Michael Schroeder-Toya is a third-year medical student at the University of Minnesota who was inspired to go to medical school because, growing up, she didn’t see people in medicine who looked like her.
Not only that, but as she went to law school and ultimately practiced law, she noticed that the most significant issues facing communities were untreated mental health conditions.
Schroeder-Toya, a member of the Navajo Nation who identifies as Jemez Pueblo and Navajo, was a trial attorney for seven years. She realized that so many of her cases came down to mental health and substance addiction, with a common theme being a lack of preventative care.
“For as much as I saw people trying to help, I never really essentially saw like a doctor who intervened in order to really try to assist the family,” she said. “It made me wonder, had there been somebody there for them from the medical community, would it have gotten this far?”
So she decided to go to medical school.
“I thought that medicine would help me be able to assist sooner rather than later, in hoping to prevent families and children from getting to a point where state involvement may happen,” Schroeder-Toya said.
There is a deep mistrust of the medical community among many Native Americans, which oftentimes gets in the way of seeking preventative care, she says.
“I think historically, there just wasn’t good relations,” Schroeder-Toya said. “It’s generational, and once those experiences are shared with the next generation and in some ways, the perception is still in place. It generates this distrust of, ‘Well, I don’t really want to go to you unless I’m really sick, or my family member went to you and they still died.'”
She feels as a Native provider, she would be able to help patients relate to her and therefore increase trust in the medical community and increase their health outcomes.
“I’ve met other people from different socioeconomic backgrounds who do have a distrust. I do try to reassure them, not just by talking to them but also by my own actions. Sharing with them that since I do have children, I did get them vaccinated. And that I do share their concerns about why they might be hesitant, but I did it anyway,” Schroeder-Toya said.
Currently, in the U.S, the number of Native doctors does not reflect their population. While American Indian and Alaska Native population in the U.S makes up 2.9 percent of the total U.S population, according to 2020 census data, they only represent .56 percent of physicians according to the 2012- 2016 American Community Survey.
The University of Minnesota is working on recruiting and retaining Native American students in medical school with its Individualized Pathways program.
One branch of the program is led by Mary Owen, the director of the Center of American Indian Minority Health at the University of Minnesota and assistant professor in the Department of Family Medicine and Biobehavioral Health.
Its emphasis is on recruiting Native American students into medicine and increasing awareness of American Indian health care issues among all students. Increasing the number of Native students in medical school will have profound effects on patient outcomes and allow others from that community to see themselves in such roles, Owen said.
“It’s something that most people don’t even think about. We take it for granted when we’re surrounded by physicians, but for native students, they don’t look like them, and they oftentimes don’t have the same background and similar frame of mind,” Owen said.
Despite the growth and expansion of medical schools in the past 40 years, the number of Native American students entering medical school has not changed significantly, according to Owen.
In the 2006-2007 academic year, Native Americans were .66 percent of medical school matriculants. Eleven years since then, in 2016, the percentage had only grown by .1 percent according to the Association of American Medical Colleges (AAMC) applicant matriculant data file.
On the UM Twin Cities campus, Native students average around 1.4 percent of the medical school class from 2014 to this year’s class. Across the university, Native American students have averaged 1.9 percent of the medical school class for the same time frame.
In Minnesota, Native American and Native Alaskans make up 2.8 percent of the state’s total population, according to 2020 Census data.
“We’re not nearly represented at a number equal to our population size,” Owen said.
The school of medicine in Duluth tends to have more Native students than the Twin Cities campus medical school.
The highest number of Native students at the University of Minnesota’s Duluth School of Medicine was 23 students in 2020, totaling around 14.4 percent of that year’s class. Owen said the numbers have not consistently grown in the years since, with Native American students making up 11.5 percent of the Duluth School of Medicine class this year … well above the state’s average Native population.
Although Native students make up a large percentage of the Duluth medical school, the majority of those students are from out of state, according to Owen. For a sustainable and equitable workforce in Minnesota, Owen says it’s crucial to build pathways for Indigenous youth in Minnesota to go into medical school.
The Individualized Pathways program
The Center of American Indian Minority Health has programs that seek to introduce and emphasize health careers for Native communities. For K-12 students, it provides activity books with games, puzzles and coloring pages for children to learn about science, wellness, math and health professions.
The center also provides after-school mentoring at Denfeld High School, where medical students and members of the American Indian Science and Engineering Society tutor students on Mondays during the school year.
For undergraduate students, the center hosts a six-week summer enrichment program for people interested in health careers, where participants complete research involving an analysis of a youth survey. The instructors include Native American faculty, health professionals, traditional elders and medical students.
The center also hosts pre-admission workshops during the year, designed for pre-health Native American students who plan to apply to medical school within the next two years. The workshops connect students to faculty and staff and teach them about research, funding and career development opportunities.
In addition to pathways programs, University of Minnesota admissions is taking a more holistic approach, hoping to consider factors that may affect test scores, like a lack of mentorship and needing to work to support themselves and family, said Dimple Patel, the associate dean for admissions at the Twin Cities University of Minnesota Medical School.
“Our first priority and our first responsibility is to serve the citizens of this state. We would like our physician population to reflect the population of our state as much as possible,” Patel said.
Schroeder-Toya wants more Native students in medicine. She decided to attend Duluth’s medical school because of the Native community there.
“I really wanted an educational experience that focused on Native American health or at least having those contexts in place,” she said. “It was also important to me to also have classmates who are Native American too. Who doesn’t like to be around people who kind of know their culture and have some similarities?”
The majority of Native American medical students at the University of Minnesota are from out of state. This presents an issue for Native communities in Minnesota because pipeline programs have shown that students are more likely to serve in their home communities, Owen said.
While Schroeder-Toya isn’t adamant on working in her hometown of Albuquerque, N.M., she does hope to work as a primary care physician and serve a Native community, although she’s not certain geographically where.
“I have a very special place in my heart for vulnerable families and children, who are struggling due to socioeconomic factors and a number of other things, and just basically general distrust of the healthcare system,” she said. “That’s really my focus.”
Barriers to recruiting in Minnesota
In Minnesota, Native students have the lowest high school graduation rates compared to other demographic groups, with a graduation rate of just 56 percent, compared to the overall state graduation rate of 84 percent in 2020.
“We happen to have, if not the worst, then pretty close to the worst rates for high school graduation for Native students,” Owen said. “That’s a huge barrier.”
After high school, the numbers pursuing higher education get smaller, and for those interested in STEM fields, smaller still.
“Those numbers shrink pretty darn fast. So, that’s the limiting factor in our state,” Owen said.
Why are the graduation rates low?
Owen attributes the low graduation rate to many of the social determinants of health.
“A higher percentage of Native families are in poverty than most other groups. Families are struggling to keep food on the table, keep their house over their heads, and to meet all the needs of their families. Kids come more often from those environments,” Owen said.
In Duluth, many Indigenous students are clustered in lesser funded schools, Owen said, pointing at the disparities between Denfeld High School, which has a higher Native population, and East High School.
“We don’t have access to the same AP (advanced placement) classes. We have lots of different opportunities that are available at East that are not to the Native kids at Denfeld,” Owen said.
Denfeld has a graduation rate of 70 percent, compared to East High’s 92 percent. Overall, in the state, increasing high school graduation rates could lead to more Native students attending college, being exposed to health-related careers and pursuing medical school.
Native students in medical school
Once Native students have hurdled past the challenges of graduating high school, completing undergraduate studies, and getting into medical school, they often have to work extra to support themselves, Owen said.
“I have students who are working, not only one, but sometimes two jobs to support themselves while in medical school,” Owen said.
And while the newly implemented tuition waiver for undergraduate Native students at the University of Minnesota helps with the cost of completing an undergraduate degree and decreasing the amount of student debt, there are still barriers in medical school, like affording tuition, accessing resources and succeeding academically.
“I think there’s kind of this misimpression that since you did well in undergrad, that easily translates into being able to do well in medical school,” Schroeder-Toya said. “For me, being a medical student, there’s still challenges for me because yes, I made it, but even as I entered the residency process, and thankfully I’ve been able to use a different set of skills to be able to navigate my way, but it’s still challenging to find those resources when your parents or a close family member is not a physician or doesn’t work in that sector.”
A lack of representation only adds to those determinants.
“We don’t see ourselves represented in the teachers. We don’t see ourselves. We don’t see any role models around for us. We’re not represented on the walls. Nothing says Native,” Owen said.