because it is still being reviewed by other legislative panels.

“Today, tribal members are receiving life-threatening ‘care’ from a broken IHS. That urgently needs to change,” said Rep. Kristi Noem (R-South Dakota), the bill's sponsor. She has spent more than two years trying to improve services in the Great Plains.

If Congress fails to take action on the measure before the end of the year, tribes will have to look for someone else to take up the cause. Noem is vacating her seat to run for governor of South Dakota so she won't be around for the next session.

Indian Health Service: Agency Faces Ongoing Challenges Filling Provider Vacancies (August 15, 2018)