UND Today

University of North Dakota's Official News Source

Rural ‘rock stars’ in Standing Rock

A dentist and a doctor: Two young professionals committed to serving a rural community in need

As rural communities work to recruit health care professionals to their facilities, most undoubtedly have a “pie in the sky” goal: find a young professional who is rooted to the community through family connections and hope they stick around for a long time.

In reality, few places easily fulfill this goal. Fortunately, the Indian Health Service (IHS) hospital in Fort Yates, N.D., has found two such professionals: Zachary Perman, D.D.S., and Amber Tincher, M.D. ’12, are young rural advocates serving the IHS hospital, part of the Standing Rock Service Unit in Fort Yates.

Two sides of the same coin

Dr. Zachary Perman is a man with a plan. From a young age, he was always thinking ahead to the future and staying laserfocused on the things that would lead him to his goals. Hailing from Selby, S.D., located about 30 miles south of the state’s northern border, Perman knew exactly what he would be doing 15 years after high school graduation. He would graduate from high school in 2007 and attend the University of South Dakota at Vermillion. He would then go on to dental school at Case Western Reserve University School of Dental Medicine in Cleveland, Ohio. Then, he would marry his high school sweetheart, move back home to Selby, and provide dental care to his surrounding communities of McLaughlin, S.D., and Fort Yates. Check, check, and check.

Amber Tincher’s interest in rural medicine began at an even younger age. Born in rural Montana, on the Fort Belknap Indian Reservation, Tincher seemed destined to follow in the footsteps of her family members who paved a path towards rural family medicine. Tincher comes from a long line of practitioners, including her mother, Michelle Tincher, M.D., a 1995 graduate of the UND School of Medicine & Health Sciences (SMHS), and aunt Jackie Quisno, M.D., who graduated from UND’s Family Medicine Residency Program. When Amber Tincher was in fourth grade, her mother was accepted into medical school at the SMHS in Grand Forks, which prompted a move from Montana to North Dakota. While in medical school, Tincher’s mother participated in the Indians Into Medicine (INMED) program.

“I saw the connection [INMED] offered her to continue to work with the Native population in our country and to connect with other INMED students and professionals,” she said.

When it was finally her turn, Amber Tincher didn’t hesitate to follow in her family’s footsteps and apply for medical school so she could return to provide care to her community.

“I was familiar with IHS being our primary source of medical, vision, and dental services. Often times there is a difficulty recruiting to these underserved areas and I wanted to be a part of the solution,” she said.

Debt reduction

Drs. Zachary Perman and Amber Tincher

Like Tincher, Perman’s family is no stranger to health care professionals, either. His dad, Clint Perman, is a 2002 graduate of the UND PA program and provides care in McGlaughlin, S.D. Perman’s sister is also a dentist and began practicing alongside him in Fort Yates in 2020. Tincher and Perman are also similar in that they are young health care professionals with little to no debt remaining thanks to scholarship and loan repayment programs through IHS.

“I am 33 years old, and my debt will be wiped out within the next six years,” said Perman, who used IHS scholarships and loan repayment to help him pay for tuition and loans, and is already well on his way to debt freedom—a scenario about which many young health care professionals can only dream.

Given their family backgrounds in health, financial security in the form of debt forgiveness, and ties to the local area, these two young professionals couldn’t help but see Fort Yates as a triple-threat for job placement. But what began as a plan and a pathway to go back home to practice dentistry and medicine has evolved into a mission to serve their community of patients in the best way possible: through collaborative care and working together toward a common goal.

Dentistry as medicine

Fort Yates is located within Sioux County, which lies entirely within the Standing Rock Indian Reservation. The county makes up about 30% of the Standing Rock Reservation with the remainder in South Dakota. The population of Sioux County is just above 4,200 residents. According to a 2021 Rapid Community Assessment, around 32% of the population lives in poverty compared to the state average of 10.6%. A high poverty rate has a huge impact on quality of life and the county’s overall health status, which makes collaboration among health care providers even more important. For example, Sioux County has a high rate of diabetes.

Though Perman does not work directly with diabetes care, there are linkages between oral and physical health, such as periodontal disease, that can be an indicator for chronic conditions like diabetes. Perman says that improving and controlling one aspect of a person’s well-being has a positive effect on other aspects. In Fort Yates, dental care is integrated into the health care facility, meaning Tincher and Perman have the ability to easily refer patients to each other for needed care.

“The integration of dental care at the IHS allows me to provide better care to the patient, as I am able to get a more accurate health history and provide better, safer care,” Perman said.

As a family medicine physician who does see patients with diabetes, Tincher agrees that integrated care is good for the patient. “Ideally it would be great if every health care facility could have integrated dental care,” she said. “Our patients benefit from direct referrals from providers to the dentist if we have concerns we’d like addressed.”

Fort Yates seems to have struck gold with the recruitment of two rural rock stars, but the real winners are the patients who have these dedicated providers working together on their behalf. By Stacy Kusler Editor’s note: After this article was written, the Standing Rock Service Unit in Fort Yates received its Critical Access Hospital designation.

Editor’s note: After this article was written, the Standing Rock Service Unit in Fort Yates received its Critical Access Hospital designation.

About the author:

Stacy Kusler is the workforce specialist at the Center for Rural Health at UND’s School of Medicine & Health Sciences.