Indian Health Service

Indian Health Service (IHS) salary schedules for health care professionals are set on a national basis. Thus, the base pay these persons receive does not differ among IHS regions or areas. However, bonuses and allowances may be paid to doctors who agree to work in hard-to-fill locations, such as the Aberdeen Area. In many IHS areas, health care delivery has been hampered by problems in recruiting and retaining health care professionals, particularly doctors. The recruitment and retention of physicians in the Aberdeen Area has been affected by the relatively low pay; inadequate housing for medical personnel on the reservations; remoteness of the reservations; cultural differences between the doctors and their patients; and a general lack of amenities, such as shopping and dining. IHS' Aberdeen Area has a higher vacancy rate for physicians than all but one other IHS area. The vacancy rate has been particularly high, more than 31 percent, at the Pine Ridge hospital. IHS is now looking at the benefits of using a physician pay structure similar to that used by the Department of Veterans Affairs.

GAO found that: (1) although all IHS health care professionals receive the same amount of base pay, certain physicians receive additional bonuses or allowances to compensate for their duty in undesirable locations; (2) IHS has had difficulty in delivering adequate health care in many states because of problems in recruiting and retaining qualified physicians and health care professionals; (3) physician recruitment and retainment in the Aberdeen service area is hampered by the relatively low pay offered, lack of adequate housing for health care professionals, remoteness of reservations, cultural differences between the physicians and their patients, and general lack of amenities; (4) the Aberdeen service area has a higher vacancy rate for physicians than all but one other IHS area; (5) the vacancy rate at the Pine Ridge, South Dakota, hospital has remained particularly high; (6) VA has experienced similar problems in recruiting and retaining physicians in isolated areas; and (7) to increase physician recruitment and retention, IHS is considering adopting the VA physician pay structure, increasing physicians' base salary, increasing loan repayment and scholarship programs, reducing IHS physicians' workload, and involving health professionals in cultural activities.