Our country’s 5.2 million Native Americans represent around 1.7% of the U.S. population—but only .56% of active physicians and .48% of full-time faculty members at U.S. medical schools and teaching hospitals nationwide. It’s a discrepancy that Tom Sequist, MD, Partners HealthCare Chief Quality and Safety Officer and physician at Brigham and Women’s Hospital (BWH), has been determined to change since his first year at Harvard Medical School (HMS).
“I was the first person in my family to finish college, so I didn’t have a playbook for getting into medical school,” says Dr. Sequist, whose family comes from the Taos Pueblo tribe in New Mexico. “The rules aren’t written anywhere, so I set out to give other students the direction I would have wanted.”
The result is the 25-year-old Four Directions Summer Research Program, a combined BWH/HMS initiative that Dr. Sequist still leads. The program cultivates promising Native American undergraduate students with the skills and confidence they need for graduate education in medicine. Participants complete a mentored research project; shadow physician-mentors; attend seminars to build writing and presentation skills; and expand their professional networks by meeting leaders across clinical and administrative roles.
The program’s impact, says Dr. Sequist, is measured in two ways. “Does the student feel both more motivated and more prepared to apply to graduate school? We work heavily on those,” he says. “But we also tell them that we provide lifelong career mentoring—and we stay in touch long after the eight weeks end.”
The program has resulted in a high rate of matriculation among participants into medical school or related graduate programs. Importantly, data from Indian Health Service (IHS) research also led by Dr. Sequist shows that as many as 14% of Native American physicians will self-select to serve native communities—which makes the program even more vital in light of the urgent need for clinicians in these underserved pockets of the country.
“There is a dramatic shortage of specialists—across specialties but particularly in mental health—in the rural areas where native populations live. It’s an urgent issue in the context of health equity.”- Dr. Tom Sequist
Wearing his quality and safety hat, Dr. Sequist develops initiatives supporting Brigham Health efforts at the intersection of health equity and community outreach. One program, the Brigham and Women’s Outreach Program with Indian Health Service, helps to fill the gap in specialty care in these south-western rural communities by both bringing physician volunteers to American Indian reservations and making their ongoing expertise available to clinicians there through telemedicine and continuing medical education (CME).
The idea behind the effort is to give general clinicians practical knowledge and experience in specialized areas of medicine, and create a cycle by enabling information sharing within their own physician community. For instance, Brigham Health psychiatrist and addiction specialist Joji Suzuki, MD, recently trained 35 IHS clinicians to prescribe suboxone, a medical treatment for opioid use disorder that now has the potential to provide real and meaningful treatment for what has become an epidemic in reservation communities. Brigham Health psychiatrists are also available via telemedicine to consult on patient cases and routinely lead remote CME talks to IHS on topics such as pain and addiction, alcohol withdrawal treatment, and depression in patients with alcohol use disorders.
Positive outcomes of these programs, Dr. Sequist notes, can be found across the system, patient, and physician levels. “In terms of physician wellness, the opportunity for our clinicians to go and make a direct impact on an underserved community is fulfilling,” he says. “Many of them say that it recharges their batteries and reminds them why they went to medical school in the first place.”
Read more about the Four Directions Summer Research Program and the Brigham and Women's Outreach Program with Indian Health Service.
Pictured in banner above; Four Directions Summer Research Program class of 2016.