Growing up, Mackenzee Thompson always wanted a deeper connection with her tribe and culture.
The 26-year-old member of the Choctaw Nation said she grew up outside of her tribe's reservation and wasn't sure what her place within the Indigenous community would be.
Through a first-of-its-kind program, Thompson said she's now figured out how she can best serve her people — as a doctor.
Thompson is graduating as part of the inaugural class from Oklahoma State University's College of Osteopathic Medicine at the Cherokee Nation. It's the first physician training program on a Native American reservation and in affiliation with a tribal government, according to school and tribal officials.
"I couldn't even have dreamed this up," she said. "To be able to serve my people and learn more about my culture is so exciting. I have learned so much already."
Thompson is one of nine Native graduates, who make up more than 20 percent of the class of 46 students, said Dr. Natasha Bray, the school's dean. There are an additional 15 Native students graduating from the school's Tulsa campus.
The OSU-COM graduates include students from 14 different tribes, including Cherokee, Choctaw, Muscogee, Seminole, Chickasaw, Alaska Native, Caddo and Osage.
Bray said OSU partnered with the Cherokee Nation to open the school in 2020 to help erase the shortage of Indigenous doctors nationwide. There are about 841,000 active physicians practicing in the United States. Of those, nearly 2,500 — or 0.3 percent — are Native American, according to the Association of American Medical Colleges.
Native students participate in training at the medical school.
When American Indian and Alaska Native people visit Indian Health Service clinics, there aren't enough doctors or nurses to provide "quality and timely health care," according to a 2018 report from the Government Accountability Office. On average, a quarter of IHS provider positions — from physicians to nurses and other care positions –are vacant.
"These students here are going to make a generational impact," Cherokee Nation Principal Chief Chuck Hoskin Jr. told the students days before graduation. "There is such a need in this state and in this region for physicians and this school was created out of a concern about the pipeline of doctors into our health system."
The Cherokee Nation spent $40 million to build the college in its capital of Tahlequah. The walls of the campus feature artifacts of Cherokee culture as well as paintings to remember important figures from Cherokee history. An oath of commitment on the wall is written in both English and Cherokee.
The physician training program was launched in the first year of the pandemic.
Bray said OSU and Cherokee leadership felt it was important to have the school in the heart of the Cherokee Nation, home to more than 141,000 people, because students would be able to get experience treating Indigenous patients. In Tahlequah, students live and study in a small town about an hour east of Tulsa with a population of less than 24,000 people.
"While many students learn about the problems facing these rural communities," Bray said. "Our students are getting to see them firsthand and learn from those experiences."
The medical school's oath of commitment, written in the Cherokee syllabary.
While students from the college are free to choose where to complete their residency after graduation, an emphasis is placed on serving rural and Indigenous areas of the country.
There's also a severe lack of physicians in rural America, a shortage that existed before the COVID-19 pandemic. The Association of American Medical Colleges has projected that rural counties could see a shortage between 37,800 and 124,000 physicians by 2034. An additional 180,000 doctors would be needed in rural counties and other underserved populations to make up the difference.
Bray said OSU saw an opportunity to not only help correct the underrepresentation of Native physicians but also fill a workforce need to help serve and improve health care outcomes in rural populations.
"We knew we'd need to identify students who had a desire to serve these communities and also stay in these communities," she said.
Osteopathic doctors, or DOs, have the same qualifications and training as allopathic doctors, or MDs, but the two types of doctors attend different schools. While MDs learn from traditional programs, DOs take on additional training at osteopathic schools that focus on holistic medicine, like how to reduce patient discomfort by physically manipulating muscles and bones. DOs are more likely to work in primary care and rural areas to help combat the health care shortages in those areas..
As part of the curriculum, the school invited Native elders and healers to help teach students about Indigenous science and practices.
Thompson said one moving moment involved a trip to the Cherokee Nation's heirloom garden, which features culturally significant plants and food practices.
Thompson said she was able to bring those experiences into her appointments. Instead of asking only standard doctor questions, she's been getting curious and asking about her patient's diets, and if they are taking any natural remedies.
"It's our mission to be as culturally competent as we can," she said. "Learning this is making me not only a better doctor but helping patients trust me more."
Part of knowing those patients is also knowing what challenges they face.
Native Americans face health crises at a disproportionately higher rate than other Americans. They face the highest rate of diabetes compared with all U.S. racial groups and continue to die at higher rates than other Americans in other categories, including chronic liver disease and cirrhosis, suicide and chronic lower respiratory diseases.
For Caitlin Cosby, it wasn't until she was on a rotation that she began to see what her patients were up against.
She said many of her patients faced significant poverty, while some lacked cars, cell or internet.
Access to care remains challenging for some rural residents on the reservation, Bray said.
Cosby, 25, is starting a family medicine residency in Durant, Oklahoma, home to the Choctaw Nation's headquarters. Cosby, a Choctaw member, said she got to meet physicians all around Oklahoma.
"Learning their perspectives was invaluable," Cosby said. "Seeing the problems they face on a daily basis firsthand, it opens your eyes to the world of medicine I'll be stepping into."
Cosby said an unexpected part of her rotations in school was seeing how Native doctors took the time to sit and listen to their patients.
"It really means a lot to folks when you just take that time to understand where they are coming from," she said. "We look at the patient as a whole and we realize that everything plays a part in their well-being. It goes way beyond medicine to help people live a better life."
The Choctaw Nation of Oklahoma gifted each of the graduating medical students a beaded stethoscope during the school's American Indian Honoring Ceremony days before the commencement ceremony.
In the days leading up to graduation, the Native graduates were honored with a ceremony. Representatives from five different tribes gave gifts to the aspiring doctors, such as a stole, sash or beaded stethoscope.
"In the spirit of your ancestors, you have embraced the path of healing, not just for individuals but for communities and cultures," Choctaw Nation Chief Gary Batton told the graduates at the ceremony.
For Thompson, these are the types of moments she wants to hang onto when beginning her residency. She's staying in Tahlequah and working for a family medicine practice.
"I already feel like I've learned so much from this community," she said. "I'm excited to give back to it now."