Indian Health Service clinics don't have enough physicians or nurses to provide quality and timely care to American Indian and Alaska Native people, and IHS data reveals an average provider vacancy rate of 25 percent, a report from the Government Accountability Office found.
American Indian and Alaska Native people have a life expectancy 5.5 years less than all other races in the U.S., and they die at higher rates from preventable causes than other Americans.
"The ability to recruit and retain a stable clinical workforce capable of providing quality and timely care is critical for IHS," the agency stated.
The GAO report looked at IHS provider vacancies and challenges filling them; strategies IHS uses to recruit and retain providers; and ways IHS mitigates negative effects of provider vacancies. The agency reviewed policies and IHS human resources data for provider positions the agency tracks and interviewed IHS officials. GAO selected facilities based on variation in their number of direct care outpatient visits and inpatient hospital beds in 2014.
Although IHS has several strategies to recruit and retain providers, including financial incentives and housing, IHS struggles to match local market salaries and lacks enough housing to meet demand.
The agency attempts to fill vacancies by hiring temporary providers, but officials said it is more expensive and may lead to less continuity of care. It is also difficult to fill provider vacancies due to many IHS facilities being in rural areas.
Long-standing vacancies hinder patient access, lower care quality and deflate employee morale, IHS officials told the GAO.
"GAO recommends that IHS obtain, on an agencywide basis, information on temporary provider contractors, including their associated cost and number of full-time equivalents, and use this information to inform decisions about resource allocation and provider staffing," the agency said.
IHS agreed with GAO's recommendation.