MD – UC Berkeley-UCSF Joint Medical Program, Berkeley, CA
Residency – General Preventive Medicine, California Department of Public Health, Sacramento, CA

Biography: Dr. Andrea Garcia, physician, is interested in research centered around American Indian health policy, especially policies that improve access to and innovations in healthcare.  She is also interested in workforce diversity, health equity, and population health.  Dr. Garcia built a research portfolio during fellowship that centers on these interests. 

Dr. Garcia worked on her main research project entitled, “Leveraging Community Partnerships to Increase Access to Health Care among American Indians and Alaska Natives Residing in Los Angeles County” with mentors including Dr. Kenneth Wells at UCLA and Drs. Tony Kuo, Hal Yee, and Stanley Dea from the Los Angeles County Department of Health Services.  She also worked with several other community partners including United American Indian Involvement and the Southern California Indian Center Puku Cultural Services Community Advisory Board.   

The purpose of the study was to understand current access to care among American Indians and Alaska Natives (AIAN) residing in Los Angeles County (LAC) and then implement a plan for improvements.  Dr. Garcia along with her mentor team and partners leveraged their community partnerships to develop and disseminate a survey (n=500) to understand factors that impact access to care among AIAN.  Then they established a partnership between LACDHS and the only AIAN clinic in LAC in order to implement eConsult, a novel technology used to improve access to specialty care. A quasi-experimental pre-post study design was used to evaluate the impact of the intervention.  Dr. Garcia found that among AIAN who are enrolled tribal members, 87% have insurance, 42% use both insurance + Indian Health Service (IHS), and 7% use IHS alone. Those AIAN who use insurance + IHS were female, ages 40-64, and preferred an AIAN clinic.  However, having a higher income and education were negatively associated with using insurance + IHS.  Implementation of eConsult has provided access to 64 specialties, and advanced diagnostic imaging. 

Dr. Garcia presented this work at the National Clinician Scholars Program Annual Meeting in New Haven, CT in November 2017, at the LA County Department of Public Health’s Annual Science Summit in Los Angeles, CA in March 2018, at the 2018 National Council for Urban Indian Health in June 2018 at Arlington, VA.  Dr. Garcia and her community partners also presented this work to the community in a town hall session in Los Angeles, CA in May 2018.  They provided data booklets with results of participating organizations and infographics to help with understanding the methods and results.  Note takers collected feedback from the sessions and this qualitative data is currently being analyzed and summarized.  A report summarizing the results of this body of work is ongoing and will be submitted to a peer-reviewed journal for review and publication. 

Dr. Garcia completed a policy elective with the Indian Health Service in Rockville, MD in April-May 2017.  She worked with Dr. Nicole Lurie who was at the time Acting Deputy Director for Quality Health Care.  From this experience, Dr. Garcia drafted a policy narrative using her story as a Native American physician to outline policy recommendations for increasing the IHS physician workforce.  Writing of the manuscript entitled, “Stereotypes vs. Reality: Policy Recommendations for Improving the Indian Health Service Physician Workforce” is ongoing and is expected to be submitted in September 2018 to Health Affairs.   

Her commitment to the local American Indian community is evident in the following activities.  Dr. Garcia is engaged in local coalition building at the city/county level to pass Indigenous Peoples Day in LA city and county. She joined the board of a national non-profit, We Are Healers, that aims to increase AIAN in the health professions. She was also involved with Census 2020 advocacy work, particularly as it relates to AIAN. She also continues to serve on the Board of Directors of the United American Indian Involvement.  Regarding workforce diversity, she attended an Indigenous Faculty Forum at the Oregon Health Sciences University.  This work has not gone unnoticed as she was appointed and confirmed by Mayor Garcetti to the Los Angeles City/County Native American Commission.  

In addition to this main project and advocacy activities, Dr. Garcia also worked on two other projects. She worked with mentors Drs. Eliseo Perez-Stable at UCSF and Tony Kuo at the LA County Department of Health Services on a project entitled, “Factors associated with graduating medical students’ intention to work with underserved populations: Policy implications for advancing workforce diversity” which was published in Academic Medicine in April 2018.  She also worked with Drs. Steven Martino and Marc Elliott on a project entitled, “Disparities in Care Experienced by American Indian and Alaska Native Medicare Beneficiaries.”  Data analysis is complete and manuscript writing is in progress.   

Dr. Garcia is in the final stages of the hiring process for the Los Angeles County Department of Mental Health where she will be the Director of Community Centered Initiatives. In this capacity Dr. Garcia will have clinical time at the American Indian Counseling Center, focus on American Indian population health initiatives, and have protected research time where she will continue to work with Dr. Wells and the Center for Health Services and Society in the Department of Psychiatry.