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Published On June 17, 2019

POLICY

Homegrown

Kayse Shrum is launching the first U.S. medical school affiliated with a Native American tribe—part of a strategy to train doctors where they’re needed most.

Kayse Shrum, president of Oklahoma State University Center for Health Sciences, didn’t start to think about a career in medicine until she was in college. Growing up in Coweta, Oklahoma, a town with a population of fewer than 10,000, Shrum had pictured herself in one of the careers held by people she knew in her community. She didn’t dream of being a physician simply because there weren’t many around.

Encouraged by a professor, Shrum applied to medical school, earned a doctor of osteopathic medicine degree and embarked on a journey that took her through programs at Harvard and Stanford. Along the way she worked to raise awareness of medicine as a career option among Oklahoma’s rural and Native American young people.

Most recently that effort has culminated in the creation of the nation’s first tribally affiliated medical school. The Oklahoma State University College of Osteopathic Medicine at the Cherokee Nation, located in Tahlequah, is scheduled to open with its first class of 50 students in 2020.

Q: How did the partnership with the Cherokee Nation come about?

A: We have been partnering with the Cherokee Nation for more than a decade to train primary care doctors for rural Oklahoma. The Cherokee Nation has allowed our students to do rotations there, and many of our graduates practice at the Cherokee Nation. During Chief Bill John Baker’s two terms as principal chief, he has made improving the health outcomes of the Cherokee people a top priority for his administration. It’s invested hundreds of millions in building new clinics and renovating existing ones and is also currently working on building an outpatient health facility.

If you look at national statistics, 0.5% of students across the United States in osteopathic and allopathic medical schools are Native American. At OSU, in the past three years, 12% to 18% of our medical students have been Native American. So the Cherokee Nation looks at us and says, “They’re dedicated to recruiting and training more Native Americans in medicine and we’re dedicated to improving the health of the Cherokee people. So let’s work together in this shared vision.”

Q: What are the issues facing rural Oklahoma?

A: Oklahoma has traditionally ranked pretty low in most health outcomes, in part because of the shortage of primary care physicians—in some counties, there is not a single one. The federal government considers all but one county in Oklahoma to be a health-professional shortage area. We have very high rates of preventable death, cardiovascular disease, diabetes and obesity.

In Stilwell, which is inside the Cherokee Nation’s jurisdictional area and about 30 minutes away from where our new medical school will be, life expectancy is 56.3 years. That’s the lowest in the United States, and it’s on par with sub-Saharan countries such as Uganda and Mozambique. When I met with my team several years ago, I said we need to look at what we can do to not be in the bottom 20% in health outcomes. We have made some tremendous gains over the years, but we need to do more. Growing our own rural doctors in partnership with the Cherokee Nation is a step in the right direction that will have meaningful health impacts on rural Oklahomans for years to come.

Q: How will a medical school help?

A: A few factors govern where people practice in the prime of their careers: where they grew up, where they did their undergraduate work, what their medical school focused on, and, of course, where they did their residency training.

We’ve done some studies on our residency programs and how they affect longer-term career decisions. When our graduates train in an urban area, 80% of them stay within a 100-mile radius of where they did their residencies. We also have seven rural residency programs, some of which are funded by the federal Health Resources and Services Agency. These federal grants have allowed us to set up residency programs in smaller rural communities, which is great. Those doctors tend to stay in those areas to practice.

What’s really interesting is that the more rural the area where residents train, the higher the retention rate. If you start a rural residency program close to an urban area, urban health systems start recruiting them out. When it comes to the more rural areas, those students are choosing to go there and there’s a desire to stay and serve in these communities. You stay, you build relationships and you make a difference. We hope that our new medical school in Tahlequah will do just that.