Tribal lands in Arizona struggle with staffing shortage

Modern Healthcare sought to map the parts of the U.S. with the poorest access to healthcare and highest levels of social vulnerability. With support from the University of Southern California Annenberg School for Communication and Journalism, Modern Healthcare used the Centers for Disease Control and Prevention social vulnerability index, along with Health Resources and Services Administration access scores, to identify areas with common problems but unique circumstances, including Evangeline Parish, Louisiana, the Bronx, New York, and Navajo County, Arizona.

Driving north through Navajo County in Arizona, a Ponderosa pine forest in the Fort Apache Reservation thins out to the arid plains of the Colorado Plateau. A mostly remote area about the size of Massachusetts, this part of Arizona is home to a diverse population of White Mountain Apache, Hopi and Navajo peoples. Scattered between the reservations are small, predominantly Mormon communities, the remnants of trading posts and formerly bustling towns along historic Route 66.

Fern Benally, a member of Navajo Nation and a Democrat who sits on the Navajo County Board of Supervisors, visits village chapters monthly, making plans to improve the roads. Local authorities struggle to maintain even basic infrastructure because of the layers of bureaucracy governing tribal lands and stipulations tied to funding, she said. And jobs are scarce.

The federal Indian Health Service has a handful of facilities nearby, but doesn’t offer many services and employs a small number of clinicians. Many residents have to travel about three hours to Flagstaff or to New Mexico for specialty care, Benally said. Many tribal members go long distances for primary care as well, said Janelle Linn, health director for the county public health agency.

Local providers struggle to hire and retain clinicians. Newly minted doctors come to the area to qualify for federal loan forgiveness, but they don’t tend to stay longer than they have to. Turnover fractures relationships with patients and causes them to believe they are receiving poor care, Benally said. “They feel like the doctors are just practicing on them,” she said.

Creating opportunities for people from the area to become health professionals would give them a path to economic success and benefit the community, Benally said. Navajo County is 53% white and 45% Native American. Twelve percent of the population identifies as Hispanic or Latino.

“We need to recruit doctors for the long term, bring in specialty physicians and grow our own as well,” Benally said. “Many of our students go off the reservation to get good educations, and I think that Native people should be encouraged to come back to the reservation to work and help the growth.”