On January 23, 2012, the Department of Health and Human Services (HHS) issued a federal register notice defining “priority health professions” for the Indian Health Service loan repayment program, which awards up to $20,000 per year for the repayment of qualified student loans in exchange for an initial 2-year service obligation to practice full-time at an Indian health program site. Naturopathic medicine was included in the list for the first time, representing the culmination of work by the American Association of Naturopathic Physicians (AANP) and the grassroots efforts of its student and physician members. HHS and the Indian Health Service have opened their doors to naturopathic doctors, and American Indians and Alaska Natives will now have access to naturopathic medicine.
IHS has created its list of “priority health professions” based on the expressed needs of its constituents and ranked those positions in order of priority. Naturopathic medicine is currently last in the list of priorities, indicative of the need to educate stakeholders on how naturopathic physicians can improve the health status of American Indians and Alaska Natives. Each site conducts its own ranking of needs for health professionals based on a set of criteria that includes critical shortages, as well as current or projected vacancies. Approval of applications by licensed naturopathic physicians will rely on how the tribes rank their needs. Priority will be given to the applications of professionals who themselves are American Indian or Alaska Natives, as well as to “individuals recruited through the efforts of Indian Tribes or Tribal or Indian organizations.” Herein lies the opportunity for the profession to highlight the need for naturopathic physicians.
Naturopathic medicine was included in the list for the first time, representing the culmination of work by the American Association of Naturopathic Physicians and the grassroots efforts of its student and physician members.
Inclusion in the IHS LRP regulatory language is indeed a monumental victory, paving the way for inclusion in all federal loan repayment programs and cementing the credentials of a naturopathic medical education. However, applicants to the program will only be accepted for positions advocated for by the tribes themselves, necessitating the creation of strong professional relationships and cultural understanding of healthcare delivery on native lands. There are examples of highly successful relationships with tribes that have hired NDs independent of the IHS and its policies, and we have a great opportunity to replicate these programs. Naturopathic medical schools and the Association of Accredited Naturopathic Medical Colleges (AANMC) will spearhead this work.
Although HHS has always held the authority to enumerate professions other than those named in statute, in the past applications of naturopathic physicians were consistently denied. On the advice of counsel, AANP initiated a legislative campaign in 2003 to change the law to include naturopathic physicians in the IHS loan repayment program. From 2000 to 2010, legislation reauthorizing the Indian Health Care Improvement Act (IHCIA), which provides legal authority for provision of healthcare to the nation’s Native Americans and Alaska Natives, slowly moved through Congress. During that time, AANP was successful in its efforts to include naturopathic medicine in the House of Representative’s legislation. Finally, in order to secure the long-awaited reauthorization of the Act, the IHCIA was tacked onto healthcare reform bills in both the House and the Senate. Through a series of legislative maneuvers designed to secure highly contentious healthcare reform provisions, the House passed the Senate bill with no amendments and no conference negotiations. The Patient Protection and Accountable Care Act became law. The IHCIA was reauthorized. Naturopathic medicine, however, was not included in the Senate bill language, meaning naturopathic doctors remained excluded from the IHS loan repayment program.
Last year, AANP re-engaged in discussions with HHS and IHS on the topic of eligibility for all federal loan repayment programs. As a result of all this effort, licensed graduates of accredited naturopathic medical schools will be applying through August 2012 to the IHS loan repayment program. AANMC is working with AANP to gather additional information on the provision of health care inside the system and successfully position naturopathic medicine by identifying potential partnerships with geographically and philosophically like-minded tribes. With patience and planning, we will create opportunities for graduates that will lead to broad-based utilization of naturopathic medicine.