professional employees from the U.S. Public Health Service Commissioned Corps. This is a non-armed service branch of the uniformed services of the United States. Professional categories of IHS Commissioned corps officers include physicians, physician assistants, nurses, dentists, therapists, pharmacists, engineers, environmental health officers, and dietitians. Many IHS positions are in remote areas as well as its headquarters outside of Rockville, Maryland, and at Phoenix Indian Medical Center in Phoenix, Arizona. In 2007, most IHS job openings were on the Navajo reservation. 71% of IHS employees are American Indian/Alaska Native. The IHS also hires Native/non-Native American interns, who are referred to as "externs". Participants are paid based on industry standards, according to their experience levels and academic training, but are instead reimbursed for tuition and fees if the externship is used for an academic practical experience requirement. Legislation The Snyder Act of 1921 (23 U.S.C. 13) was the first formal legislative authority allowing health services to be provided to Native Americans. In 1957, the Indian Facilities Act authorized funding for community hospital construction. This authority was expanded in 1959 with the Indian Sanitation and Facilities Act, which also authorized construction and maintenance of sanitation facilities for Native American homes, communities, and lands. Indian Self-Determination Act of 1975 (Public Law 93-638) ExpectMore.gov lists four rated areas of IHS: federally administered activities (moderately effective), healthcare-facilities construction (effective), resource- and patient-management systems (effective), and sanitation-facilities construction (moderately effective). All federally recognized Native American and Alaska Natives are entitled to health care. This health care is provided by the Indian Health Service, either through IHS-run hospitals and clinics or tribal contracts to provide healthcare services. Indian Health Care Improvement Act of 1976 (Public Law 94-437) The passing of the Indian Health Care Improvement Act of 1976 expanded the budget of the IHS to expand health services. The IHS was able to build and renovate medical facilities and focus on the construction of safe drinking water and sanitary disposal facilities. The law also developed programs designed to increase the number of Native American professionals and improve urban Natives' health care access. Other legislation Title V of the Indian Health Care Improvement Act of 1976 and Title V of the Indian Health Care Amendment of 1980 have increased the access to healthcare Native Americans living in urban areas receive. The IHS now contracts with urban Indian health organizations in various US cities in order to expand outreach,