More Than a Clinic: What Native Healthcare Means to My Family

My grandmother has had both hips replaced and procedures performed on her heart valves. Each time, her care began with doctors at her Choctaw clinic, evaluating what she needed and referring her for treatment they could not provide there.

She has Medicare, and she told me she paid nothing out of pocket for those procedures.

In her words, “I am blessed for sure.”

When I think about what Native healthcare means to my family, that is where I begin. My grandmother received care she needed without those procedures becoming a financial burden. As a mother, I also find comfort in knowing that my children and I have a Choctaw clinic we can turn to.

I have spent much of my career in healthcare staffing, dedicated to identifying the communities that need more clinicians—and what happens when positions remain unfilled. As a member of the Choctaw Nation, those questions are personal, too.

During National Native American Heritage Month, I want to share that perspective while recognizing its limits. My family’s experience with the Choctaw Nation of Oklahoma does not represent every Native family or every tribal health system. Available services, eligibility, funding and geography can make someone else’s experience very different.

Understanding the systems behind Native healthcare

Healthcare for American Indian and Alaska Native people is connected to treaties, federal law and the government-to-government relationship between the United States and sovereign tribal nations. The Indian Health Service identifies these as foundations of the federal responsibility to provide healthcare.

How that care is delivered varies. Some people receive services directly through the Indian Health Service. Others receive care through tribally operated health systems or urban Indian organizations. These organizations serve distinct communities, with different resources, priorities and needs.

The Choctaw Nation operates its own health system, including a hospital in the small rural town of Talihina and clinics across southeastern Oklahoma. For my family, those facilities provide a place to begin when a health concern arises. My grandmother’s experience also shows why connections to care outside the system matter. Her clinic could evaluate her needs and help her reach services it did not provide locally.

That coordination is an important part of access. So is understanding what a program covers. My grandmother’s financial experience should not be read as a promise of the same outcome for everyone. Choctaw Referred Care can help pay for approved services if patients meet eligibility requirements, use other available sources of payment first, and program funds are available.

Having a clinic does not remove every barrier

My grandmother’s brother, George, travels from Little Rock, Arkansas, to Talihina, Oklahoma, for audiology, dental and vision care. It’s an 180 mile drive, one way. 

Distance is also only part of the experience. When my grandmother and I talked about care, she emphasized the importance of being heard. As she put it, “the doctors have to listen, and listen again.”

That observation stayed with me. A clinician needs to understand the concern that brought someone into the office, but also what may affect the next step. Can the patient travel for a referral? Do they understand the treatment plan? Have their questions been answered?

Trust develops through those interactions. A familiar location can help, but patients still need clinicians who take their concerns seriously and follow through.

My grandmother’s story holds both realities: gratitude for the care she has received and an understanding that getting care can still take effort. 

The people who make access possible

Behind every appointment and referral are dedicated healthcare professionals doing the work: physicians, advanced practice providers, nurses, dentists, pharmacists, behavioral health professionals and the staff coordinating care.

Recruiting and retaining that workforce can be difficult, particularly in rural settings. A 2018 Government Accountability Office report, using November 2017 data, found a 25 percent clinical provider vacancy rate across eight Indian Health Service areas where the agency provided substantial direct care. 

That is a historical finding about federally operated IHS services. It is not a current vacancy rate for the Choctaw Nation or for all tribal health systems. Still, the report documents how persistent vacancies can affect patients’ access and place pressure on the clinicians who remain.

Through my work in staffing, I see why temporary coverage can be useful while a facility recruits a permanent clinician or addresses a specific gap. It can help keep appointments available or give an existing team needed relief. 

Support should follow the community’s priorities

For a staffing partner, the first step is understanding what the facility and its leadership need.

That means learning how the health system operates, how referrals work, what resources are available and how an incoming clinician will work with the local team. It also means respecting tribal governance and approaching each community without assuming that experience in one setting prepares someone for every other setting.

At Barton, we’ve placed more than 800 providers at more than 100 tribal and IHS-affiliated facilities across 23 states. 

Thoughtful orientation, clear handoffs and repeat assignments where feasible are practical ways to support continuity. Local teams should help determine what preparation is necessary and whether the arrangement is working.

Temporary staffing can be one part of a workforce plan. Lasting access also depends on permanent recruitment and retention, opportunities for Native people pursuing healthcare careers, facilities and resources that support care, and tribal leadership’s ability to set priorities.

What I want people to understand

I am grateful that my grandmother has a place to turn when she needs care. I am grateful that clinicians recognized when she needed treatment elsewhere and helped her take that next step.

Her experience gives me a concrete understanding of what a health system can mean to a family. It also makes me want to understand where the gaps remain and how the people responsible for care want to address them.

For those of us working in healthcare staffing, that requires listening before proposing a solution. We need to understand what a Nation has built, what its care teams need and where outside support would be useful.

My grandmother’s words are a good place to start: listen, and listen again.