Late Breaking News
HIV Provider Shortage Threatens the HIV Care System
- Categorized in: August 2009 Issue
WASHINGTON, DC—A looming HIV provider shortage threatens the HIV care system in the US, according to a report released by the American Academy of HIV Medicine and the HIV Medicine Association.
The current HIV medical workforce is largely composed of the first generation of HIV medical providers who entered the field when they were in training more than 20 years ago. The report, Averting a Crisis in HIV Care, warned that as these clinicians retire without qualified recruits to take their place, the HIV care system faces a serious crisis in care capacity. “Our concern is that if we fail to address it now, 5 or 10 years from now, we may have a collapse in our ability to provide HIV care,” said Dr Jim Sosman, an HIV provider who presented the report.
A survey conducted by the American Academy of HIV Medicine in 2008 of over 400 of its members found that one-third of current providers are in the last quarter of their careers and plan to retire within the next 10 years. More than 90% of these providers have seen an increase in HIV patient load over the last 2 years.
Choosing HIV Care
The report noted that medical students often do not choose HIV care as a specialty because they have accumulated high debt in medical school. A 2009 AAHIVM survey of HIV practitioners found that the debt level for medical students ranged from $75,000 to $200,000. At the same time, reimbursement for HIV care under Medicaid and Medicare is low.
The report recommended that the government offer loan forgiveness opportunities for clinicians willing to provide HIV care in underserved areas as an incentive to pursue HIV medicine.
The report found that another barrier to building an adequate HIV medical force is that while doctors in training receive most of their training in an inpatient setting, advances in HIV therapy have resulted in healthier HIV patients who get more of their care in the outpatient setting. “HIV/AIDs care, for the most part, has become an outpatient type of care, but most of our training for our residents and medical students remains in the inpatient setting,” according to Dr Squires, an HIV provider who spoke at the briefing.
Doctor Squires said that this has resulted in residents and medical students treating end-stage HIV patients in inpatient settings, but not learning about evaluating and managing the medications of patients who are seen in the outpatient setting. “It’s complicated to figure out the best way to resolve these medications, so they don’t see that challenge and that excitement. That, unfortunately, does not translate into continued interest in this particular disease state,” Dr Squires said.
The report recommended that this issue be addressed by expanding outpatient opportunities to medical and family practice residents to enhance their competence in managing HIV patients.
HRSA Tackles HIV Care
Doctor Laura Cheever, an official with the HIV/AIDS Bureau in the Health Resources and Services Administration, said that as HIV patients live longer due to better HIV therapy, they now need preventive health care that they did not receive in the past. For example, a colonoscopy for an HIV patient at age 50 was something that “just wasn’t done 15 years ago,” since the patient would generally die of HIV before they died of colon cancer, Dr Cheever explained. “Patients are living longer and have more primary care needs,” she said.
HRSA has funded a study on HIV workforce issues to better understand the state of HIV care, according to Dr Cheever. The study is examining the current HIV workforce situation in communities and factors that will likely impact the workforce capacity in the future, among other things. The results of the study should be available this fall, according to Dr Cheever.
The agency is also hopeful that Congress will approve the increased funding proposed by the president in his FY 2010 budget for the AIDS Education and Training Centers (AETCs). Through the AETC program, centers around the country offer educational opportunities to healthcare workers providing HIV care. “We have had a $4 million increase in the AETC program in the President’s 2010 budget to provide new grant opportunities for in-depth, long-term training in HIV care,” Dr Cheever said.
From Aug 10-12, the agency is hosting a summit that will look at the demand for primary care services in general, Dr Cheever said. Many inner city and rural communities continue to struggle to recruit and retain an adequate number of primary care health professionals to provide care. More information on the summit can be found at http://bphc.hrsa.gov.