WASHINGTON—Yvette Roubideaux, MD, became the first woman to lead the Indian Health Service when she was sworn in as the agency’s director on May 12. She replaces Robert McSwain, who previously held the position. Dr. Roubideaux is a member of the Rosebud Sioux tribe. She recently served as an assistant professor in the Department of Family and Community Medicine at the University of Arizona College of Medicine.

She has done extensive work on American Indian and Alaska Native health policy. She served as the co-director of the Coordinating Center for the Special Diabetes Program for Indians Competitive Demonstration Projects, an IHS program implementing diabetes prevention and cardiovascular disease prevention activities in 66 American Indian and Alaska Native communities. She also served as director of two programs, the UA/ITCA Indians Into Medicine (INMED) Program and the Student Development Core of the ITCA/ UAAmerican Indian Research Center for Health. These programs focus on recruiting American Indian and Alaska Native students into health and research professions.

Doctor Roubideaux previously worked in the IHS as a medical officer and clinical director on the San Carlos Service Unit on the San Carlos Apache Indian Reservation, and as a medical director at the Hu Hu Kam Memorial Indian Hospital on the Gila River Indian Community.

She received her medical degree from Harvard Medical School and her MPH from the Harvard School of Public Health, and completed her Primary Care Internal Medicine Residency Program at Brigham & Women’s Hospital in Boston. Dr. Roubideaux also completed the Commonwealth Fund/Harvard University Fellowship in Minority Health Policy in 1997.

Her awards include the American Diabetes Association’s 2008 Addison B. Scoville Award for Outstanding Volunteer Service and the 2004 Indian Physician of the Year Award from the Association of American Indian Physicians.

New IHS Director’s Priorities

At a hearing held on her nomination in April, Dr Roubideaux told the Senate Committee on Indian Affairs that as IHS director she would “renew and strengthen the Indian Health Service’s partnership with tribes.” In addition, she said her goals would be to discuss with tribes, health care providers and patients how to reform the IHS. She also cited improving the transparency and accountability of IHS and improving the access and quality of care as goals. “We need to implement more strategies to increase access to care in our system, to improve the quality of clinical services that we provide, and just as importantly, to provide better customer service,” she said.

Doctor Roubideaux also voiced her support for the reauthorization of the Indian Health Care Improvement Act. The reauthorization of the bill has been a top issue for groups representing American Indian and Alaska Natives. Indian advocacy groups say that its reauthorization will facilitate the modernization of the IHS health care system by increasing funding for programs like cancer and diabetes screenings, among other things. Leaders in Indian Country have worked to see the legislation reauthorized, but it has hit several snags along the way in gaining passage in recent years. “Both the President and I support passage of this important legislation. I am looking forward to working with you to find solutions to ensure that we pass this important piece of legislation,” she told the committee.

Meeting the Challenges

Members of the committee made it clear during her nomination hearing that she would face challenges in leading the IHS. “Dr. Roubideaux will be inheriting and Indian Health System that is broken. The Indian Health Service is only funded at about half of its need, clinician shortages are rampant and significant health disparities permeate Indian Country,” said committee chairman Sen. Byron Dorgan, D-ND.

Senator Tim Johnson, D-SD, wanted to know whether she could address the issues of preventive care, diabetes, suicide, cancer and mental health with the current IHS budget funding levels. “It is clear that the Indian Health Service funding is woefully inadequate to meet the needs of this population. It is clear that we could do a lot better job if we had more resources. Of course, these are diffi cult budgetary times and everyone is being asked to do more with less. But if you look at the Indian Health Service I am confident that it needs a significant increase in additional resources to help address some of these problems,” she said.

Members of the committee also offered Dr Roubideaux advice. Sen John McCain, R-Arizona, told her she should get involved in determining how the $227 million for construction of IHS facilities that was allotted to IHS in the economic stimulus money will be spent. “Let me recommend to you $227 million dollars for construction in IHS facilities—an additional $227 million—doesn’t come along very often, and so let me be a little presumptuous and strongly recommend that you jump right into that process,” he told Dr Roubideaux.

Senator Dorgan advised her that she should hire someone in the “number 2 spot” at IHS who has “signifi cant” managerial experience, since she does not come to the position with much managerial experience. “The Indian Health Service is in desperate need of good management and your experience and background would not be in managing a large organization. I think you would be the first to admit you don’t come here saying you have a lot of experience managing 1,500 people, but you come here with a lot of other great qualities. I think the number 2 spot that you are going to have to fill, I really hope you will take a strong look at someone with a very significant background in management,” he said.

Doctor Roubideaux said that she would seek to hire qualified individuals to work with her. “I know it is a large complex organization and there is a lot to be done and there are enormous challenges so I would definitely look back at that position, look at the responsibilities and look at the possible candidates for that position, and make a good choice,” she said.