Witnesses back bill to create IHS graduate medical‑education office; HHS flags implementation questions
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Summary
HR 3670 would establish an Office of Graduate Medical Education in the Indian Health Service with an initial authorization of $4 million per year to expand residency and fellowship opportunities inside IHS facilities; witnesses cited severe staffing shortages and evidence that training in place increases retention.
The subcommittee considered HR 3670, the Indian Health Service Provider Expansion Act, which would amend the Indian Health Care Improvement Act to establish a permanent Office of Graduate Medical Education within IHS and authorize $4,000,000 per year to stand up and operate the office.
Representative Stansbury, sponsor of the bill, and Dr. Adrienne Begay, a physician and senior advisor with the HEAL Initiative, said the office would create a pipeline to train more clinicians in tribal and IHS settings and help reduce chronic provider shortages. Begay told the subcommittee that IHS covers services in 37 states, serves more than 2 million people, and is operating with large vacancy levels: testimony stated IHS had more than 1,330 vacancies and that primary clinical positions average approximately a 33% vacancy rate.
Begay cited national data showing training location strongly predicts practice location: residents trained in rural or tribal settings are far more likely to stay and practice in those areas. She said that of the 145,000 medical residents nationwide only 77 train full time at IHS, tribal, or urban Indian sites (about 0.05%). The bill’s proponents pointed to existing tribal residency and fellowship programs with high retention—four tribal family medicine residencies retained 51 percent of graduates within the IHS system and three Oklahoma tribal residency programs retained 72 percent in rural practice.
Daryl LaRoche, acting deputy director of IHS, told the committee that IHS supports development of mechanisms to expand training but raised technical questions: the written testimony and oral remarks noted the bill does not include a detailed implementation plan, that the $4,000,000 figure appeared in prior budget requests and may require further technical analysis, and that long‑term sustainability would depend on additional appropriations and interagency coordination. LaRoche said IHS would welcome an interagency workgroup and technical assistance from the committee to design the office for long‑term stability.
Members asked about cost assumptions, how the office would coordinate with academic medical centers, and how training programs have produced demonstrable retention gains. Witnesses urged Congress to create the office to build a culturally competent workforce that can provide care in Indian country.
No committee vote occurred during the hearing.