Page:LewisMeriam-TheProblemOfIndianAdministration.djvu/259

position has not had high enough standing either on the reservation or in the community. Not infrequently agency employees say that in case of illness in their own family they seek outside medical advice, even to traveling considerable distances over the road, but this situation is by no means universal. The Indian Service has had, and still has a number of capable physicians, but by and large the medical personnel has not been of a standard equal to that in other medical services of the government. Sometimes it has even found itself with men of questionable morals and character, but has had to be slow in removing them because of the difficulty of securing anybody else. The bitter criticism voiced from time to time by private citizens against Indian Service physicians has in some cases been based on fact, as has been seen during the course of this survey. The existing situation would be well nigh hopeless if it were not for the few really earnest and capable physicians and the interest displayed by the present administration in improving conditions. Within the past year or so a much higher grade of physicians has been added to the Service and the plans for the future will undoubtedly improve the situation.

The general causes for dissatisfaction among Indian Service physicians have been their subordination to lay authority in professional matters, the low salaries paid, and the poor housing facilities available. All these complaints are founded on a considerable amount of fact. The first has been touched on. The effect of low salaries, especially on physicians now in service, is by no means uniform. A few physicians who have been with the Indian Service for years are doing all that could be asked. The service rendered by one in particular is worth several times his present salary. If he were paid far more he could not handle one more case than he does, because he has been and is working to the limit of his physical strength. Some who clamor for more salary would probably do no more than they do now and would not do it much better. The item of salary does, however, affect the facility with which the Service can attract new men with suitable qualifications. If salaries were reasonable and working conditions favorable, undoubtedly many capable men would, from altruistic motives, enter the Service at a lower income than they could realize in private practice.

The salaries in the Indian Service have been much lower than those offered in other government medical services, consequently