"A generation ago about half of all medical students picked general medicine over a specialty practice; today’s it’s only about 30 percent. In the larger health care system the main reason for that disparity is wealth. Specialists earn far more than general practioners; a gap of more than $100,000 per year.

The Patient Protection and Affordable Care Act addresses this shortage with several provisions. For example bonuses will be paid for Medicare and Medicaid for primary care practices and repayment of student loans for underserved areas with the National Health Service Corps.

The Indian health system represents one of those underserved areas. The Congressional Research Service recently reported: “The IHS has a high vacancy rate in many of its health professions, 20 percent for physicians, dentists, and nurses, for instance, as of December 2008.” The new law opens up a number of options for American Indians and Alaska Natives interested in health careers: scholarship and loan repayment programs; incentives designed to encourage health professionals to work at Indian health, funds for continuing education and new demonstration projects using students. There will be new grants for “teaching health centers” and for expanding or creating primary care residency programs. The law also allows for newly accredited or expanded primary care residency programs.

But even then will that be enough? How long will it take to fill those pipelines? The answers might not come from a doctor."

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