Physician shortages are being felt across the country, particularly in rural areas—home to about one in five Americans. Leaders at one tribal medical education program think they have created a blueprint to help bring more physicians to rural areas—and keep them there over the long term.
“Oklahoma State University is so thankful to have the opportunity to partner with the Cherokee Nation," said Natasha Bray, DO, dean of Oklahoma State University College of Osteopathic Medicine (OSUCOM) at the Cherokee Nation. OSUCOM is located in Tahlequah, Oklahoma, capital of the Cherokee Nation. It is the only tribally affiliated medical school in the country.
“We really have a shared mission of addressing Oklahoma's primary care health workforce needs, and aligning in this partnership really allows us to come together to talk about how we train physicians to serve both our rural and our tribal populations," said Dr. Bray.
During a recent episode of “AMA Update,” Dr. Bray talked about that shared mission and how it will impact rural areas.
Integrating students into the community
Two decades ago, the Cherokee Nation approached Oklahoma State University with its concerns about maintaining a physician workforce. Most physicians came to the city of about 16,000 people through programs like the Indian Health Service Scholarship Program, Dr. Bray said, but these physicians would often not stay in the community.
In 2005, the school began to place third- and fourth-year students within the Cherokee Nation's health system for clinical rotations. In 2008, a family medicine program partnership was created. And in 2020, the full-fledged four-year medical school was opened.
The school will graduate its first class in May.
"From the time students step onto campus, they're embedded in Cherokee culture," Dr. Bray said. "We think that's really important because if we want them to serve a community, we need them to understand … the needs of the community—what are the challenges in that community? That comes a lot easier when you live in the community than when we begin to try to talk to you about how social determinants of health impact access to care."
Students gain clinical exposure beginning the first year in the program. For their clinical core rotations, students train in the community, rather than in an academic health care center. They choose one of four training tracks: rural, tribal-based, urban underserved or traditional.
Each track's mission is to help students recognize every patient comes with their own background, Dr. Bray said.
“It really changes how we approach patients to ensure that we're providing patient-centered care that's respectful of culture, respectful of their language, respectful of their heritage so that we really partner with our patients to ensure the best outcomes that we can," Dr. Bray said.
Subscribe to AMA Update
Get videos with expert opinions from the AMA on the most important health care topics affecting physicians, residents, medical students and patients—delivered to your inbox.
Improving health outcomes
A study published in the Journal of Graduate Medical Education identified that family medicine residents who spent at least half of their training time in rural settings were five times more likely to practice in a rural setting compared to a resident with no rural training.
OSUCOM at the Cherokee Nation has seen similar results, said Dr. Bray.
“Those residents who come through [our] training programs are staying in this community or in communities that look like this," she said. “They're going to communities that are medically underserved, and they're establishing practices there and staying there throughout their careers.”
Unfortunately, that same study found more than 90% of residents have no rural training experience. That is why efforts such as those undertaken by OSUCOM at the Cherokee Nation are so important, Dr. Bray said.
“We know we have wide areas of underserved populations in the United States," she said. “We have to find ways to get the right physicians to those communities so that they can engage in care of those communities if we hope to really produce health equity [and] change the health outcomes of our patients.”
“AMA Update” is your source for physician-focused news. Hear from physicians and other experts on trending public health concerns, practice issues and more—because who’s doing the talking matters. Catch every episode by subscribing to the AMA’s YouTube channel or listen to all AMA podcasts at ama-assn.org/podcasts.
