This interview is part of the series, Pathways to Practice: Stories from Underserved in Medicine, which features current residents, fellows, and recent graduates sharing their personal journeys – from formative experiences before medical school to the realities of being in their residency and/or fellowship programs. Each story highlights the moments, mentors, and motivations that led them to choose graduate medical education (GME) programs focused on medically underserved areas. Through these reflections, interviewees explore how their backgrounds and clinical education and training shaped their commitment to providing high-quality health care for all and influenced the paths they plan to pursue in practice.
Shelbie Shelder, MD is a graduate of the Swedish Cherry Hill Family Medicine Residency in Seattle, Washington, currently a practicing family medicine attending at Keweenaw Bay Indian Community (KBIC) Health System in Baraga, Michigan. KBIC is the first Tribal Health Department in Michigan to be designated by Blue Cross Blue Shield as a Patient Centered Medical Home. With a strong passion for public health, Dr. Shelder is considering a future career that blends both clinical medicine and public health, where she can advocate at a broader level and work toward meaningful change.
ACGME: Tell us about your journey and how it led you to where you are today, including about your medical school and residency or fellowship.
Dr. Shelder: I started my journey studying nutrition and public health at Michigan State University. My original plan was to go to graduate school for public health. However, in my study of public health, I learned about the significant shortage of doctors at the Indian Health Service and the small number of American Indian physicians in the country. I became motivated to become a doctor and return to my community. I wanted to pick a career where I was needed the most. I applied to medical school and ultimately chose to go to University of Minnesota (UMN) because of their Center of American Indian and Minority Health. I also knew that I would be in community with other American Indian medical students at UMN. I started at the Duluth campus because of my strong desire to practice rural health. My specialty of choice was family medicine, and I graduated from medical school in 2017. I chose to go into family medicine because I wanted to care for the whole person in all stages of their life. In addition, I knew that rural areas needed family medicine doctors the most. I matched at Swedish Cherry Hill family medicine residency in Seattle, Washington. This was my top choice because of their strong training in inpatient medicine and obstetrics. I also was excited to care for American Indian patients, both inpatient and outpatient, at the Seattle Indian Health Board. I graduated from residency in 2024 and started my first job as an attending physician at KBIC Health System in Baraga, Michigan. I still work at the KBIC clinic, which is a tribally run clinic in the Upper Peninsula of Michigan. My life came full circle when I stepped into my role at a rural tribal clinic, fulfilling the intention I set from the very start.
Background and Early Influences
ACGME: How did your background and early experiences help shape your interest in medicine and your understanding of health care disparities, especially in underserved areas?
Shelder: My background growing up involved intermittent lapses in health care. This was especially true when my dad left his job when I was in middle school. I witnessed firsthand how difficult it can be to navigate the health care system when you don’t have money or resources. My interest in medicine came as an “act of resistance” to be the doctor I always wanted growing up. In my teenage and young adult years, I often felt that the doctors I encountered lacked understanding or empathy for the experience of living in poverty. As a Native person, my understanding of health disparities is rooted in my own lived experience. These challenges have affected my family and community for generations and continue to shape our health today.
Choosing a GME Program
ACGME: When it came time to choose a residency or fellowship program, what inspired you to select a program focused on underserved areas, and which aspects of the program aligned with your goals or values?
Shelder: I knew before I even applied to medical school that I would work in an underserved area. It was the whole reason I decided to be a doctor. When it came to choosing a residency, I knew I would not be as fulfilled if I did not go to a program focused on underserved areas. Residency is an extremely challenging time, but if you can find meaning and fulfillment in your patients it makes it all worth it. That meaning for me was working with underserved communities. At my residency program, the continuity clinics are community health centers (Federally Qualified Health Centers (FQHCs)) with a predominantly underserved patient population. This aligned with my goals and values of providing community-centered primary care to those who need it the most.
Experiences During Residency/Fellowship
ACGME: Can you share some of the most meaningful challenges and lessons from your residency/fellowship program working in underserved communities, as well as how they have influenced the kind of physician you are becoming?
Shelder: Some of the most meaningful challenges and lessons I learned from my residency program involve understanding how my patients’ lives impact their health. For example, I was able to witness the devastating effects of poverty, homelessness, and trauma in my patients in residency. I worked at an urban Native clinic in the heart of Seattle. I quickly learned that “compliance” or “non-compliance” are NOT terms I will ever use with my patients. This type of thinking and language puts the blame on the patient rather than understanding their barriers. It also ignores structural issues, like transportation limitations, food insecurity, and trauma. I now use language that takes into consideration barriers, context, and shared decision-making with each patient. This is a life lesson you have to learn as a physician working in an underserved community.
ACGME: What unique skills or insights have you developed through your residency program that you might not have gained elsewhere?
Shelder: During my residency, I gained unique skills and insights, including strong training in addiction medicine, advocacy, and meaningful community engagement. I also developed a deep understanding of the city of Seattle and its homelessness crisis. In addition, training alongside a unique group of physicians allowed me to learn from their different backgrounds and perspectives, which broadened my own worldview. My scope of practice as a family medicine physician in Seattle was exceptionally wide. At my continuity clinic, the Seattle Indian Health Board, we managed numerous acute and complex chronic conditions that patients might not otherwise bring to a specialist. This experience helped me become comfortable with a wide range of care, providing excellent preparation for practicing rural medicine.
Looking Ahead
ACGME: What does your future in medicine look like? Can you share the kind of difference you hope to make in underserved communities and any advice you have for physician learners considering similar paths?
Shelder: I am currently a full-time family medicine physician at a tribal clinic in the Upper Peninsula of Michigan, and I hope to continue serving this community for several more years. I still have a strong passion for public health, and I am considering a future career that blends both clinical medicine and public health. I often see systemic issues affecting my patients and sometimes feel limited in my ability to address them within the exam room alone. Pursuing public health and policy would allow me to advocate at a broader level and work toward meaningful, systemic change.
The advice I have for physician learners pursuing a similar path is to keep an open mind and always consider a patient’s illness within the context of their whole life. Take a holistic approach when caring for patients and in the long run it will be more meaningful for you and more beneficial for them.
ACGME: What are important considerations for graduate medical education programs to help prepare residents and fellows for practice in underserved communities?
Shelder: A key consideration is ensuring that residents and fellows develop a strong understanding of social and structural determinants of health. It’s also essential to train them to “wear many hats.” In underserved, underfunded settings, physicians often take on multiple roles beyond traditional clinical duties. Having an open mind and a willingness to step in wherever help is needed is crucial. Maintaining the mindset that no task is beneath you, whether it’s cleaning an exam room or helping room a patient when staff members are short. This will make you a more effective and respectful member of the care team. Lastly, keep returning to your purpose. The work is challenging, but it carries immense meaning.
If you are in your last year of residency/fellowship or are a recent graduate serving in a rural or underserved area, and would like to be featured in a future post in this series, email underserved@acgme.org to share what you’re doing. Visit the Rural and Underserved GME section of the ACGME website to learn more about the ACGME’s work in this area.