By Michelle Wein and Kate Frieden
Recently, MHC Insight presented findings on Michigan’s American Indian and Alaskan Native (AIAN) healthcare workforce at the Tribal Healthcare Workforce Summit. At the Summit, we discussed the state of the current AIAN workforce– including top occupations and employers, occupations with the highest need for workers, and declines in practitioners– and workforce recommendations. This data represents individuals who self-identify as AIAN, and does not include individuals of two or more races, which often includes many individuals with an AIAN background.
Findings
The top five healthcare occupations among AIAN practitioners are Home Health and Personal Care Aides, Registered Nurses, Nursing Assistants, Medical Assistants, and Pharmacy Technicians. There is difficulty associated with promoting these careers to individuals in this community, since AIAN practitioners represent less than one percent of each occupation’s workforce in the state by race and ethnicity.
Top Occupations
American Indian or Alaskan Native Practitioners by County
The colored dots represent Tribal Health Center and Urban Indian Health Organization locations in the state of Michigan. Each county has a different shade of blue that pertains to the number of AIAN healthcare practitioners—the deeper the color, the more AIAN practitioners work there.
The metro Detroit area (Wayne and Oakland counties) has the most AIAN practitioners because a little over 30 percent of the state lives there. Many counties with or surrounding a Tribal Health Center or Urban Indian Health Organization location have more AIAN practitioners than counties without or not in the vicinity of a location. As a reminder, this heat map shows practitioners who solely identify as AIAN and omits any practitioners who may identify as AIAN along with another race or ethnicity.
Overall, there has been a steady decline in AIAN practitioners over the last ten years. Nursing Assistants had the highest decline, with 137 practitioners, followed by Registered Nurses with 65. This decrease in active practitioners demonstrates the need for more AIAN healthcare workers across the state.
Occupations with Highest Need for Workers
There is great demand for AIAN representation in many underrepresented occupations. Dentists, Orthodontists, Prosthodontists, Clinical and Counseling Psychologists, School Psychologists, and several other occupations have the highest need for workers, with many having fewer than ten practitioners of AIAN descent.
Top Employers
Many career opportunities can be found at Tribal Health Center and Urban Indian Health Organization locations across the state. American Indian Health and Family Services, the Pokagon Band of Potawatomi, and the Nottawaseppi Huron Band of the Potawatomi had high numbers of total job postings over the past two years. However, the Pokagon Band of Potawatomi, the Sault Ste. Marie Tribe of Chippewa Indians, and the Keweenaw Bay Indian Community had the most unique job postings, meaning they posted about the most job opportunities.
Recommendations
A substantial body of literature suggests that fostering a diverse and inclusive workforce is critical to increasing access to care and improving aspects of healthcare quality among underserved populations, including American Indians and Alaskan Natives. Some studies have suggested that a diverse workforce may improve healthcare professionals’ cultural competence and better prepare them to respond to the needs of the entire population. Literature on patient-physician concordance suggests that diversity may be important for the quality of care with regard to patient communication, preventive care, and patient satisfaction.
Having more AIAN healthcare practitioners around Michigan will ultimately result in better quality of care for the AIAN population, and also increase the amount of care provided in many rural and underserved communities.¹ Tailoring solutions to this problem should be the focus of a diverse group of stakeholders around Michigan– from government officials, health systems, colleges and universities, workforce development professionals, and the tribal members themselves.
MHC Insight’s extensive experience and access to nationwide labor market information help create a better understanding of healthcare professions. Visit mhc.org/contact to learn more or to request custom data.
Notes
¹ Lyndonna M. Marrast et al., “Minority Physicians’ Role in the Care of Underserved Patients: Diversifying the Physician Workforce May Be Key in Addressing Health Disparities,” JAMA Internal Medicine 174, no. 2 (February 1, 2014): 289–91, https://doi.org/10.1001/jamainternmed.2013.12756; Kirsten Wilbur et al., “Developing Workforce Diversity in the Health Professions: A Social Justice Perspective,” Health Professions Education 6, no. 2 (June 3, 2020): 222–29, https://doi.org/10.1016/j.hpe.2020.01.002; Joel C. Cantor et al., “Physician Service to the Underserved: Implications for Affirmative Action in Medical Education,” Inquiry: A Journal of Medical Care Organization, Provision and Financing 33, no. 2 (1996): 167–80; Patricia Gurin et al., “Diversity and Higher Education: Theory and Impact on Educational Outcomes,” Harvard Educational Review 72, no. 3 (2002): 330–66, https://doi.org/10.17763/haer.72.3.01151786u134n051; Megan J. Shen et al., “The Effects of Race and Racial Concordance on Patient-Physician Communication: A Systematic Review of the Literature,” Journal of Racial and Ethnic Health Disparities 5, no. 1 (February 2018): 117–40, https://doi.org/10.1007/s40615-017-0350-4; Amelia Goodfellow et al., “Predictors of Primary Care Physician Practice Location in Underserved Urban or Rural Areas in the United States: A Systematic Literature Review,” Academic Medicine: Journal of the Association of American Medical Colleges 91, no. 9 (September 2016): 1313–21, https://doi.org/10.1097/ACM.0000000000001203; Elizabeth A. Mertz et al., “Underrepresented Minority Dentists: Quantifying Their Numbers And Characterizing The Communities They Serve,” Health Affairs 35, no. 12 (December 2016): 2190–99, https://doi.org/10.1377/hlthaff.2016.1122; Jordan J. Cohen, Barbara A. Gabriel, and Charles Terrell, “The Case for Diversity in the Health Care Workforce,” Health Affairs 21, no. 5 (October 2002), https://doi.org/10.1377/hlthaff.21.5.9
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