Relationships and autonomy shape provider retention in Indigenous healthcare settings

Healthcare providers working in Indian Health Service (IHS) and Tribally operated facilities across the United States report that their sense of fulfillment and intention to stay in their jobs rests less on financial incentives and more on relationships with the Indigenous communities they serve, supportive workplace conditions, and opportunities to grow professionally. That is the central finding of a qualitative study published in BMC Health Services Research, which set out to understand why recruiting and retaining providers remains a persistent challenge in these rural and community-based settings, where turnover can disrupt continuity of care.

The research team conducted key informant interviews with seventeen healthcare providers working in IHS and Tribally operated healthcare settings. Interviews explored participants’ values and motivations, their relationships with people, physical place, and their work, and the factors influencing their wellness, fulfillment, and intentions to stay or leave. The transcripts were analyzed thematically using an interpretive descriptive approach, a method suited to capturing how practitioners make sense of their own experiences rather than testing predefined hypotheses.

Participants described making deliberate efforts to build relationships with the Indigenous communities they served, and they reported that these connections deepened their commitment to their work and to patient care. This theme is captured in the study’s title, drawn from a provider’s own words: ‘When you’re connected to people and when you’re connected to the place, it reaches you spiritually.’ The finding suggests that community connection is not a peripheral benefit but a core component of how providers experience their roles in these settings.

Within the workplace itself, two conditions stood out. Providers valued autonomy coupled with support, which allowed them to pursue impactful roles that matched their interests, and they valued opportunities to learn and grow. Participants’ sense of fulfillment and intention to stay were shaped by five interlocking influences: their relationships with the Indigenous communities they served, alignment between their personal motivations and values and their roles, supportive relationships with coworkers, autonomy and support in their work, and chances for professional development.

Place-related considerations also influenced whether providers intended to stay or leave, but these consisted mostly of family considerations rather than features of the communities themselves. By contrast, the factors undermining wellness were clearly identified: inadequate staffing and poor work-life balance contributed to providers’ intention to leave their positions. The authors note that existing recruitment and retention strategies in these settings rely primarily on financial incentives, which may be insufficient given the broad range of factors driving rural provider turnover.

The study’s conclusions point toward policies and workplace designs that encourage relationship-building, protect work-life balance, provide autonomy alongside support, and create learning opportunities. Such measures, the authors suggest, may strengthen provider wellbeing and retention and complement the financial interventions already in place. Because the study is qualitative and based on seventeen interviews, its findings describe the experiences of this group of providers rather than measuring the prevalence of these factors across the IHS and Tribal health systems, and the results are intended to inform contextually relevant strategies rather than establish causal effects.

Subject of Research: A qualitative interview study of healthcare providers' experiences and retention factors in Indian Health Service and Tribally operated healthcare settings in the United States.

Article Title: ‘When you’re connected to people and when you’re connected to the place, it reaches you spiritually’: a qualitative study of the experiences of providers working with Indigenous communities in the U.S.

Article References: Ambrose, G., Gardner, W., Cushman, N., Reilley, B., & Leston, J. (2026). ‘When you’re connected to people and when you’re connected to the place, it reaches you spiritually’: a qualitative study of the experiences of providers working with Indigenous communities in the U.S.. BMC Health Services Research. https://doi.org/10.1186/s12913-026-15471-5

Image Credits: AI Generated

DOI: 10.1186/s12913-026-15471-5

Keywords: Indian Health Service, Tribal healthcare, provider retention, qualitative research, workforce wellbeing, rural health, Indigenous communities, work-life balance, health services research, provider burnout, connected, people