Roubideaux has spent her four years on the job focusing as much on increasing the quality of health care for Native Americans as on reforming IHS. The agency provides health care for roughly 2 million of the country's 3.4 million American Indians and Alaska natives. In a letter to the entire IHS staff on the two-year anniversary of her appointment, Roubideaux highlighted improvements to the agency's financial management, hiring process, and transparency. The Affordable Care Act also reauthorized the Indian Health Care Improvement Act, and the agency has expanded its Improving Patient Care initiative, originally launched in 2006. But it's only a start. "If it was easy to 'fix' IHS, someone would have already done it," she wrote. Roubideaux, 50, has focused on health issues for these groups throughout her career. She attended Harvard University and graduated from Harvard Medical School in 1989. She spent four years as a clinical director and medical officer on two Indian reservations in Arizona before turning her focus to health care research and policy. In 1997, Roubideaux earned a master's degree from the Harvard School of Public Health. She became an assistant professor at the University of Arizona College of Medicine, researching how diabetes impacts American Indians and Alaska natives, and she has worked on programs to recruit individuals from these communities into health professions.