Document Type



Purpose The Indian Health Service (IHS) has a critical need to determine its needs for mid-level health providers (MLHPs), i.e., Physicians Assistants, Nurse Practitioners, Certified Nurse Midwives and Clinical Nurse Specialists through the Year 2000 and to address recruitment of MLHPs. Methods Initially, a literature search and review of available IHS documentation on MLHPs was completed. In 1993, the authors developed an MLHP Survey Instrument, Site Visit Protocols, and Case Study Protocols and Methodology for data collection purposes. The site visits and case study were conducted in January 1994. The field site visits were conducted at IHS facilities in Tahlequah, Oklahoma, Gallup, New Mexico, and Albuquerque, New Mexico. The case study was conducted in Albuquerque. The MLHP and Primary Care Manager Surveys were mailed out to IHS Service Units in February 1994. Surveys were sent only to IHS facilities. Results This study resulted in obtaining responses from 119 MLHPs (43% of the curren MLHP staff) and 14 of the primary care managers. The surveys confirmed the MLHPs are making a major contribution to the IHS primary care program and are well utilized. The MLHPs indicated throughout the IHS that increases in salaries, continuing medical education (CME) benefits and recognition as a health care professional with policy making privileges, are key retention points for consideration in their decisions to stay within the IHS. Conclusion Recommendations include: 1) increase MLHP salaries; 2) establish a chief MLHP at each direct care facility; 3) establish a competitive CME program for recruitment and retention purposes; 4) provide increased administrative support for MLHPs; 5) establish a Native American Recruitment Master Plan; 6) establish a part time employment program; and 7) establish Satellite Programs to enhance MLHP training opportunities.

Publication Date



Indian Health Service, Staff Office of Planning, Evaluation and Research, Rockville, MD 20857 (SSI-01).