The tiny number of Indigenous students in U.S. medical schools has long been a concern, but Native American medical leaders were taken aback to see 22% fewer American Indian or Alaska Native students had enrolled last year when numbers were released in January.
“It’s pathetic, isn’t it? It’s so small,” said Donald Warne, a Lakota physician and co-director of the Center for Indigenous Health at the Johns Hopkins Bloomberg School of Public Health, as he looked closely at tables showing the size of this year’s incoming group during an interview with STAT: Just 201 out of more than 21,000 students accepted nationwide.
For Mary Owen, a Tlingit physician and associate dean of Native American health at the University of Minnesota Medical School, the sharp drop was just more bad news. “The bigger picture is we have had no increase in decades. We’re going nowhere,” she said. Analyses have shown that the enrollment of Native American and Alaska Native students in medical school has remained just a fraction of 1% for the past four decades.
In interviews with STAT, leaders in Native American medical education, and students themselves, said the declines were due to a combination of factors, including the impact of the Covid-19 pandemic as well as inflation making the cost of medical school even more unaffordable. They said the decline was a clear signal that more needed to be done to support Indigenous students interested in health careers, both for the sake of underserved people in their communities — and for the future of medicine more broadly.
A 2023 Lancet paper predicted it would take more than a century for Native American physicians to reach parity with their percentage in the national population, which is 3%. Of the nation’s nearly 1 million physicians, just 0.3% are Native American or Alaska Native. That goal may be even more distant now, given last year’s decline in enrollment and the Trump administration’s hostility toward efforts to promote diversity in medicine and society at large. But work to increase the numbers of Indigenous physicians remains critical, said Alec Calac, a M.D./Ph.D. student at the University of California, San Diego, and one of the Lancet study’s authors. He is also a member of the Pauma Band of Luiseño Indians.
“I was the only American Indian student in my medical school class of 134,” he recently told an online gathering of the Roundtable on Black Men and Black Women in Science, Engineering, and Medicine. “We do not see ourselves represented … and it is extremely hard to be what you cannot see.”
The precipitous enrollment decline came in the wake of a 2023 Supreme Court decision to limit the use of race or ethnicity in admissions, something that has roiled the world of higher education and led to drops in Black and Hispanic students at many universities and also medical schools, which saw double-digit declines of students from both groups this year.
But that decision should not have affected Native American enrollment, leaders say. The designation Native American/Alaska Native is a racial one, but also a political one. Being an enrolled member of a federally recognized tribal nation is a political designation protected by treaties. These students are therefore not included, many experts believe, in the court’s ban on racial or ethnic affirmative action. (Sen. Lisa Murkowski, the Alaska Republican who chairs the U.S. Senate Committee on Indian Affairs, made a similar argument in a recent letter to the Office of Management and Budget asking it to ensure that tribes, their programs, and their federal funding are not impacted by President Trump’s executive orders prohibiting programs promoting diversity, equity, and inclusion.)
Still, many leaders think the Supreme Court decision did have an impact on Native American students, both because it may have discouraged some from applying and because many — including some students and medical school admissions leaders — aren’t aware of the political designation Native American students hold and the protections it affords.
“It’s something that people don’t understand in this country,” said Erik Brodt, an Ojibwe physician who directs the Northwest Native American Center of Excellence at the Oregon Health & Science University School of Medicine.
For Brodt and others, it’s clear that the reasons for the decline in admissions are deeper rooted, and go back several years further, than the Supreme Court’ ruling. They believe they are seeing the long tail of Covid-19’s impact on Native communities, some of which saw mortality rates much higher than the rate of the general U.S. population. When schools suddenly switched to remote learning, many Native students had little access to broadband service, and their education suffered.
“Covid really disrupted families in our communities. It was just off the charts, crazy different than for other people,” said Brodt, who lost family members to Covid and had students who lost family members as well. “If you’re grieving, if you don’t have the resources to stay in school, if you don’t have access to broadband, of course you are going to have drawbacks.”
What is most concerning to him is that Indigenous students, unlike other groups, saw declines not only in enrollments but also in applications to med school. While Black and Latino applicants increased by more than 2%, Native American applicants decreased by more than 15%. “That’s a bigger red flag,” he said. “That shows a real achievement and enrichment gap.”
Owen said the pandemic also shut down or shrank many pipeline programs that support and encourage Native American students hoping to enter the medical profession. “Students don’t have enough guidance counselors supporting them,” she said. “They are not getting the message they can do this.”
That’s one reason she founded IHEART, the Indigenous Health, Education, and Resources Taskforce, a national collaboration to address the scarcity of Native Americans in health professionals and provide more support. Indigenous students, she said, often don’t have relatives who are doctors, like nearly a quarter of medical students, and often face financial and educational challenges. “People should be supported all the way to kindergarten. Even prenatal in my mind,” she said.
Such support is key to success, say recent medical school grads from tribal communities. Jake Smith is a member of the Walla Walla tribe, part of the confederated tribes of the Umatilla Indian Reservation in northeastern Oregon, who grew interested in medicine because of health challenges such as dermatitis he faced as a child and because of the many health disparities he’d seen in his own family; some of his grandparents died so young he never got to know them. He originally wanted to become a physical therapist after seeing his mother’s uncle, a medicine man, recover from a severe stroke after rehab, before he decided he wanted to be a physician instead.
Smith was one of the first in his family to attend college, but went to a small school in Oregon, Linfield University, where only a handful of students in his class were pre-med. “Someone down the hall had a parent who was an orthopedic surgeon so I glommed onto them,” he said, but he didn’t get much official career advice. “I got out and said, ‘What’s this MCAT I have to take?’”
Since he hadn’t known to take prep courses for the medical school admissions test, he didn’t do well enough to be admitted. So he enrolled in Wy’East, OHSU’s tuition-free post-baccalaureate physician pathway program. “For the first time, it was like, ‘Oh, my gosh, look at all these like-minded people from the same family background,’” he said. “That was incredible.” Smith is now a second-year resident in dermatology — a field with only about 30 Native Americans.
Jasmine Curry-Thomas is a citizen of the Navajo Nation. She said she’d never seen a Native American physician until she accidentally ran into one at a Jamba Juice on the University of Arizona campus where she was attending college. “I was starstruck,” Curry-Thomas said. “I thought, ‘Wow. She’s from where I’m from and she did it. I can do it, too,’” she said. She did. A graduate of Wy’East and now a second-year family medicine resident at OHSU, she said she thought economic factors, like the inflation of recent years, were a definite factor in declining enrollments.
“It can be difficult to consider a career in medicine for the most marginalized populations,” given the education costs, she said. “A career in medicine is not a quick fix for long-term problems.”
Brodt is proud of these graduates, but also concerned that fewer and fewer will follow them. “What we are doing at OHSU is amazing, and it works, but it won’t make a difference unless 20 to 30 other schools are doing it too.”
Warne, of Johns Hopkins, would like support of Indigenous students to go much further; he’d like to see the creation of an Indigenous-led medical school. He’s currently assessing the feasibility of such a school now. He envisions this Indigenous School of Medicine to be on tribal land and to be built around cultural components important to Native Americans, such as strong connection to community culture. Many Native American students have experienced historical trauma and poverty and their cultural needs are often not met in medical school, he said. “Traumatizing them further is really stupid,” he said.
He said the school would benefit non-Native students as well. “A quarter of all medical students want to quit medicine,” he said, citing recent reports. “What if medical school was a healing experience?”
While a new medical school campus on the Cherokee Nation opened by Oklahoma State University last year graduated its first class, which included nine Native American physicians, that school — like every other medical school in America — does not have top leadership that is Native American. “We’re not underrepresented in medical leadership, we’re unrepresented,” he said. “We have zero medical school deans. We’re not at the table.”
Training more Indigenous physicians, he added, could be critical to the country staving off a crisis in rural medicine as many rural doctors retire in coming years. It’s something, along with the increasing lack of maternal health care in rural areas, that Warne calls a “ticking time bomb.” Indigenous physicians, Brodt added, are among the most likely to serve under-resourced areas. “You’re so tied to land and community and culture and tied to serving that you go back,” he said
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