In Nova Scotia before Confederation, medical care for native peoples formed an integral part of the fledgling Indian administration. As the colonial authorities became more involved in all aspects of native life, an opportunity for self-advancement was presented to doctors. Practioners among the Mikmaq came from the emerging medical elite. This article argues that their service to the Mikmaq was part of a broader and widespread reform effort. Doctors not only delivered care to the Mikmaq, but they also served the needs of a colonial administration actively seeking to settle natives in reserve communities. The activities of doctors, however, did not go uncontested. This study illustrates the complex interaction among the native administration, the Mikmaq population, and a medical community struggling to organize.