The only tribal medical school in the U.S. graduates its first Native American doctors

There are so few Indigenous physicians in the United States — just 0.3% of doctors — that their numbers barely show up in charts and graphs depicting the diversity of the medical workforce. But as of Thursday, there will be at least nine more.

Thursday is graduation day for the first class of the nation’s only tribally affiliated medical school, the Oklahoma State University College of Osteopathic Medicine at the Cherokee Nation. Started in 2020, it’s an effort to boost the numbers of both Indigenous physicians and doctors willing to treat patients in rural areas experiencing severe physician shortages.

The nine Native American graduates represent 20% of the first class of 46 students. That may sound small, but it’s a start. In future classes, the number of tribally affiliated students ranges from 16% to 30% of the class. Students in all four years represent 11 different tribes and come from 46 Oklahoma counties, said Natasha Bray, the medical school’s dean. The graduating class at OSU’s larger main campus, in Tulsa, includes 15 additional Indigenous doctors.

Of the nation’s nearly 850,000 physicians, only about 2,500 are Native American. According to the Association of American Medical Colleges, some specialties including endocrinology, neonatal medicine, and vascular surgery, include no Native Americans at all. Nationwide, AAMC statistics show this year’s graduating class includes about 250 students who identify as Native American or Alaska Native alone or in combination with another race.

New graduate Caitlin Cosby, 24, will start a family medicine residency in rural Durant, Okla., on Choctaw lands, where she is an enrolled member of the tribe. Once finished with her training, she’d like to provide care to Native American patients at the Choctaw Nation Family Clinic, where in addition to caring for patients, she hopes to be a role model for the next generation.

“To show people, as a Native American, you can be in medicine. It’s not unattainable,” said Cosby, who recalled treating a Choctaw patient who had asked what tribe she was from and then told her how proud he was of her, being Native American, and a woman, working to become a physician. “He said, ‘Thank you for representing us,’” she said. “I just wanted to cry.”

The school also is doing community outreach, helping to mentor potential future doctors about which classes to take in college and when to take the MCAT medical school entrance exam, and helping them with personal statements for medical school applications and interview skills. Many tribal students come from small schools or community colleges that don’t offer such support, said Bray.

Because a high percentage of Native American medical students drop out of medical school or don’t finish in four years, Bray said her campus provided resources and support to students who needed more time for medical or family reasons. “We want them to finish,” she said. “We need each of them to go out and serve their communities.”

Cosby and her class started medical school in the grip of the pandemic, when they were barred from having family attend their white coat ceremony, a rite of passage for medical students as they begin their clinical training. The students could not meet in person, and could not enter the brand new $40 million, 84,000-square-foot building the Cherokee Nation paid to construct in Tahlequah, a small town in northeastern Oklahoma where the tribe is headquartered. The new campus is a partnership between the Cherokee Nation and OSU.

Things soon got better. In 2021, the students moved into the building, which is decorated with 200 Cherokee artworks and surrounded by a garden of plants traditionally used for healing — including elderberry, which students harvested and used to make jam. The campus made full use of the knowledge of Native elders, healers, artists, and writers, Bray said, through art lessons and a library filled with hundreds of books from writers from Oklahoma’s 38 federally recognized tribes.

“I am just absolutely overwhelmed with joy and pride and gratitude,” she said of the new physicians. “The success of what we’ve done is a testament to that first class.”

Students also have access to state-of-the-art technology, including a simulation lab. Cosby said the mixture of modern and traditional was a high point of her education, as was the fact that she was able to learn from Native American physicians who provide health care in the Cherokee Nation.

While the school hopes that its new graduates will serve tribal and rural patients in Oklahoma — 75 of 77 of the state’s counties face a shortage of health professionals — that’s not a requirement. Graduates are free to practice wherever they like and pursue any field or speciality. Sixteen of the new graduates are moving on to train in specialties including urology, pathology, psychiatry, and, in the case of Ashton Glover Gatewood, 34, obstetrics.

Gatewood worked for six years as a public health nurse at the Oklahoma City Indian Clinic, and jumped at the chance to become a physician when she read about the new school in a newspaper. Medical school has been hard — she has two young children, so studying around the clock was not always possible. But she’s now headed to an OB-GYN residency at the University of Oklahoma, inspired by a female Native American general surgeon who encouraged her. “I originally wanted primary care, but I got to a point and realized I wanted to deliver babies every day,” she said. “I loved the OR and surgical aspect of it.”

When finished with residency, Gatewood hopes to work in a hospital serving Native American expectant mothers, and help curb the maternal mortality crisis among Indigenous women.

Gatewood said the best part of medical school for her was having numerous Native American medical students as colleagues. “In most medical schools, you might have just one student per class, or three in the whole school,” she said.

Gatewood, who is a member of the Choctaw tribe but also has Cherokee and Chickasaw ancestors, said she knows first hand that cultural competency is critical. Once, when she was working as a nurse, a co-worker was about to call child protective services to report potential child abuse because a child from the Muskogee Creek Nation had scratches on her arms. Gatewood was able to ask a Muskogee elder about the marks, and learned they were part of a purification ceremony and that the child was in no harm. Clinic staff told the parents how to keep the scratches clean and free of infection and avoided an incident that could have furthered mistrust of doctors and nurses. “We knew the parents’ purpose was the same as ours, to keep the child healthy and well,” she said.

The new medical school is part of a long-term plan to improve health care in the Cherokee Nation by investing in health facilities and personnel. Among the early signs of success was the Nation’s exemplary response to the Covid-19 pandemic, which earned national praise.

Earlier in the week, before Thursday’s graduation ceremony on the OSU campus in Tulsa, the new physicians were honored at both a Native ceremony with leadership from their respective tribes and a dinner held for them and hosted by Cherokee Nation Principal Chief Chuck Hoskin Jr. “Our ancestors would undoubtedly be proud of their achievements,” he said, “knowing that their perseverance continues to inspire progress and healing in our communities.”