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It would have been even more difficult to locate competent physicians who would have been willing to relocate to the isolated and potentially dangerous Indian reservations. William Mitchell, agent for the Warm Spring Agency in Oregon, complained that for $1,000 per year “no physician of even ordinary ability” could be had. Not only was the pay insufficient, but few gentlemen of “education and ability” would be willing to live somewhere which completely lacked a “society.”<ref><i>Annual Report of the Commissioner of Indian</i> (1869): 169.</ref> Even if the OIA had instituted some standards, it is not clear that the medical profession could have provided physicians who could improve Native American health.

While treating Indian disease was an auxiliary mission of the OIA, its primary goal was to control the Indian population and permit westward expansion. Unfortunately, several agents believed that this mission was severely compromised by the failure of the OIA to provide enough qualified physicians for Indian communities. In 1886, John S. Ward, the Indian Agent for the Mission Indians in California, complained that his physician could not adequately care for the 3,000 Indians under his care because the physician was required to cover an area the size of New England. Ward argued that his physician needed a horse and buggy and at least $1,000 a year in pay to treat his charges.<ref><i>Annual Report of the Commissioner of Indian</i> (1886): 45.</ref>