Dr. Randy Smith: Stopping the Rural Brain Drain with Tribal Healthcare

Welcome to another episode of Impact Unfiltered, where we dive into honest conversations with leaders creating real change in healthcare and beyond. In this session, host Stuart sits down with Dr. Randy Smith — an enrolled member of the Choctaw Nation of Oklahoma who serves as Executive over Health and Human Services for the Kiowa Tribe and CEO of Kiowa Health Services in western Oklahoma. He also holds a PhD in leadership and is a former rural college president.Dr. Smith shares how the Kiowa Tribe is launching its own primary care clinic and pharmacy — a venture projected to generate more revenue than the casino. He explains why tribally-run healthcare consistently outperforms IHS on service and billing, and why a rural EMS system is next. Together, they explore the rural “brain drain” hollowing out small communities, why tribes are uniquely positioned to anchor them, and Dr. Smith’s belief that leadership — passion, follow-through, and removing obstacles — is the single limiting factor on everything else.1. Background and Role Choctaw Nation member, Kiowa Tribe executive, CEO of Kiowa Health Services, PhD in leadership, and former rural college president.2. Launching a Tribal Clinic and Pharmacy Kiowa’s new clinic and pharmacy will serve Native and non-Native patients, extend hours, and generate more revenue than gaming.3. Diversifying Beyond Casino Revenue Tribes need multiple revenue streams. Healthcare, EMS, and rural services create sustainable growth.4. Stepping Into the Rural Healthcare Gap Rural hospitals struggle; tribally-run clinics bridge gaps and expand access.“We all make those rural communities sustainable long term.”5. Stopping the Rural Brain DrainTribes stabilize rural communities through healthcare, education, broadband, and workforce development.“If we can help stabilize our rural communities… we’re going to stop that outflow of migration.”6. Leadership as the Limiting Factor Strong leadership drives projects forward. Without it, even great ideas stall.7. Where Leadership Comes From Parents, coaches, and teachers shaped Dr. Smith’s values. Athletics taught resilience and teamwork.“Nothing can constitute for failure in the home.”8. The Leader’s Real Job Set tone, vision, and culture. Remove obstacles. Build workplaces people want to return to.“A good leader gets to set that tone every day.”9. Benchmarking and Celebrating Wins Track progress and celebrate milestones.“When you score a touchdown, you get to celebrate in the end zone.”10. The Follow-Through Problem Indian country often struggles to finish projects. Dr. Smith calls for completion.“Let’s see these things through to completion.”11. Borrowing Confidence from a Trusted Coach Leaders sometimes need guidance. Great players need great coaches. Dr. Smith offers himself as a resource.12. Closing Remarks and Gratitude Recognition of Dr. Smith’s vision, appreciation for his offer to help other tribes, and encouragement for rural tribes to step into leadership.