On the Reservation: Providing locum tenens to Native Americans -

On the Reservation: Providing locum tenens to Native Americans - - ModernMedicine

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If you're seeking a locum tenens opportunity that combines humanitarian aid, public health medicine, and breathtaking terrain, the Indian Health Service (IHS) offers it all. Through the IHS, the U.S. government provides medical care to 47 percent of the nation's 3.3 million American Indians and Alaska Natives. With a history of neglect, persistent poverty, and inadequate preventive education, Indian nations' members also endure high rates of alcoholism, depression, diabetes, and obesity. And staffing shortfalls worsen these problems by limiting access to skilled medical professionals.

Locum tenens physicians have never been more crucial to filling these openings. Positions are plentiful, streamlined government licensing requirements can get you started quickly, and your new colleagues will teach you how Indian traditions will influence your medical practice. Learn how an IHS contract can reconnect you with the spiritual aspect of patient care.

SWIFT LICENSING PROCEDURE

Your valid, unrestricted state medical license will qualify you to practice at IHS facilities; certain states, like Alaska and California, may impose additional licensing requirements. One side benefit: If you want to add a new state license, you can study for it while fulfilling an IHS contract in that state, where you'd otherwise be unable to practice.

Village of Supai, Ariz. (Photo: Getty Images/National Geographic/Taylor S. Kennedy)

Credentialing time can vary, but it is usually swift. "If you're working at one of the IHS state hospitals, where you might have to obtain privileges," two to four weeks may be needed, says Rick Bailey, manager of Cleveland-based Locum Medical Group's government division. For a smaller IHS health center or station, two to three days is more typical.

You may need specialized certifications for some isolated IHS centers. For example, physicians serving the Havasupai tribe, at the bottom of the Grand Canyon (see sidebar, "Frontier medicine: Serving the Havasupai"), must possess extensive advanced life support certification. But you won't have to wrangle directly with the government. As with other assignments, your agency will arrange all necessary paperwork after you select an opening.

ABUNDANT NATIONWIDE POSITIONS

Across all specialties, the IHS suffers a 21 percent physician job vacancy rate. Bailey ascribes this deficit to doctors' perception of inadequate compensation (which, as with Veterans Affairs locum tenens contracts, is subject to government budgetary limits). Other hindrances the IHS cites include reluctance to move to rural locations, being remote from fellow physicians, poor spousal job prospects, and limited educational options for children. This represents an opportunity for flexible locum tenens seeking a steady chain of assignments.

With new doctors preferring lucrative specialties, Bailey says primary care positions—often predominant at smaller IHS facilities—are in greater demand. "A lot of these places are really remote, so primary care physicians are on the front line. So you need more of them," he adds, also observing that IHS requests for psychiatry and OB/GYN specialists have risen over the past six months. Benjamin Stapley, a scheduling director for family medicine with VISTA Staffing Solutions in Salt Lake City, notes that rural practice experience is a plus.

IHS contracts typically last between two and six months. Shorter stays don't allow physicians to adapt to the culture of the facility and its patients, reports Stapley, so IHS units prefer at least a two-month commitment. If your first tour goes well, you'll likely be welcomed back—an appreciative patient population is one reason. "They typically love the idea of giving back and helping out an underserved population," Stapley says of his doctors. "[Patients are] definitely thankful for the care that they're getting, and that really resonates with our physicians. So we do get a fair amount of return assignments."

The ready availability of positions is also attractive for either the "career locum" or a staff physician taking a break. Danielle Mylroie, an emergency medicine scheduling director with VISTA, has physicians who take periodic leave from their full-time jobs for IHS contracts, as well as others who've returned to facilities on a continual basis, including one doctor who remained with the same hospital for nearly a decade. "Once they become part of a community, they love it. They become part of that culture," she says. "The types of cases they see aren't what they'd normally see back in the big city."

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