The Indian Health Service (IHS) is the only large federal health system to lack formalized partnerships with academic medical centers. This gap hinders the agency's ability to recruit and retain physicians and may contribute to regional physician vacancy rates as high as 46%. 1 In comparison, the Veterans Health Administration (VHA) has had 75 years of active partnership with teaching hospitals through its Office of Academic Affiliations. An annual budget of more than $1.4 billion in 2014 supports 120 000 annual trainees and 11 000 graduate medical education (GME) positions. 2 Similarly, the Military Health System (MHS) operates more than 20 teaching hospitals and a medical school, the
Arsenic trioxide (ATO) is generally well tolerated for treatment of APL. We present a patient with severe watery diarrhea and pancreatitis thought to be due to ATO toxicity in the setting of obesity and acute kidney injury. Future studies evaluating ATO levels in patients experiencing toxicities may help guide dose modifications.
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