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Preserving a critical pathway

U fights to save the enter of American Indian and Minority Health

Recent federal budget cuts threaten a successful University of Minnesota program that has graduated more American Indian physicians than all but one other medical school in this country. The Center of American Indian and Minority Health (CAIMH), located on the University of Minnesota Medical School’s Minneapolis and Duluth campuses, lost 83 percent of its budget when its federal funding ended September 1. The Medical School is seeking support from Congress, possibly the state legislature, and private donors to replace those funds. Without that support, fewer students will be able to participate in this popular program that encourages Native Americans to go to school, stay in school, and graduate from college and medical school.

Deborah E. Powell, M.D., dean, University of Minnesota Medical School

We asked Medical School Dean Deborah Powell about CAIMH’s successes, what the cuts mean for its programs, and why she believes it is crucial that the center survive.

How Well has the Medical School Served Native American Students?

I am proud to say that the University of Minnesota Medical School ranks second in the nation in the number of Native American medical graduates—123 over the last 30 years, or more than 7 percent of the American Indian doctors practicing in the United States. And half of those physicians serve American Indian communities. This year, 14 American Indian students entered the Medical School, for a total enrollment of 32—the highest number in the school’s history.

These results are the product of visionary educators who in the early 1970s were alarmed by the mortality rates of underserved native communities, appreciated the value of diversity in our classrooms, and recruited, taught, coached, and nurtured American Indian students.

What Role has CAIMH Played in Those Achievements?

The Center of American Indian and Minority Health was created in 1989 to encourage American Indians to enter careers in health care. The center, which has offices on both the Duluth and Twin Cities campuses, is one of four Native American Centers of Excellence nationwide devoted to preparing American Indian physicians to address health disparities in American Indian communities.

CAIMH’s success extends well beyond graduating physicians, however. We also see measurable improvements in high school and college achievement among American Indians who have participated in the center’s programs. For example: Today, only half of Minnesota’s American Indians graduate from high school, in contrast to about 90 percent of the students who attend CAIMH’s SuperStars high school program. And of those who do graduate, fewer than 30 percent attend college. Yet 74 percent of the students in CAIMH’s undergraduate Native Americans into Medicine program have received a college degree or are currently enrolled in college.

What is unique about our program is the way it has closed both the cultural gaps in our classrooms and the gaps in student performance. I credit CAIMH’s Indian health pathway, a series of programs that offer encouragement, mentoring, and education to young people from kindergarten through graduate school.

If CAIMH is so Successful, Why Did the Government Discontinue its Funding?

The four National Centers of Excellence dedicated to American Indian education have been supported by federal Title VII dollars. According to the Health Resources Services Administration, the Government Accounting Office concluded that too few health-career graduates are providing care to underserved populations—a key program goal. As I mentioned, at the University of Minnesota, more than half of our graduating Native American physicians are serving Native American communities, a much higher result than we see in the GAO study. But in a fiercely competitive environment, in which many health sciences organizations—and other groups—are fighting for limited federal dollars, even successful programs can face cuts or elimination.

So the University of Minnesota Medical School isn’t Confronting this Problem Alone.

That’s right. Many education leaders are dismayed that federal budget cuts will impede the progress that they worked so hard to achieve. Our Medical School is a member of Association of American Medical Colleges (AAMC), which is mounting a campaign to attract more minorities overall into medical school. AAMC statistics show that, while one in four Americans are racial or ethnic minorities, fewer than one in eight medical school graduates are from these groups. The AAMC believes the harsh reality of racial and ethnic disparities in health care, combined with the predicted shortage of U.S. physicians, demands a call to action.

Will the University Try to Replace the Federal Dollars?

The center is losing $1.1 million in annual federal grants—83 percent of its budget. Nationally, we will continue to work with our congressional delegation to tell our story and encourage them to take action. So the door is not totally closed on federal funding. We also will be discussing this fall whether to pursue state funding. We will have a total budget next year of $550,000; $350,000 of that will come from the Medical School, $150,000 from central administration, and $50,000 from a one-time donation by the Office of Clinical Research for clinical research activities, including medical students’ research. And we are seeking outside funds through grants and donations.

How will CAIMH’s Programs be Affected by the Cut?

Reyanna Hain participates in CAIMH's SuperStars program.

Center director Dr. Joy Dorscher and I are still assessing that. We will have to reduce staff. Fewer students will be served, especially in the high school and college undergraduate programs; for example, our summer program will be reduced from 25 to 15 high school students. Six-week programs will be reduced to one to two weeks; and most significantly, less mentoring will be available to help students navigate the University’s complex system. Without full funding, we can support our pioneering mission: to encourage young, already-enrolled college students to make a medical career choice and then support them in medical school. But that’s all.

That means we could lose people like Katie Cannon, who was just named a Dean’s Scholar. Her scholarship has allowed her to enter medical school, and her aim is to become a physician working on a reservation—and, she says, to become a role model for other young women. Katie, who’s from the White Earth reservation, tells me that without CAIMH support and the scholarship, she might still be working in a vegetable-drying factory, which would be a terrible waste of her talent.

What Will the Larger Repercussions be for Native American Students?

The number of American Indians choosing health-care careers is certain to drop. Many young Native Americans will face higher hurdles without the support the program has provided. CAIMH does much more than teach these students about health care. It teaches them how to enter a large educational institution and succeed in that environment. Many of these students have come from reservations, small towns, and a narrow set of experiences. They’ve entered the University and have had to learn the very basics: how to register and make class choices that work for them. They’ve had to learn the difference between a doctor, an intern, and a resident. They’ve had to make basic work and life decisions that most of us take for granted.

We also know that it’s important to support youngsters’ early education needs if we are going to encourage them to stay in high school, graduate, go to college, and choose a health-care career. CAIMH funding helped us do that. Our statistics show we’ve been very successful at blazing a trail for young high school students as well as at supporting college undergraduates and medical students.

Some people have suggested that scholarships can help bridge the gap, but we have seen too many of these students fail with scholarships alone. Scholarships do not provide the experience, advice, mentoring, and academic support these students need.

Many graduates of the program would agree. Dr. Arne Vainio, now a beloved physician on the Fond du Lac reser-vation in Cloquet, will tell you that he would not have even considered medical school if someone hadn’t recognized his talent and pushed him through our doors. And once here, he depended on the extra support of mentors and professors to help him make class choices and navigate through our educational bureaucracy.

Why are Programs Like These so Important?

American Indian physicians who understand American Indian health needs are critically important. In Minnesota alone the need is great. According to the Minnesota Department of Health, from 2000 through 2004, American Indians in Minnesota had the highest mortality rates in 11 of 18 causes of death, including heart disease, cancer, unintentional injury, diabetes, cirrhosis, and suicide.

To serve a diverse patient population, we need a diverse physician workforce. And American Indian students have much to teach us. If we have a diverse medical school class, then students are learning from their colleagues about different cultures, beliefs, healing practices, and customs—which will ultimately help them become better doctors.

Encouraging American Indians to become doctors also enriches medical care in a broader sense. Students overcome serious educational disparities in order to achieve their dreams of becoming health professionals. On their path, they affect health care for all communities, including American Indian populations, by offering a unique perspective on health care, ways to address health disparities, and culturally sensitive communication techniques that can be used with all patients. 

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