I was in the public health service Jr-COSTEP program as a med student and worked for the IHS out of the Billings office, and then interviewed for a couple of positions in the Albuquerque and Phoenix service areas after residency. I now work in Anchorage for the hospital that serves Alaska Natives but is not IHS. I don't understand the ins and outs of my current employer's status; there is a local corporation that runs it but I am entitled to some federal benefits. I think it was the Indian Self-Determination Act that gave local tribes the ability to receive federal funding to take over their own health care services in place of IHS. Congress has not been particularly generous with funding the IHS and the people I worked with out of Billings felt that tribes privatizing health care services was making it even tighter. Most of the facilities are in pretty remote locations and struggle to recruit anyway and when they're understaffed, I'm sure it's tougher. Some of the facilities are shiny and new and there are some that looked pretty out of date. Funding to different service areas may be wildly different.
The job interview experience was mixed- I was able to set up three interviews at three different facilities in one trip, which was nice. One of the recruiters was pretty green, though, and it turned out that she hadn't communicated well enough with the psychiatrists to understand that they needed someone to do mostly inpatient work, which I wasn't allowed to do because I was in the NHSC. There was one job that I was seriously considering, but the gears of bureaucracy ground so slowly that I had to give up- I interviewed in early October and got a verbal offer the day of the interview- but they couldn't? didn't? send anything in writing until late May. In between when I interviewed and when they got back to me, the one psychiatrist they had had resigned, and they wanted three or four psychiatrists. There was some tension with the emergency room staff because they had wanted psychiatrists on call, and one person couldn't do that. Salary wasn't the most generous offer that I got right out of residency but I think it was second best, and benefits were good. I'm pretty sure that there are housing shortages on every reservation and the options for staff were kind of like student housing, although larger units.
My current employer didn't take as long as the IHS with the interview process, but it was the slowest process I've been through besides the IHS, and the paperwork for credentialing was the worst I've dealt with. Worse than FCVS. It's a management-heavy organization and they don't understand the perspective of providers because many of them don't have any medical training. There wasn't any cultural orientation but I gather that the local IHS hospital had been a pretty negative experience for lots of patients; this organization is so patient-centric that it seems at times to have a negative impact on the service we can provide. Like being told that we need to provide a psychiatric assessment at the time of visit, even if someone shows up 55 minutes into an hour long appointment. The option for integrated care is pretty nice, though, and not worrying about insurance is a huge luxury.
