The Landscape of Physician Residency Training in the Indian Health System

The Indian Health System, which includes the Indian Health Service, Tribal health systems, and the Urban Indian Health Program, trains fewer resident physicians than would be expected based on its user population. Investment in equitable graduate medical education could address the Indian Health System’s shortage of physicians, which could in turn strengthen health operations and improve health outcomes. Several federal and grassroots initiatives offer opportunities for residency program development and implementation, but substantial barriers limit widespread growth of residencies. To inform leaders and educators, the authors review the relevant context of the Indian Health System, outline the key facilitators of the physician residencies currently based there, and describe the considerations relevant to future expansion.