Declining numbers of physicians are entering infectious disease care, but patients with HIV are living longer. A new report proposes a different kind of training track.
Individuals with HIV/AIDS are living longer, but their needs as they age is revealing a gap in care that has led some to call for a specialized training track for medical residents.
“HIV management is included in many residency training programs, but there is no particular emphasis on it in most. It competes with other important training content,” Howard Libman, MD, director of the HIV Program at Healthcare Associates at Beth Israel Deaconess Medical Center and professor emeritus of medicine at Harvard Medical School told Medical Economics.
Howard Libman, MD
Libman and several colleagues decided to tackle the problem by creating an HIV-specific primary care track for internal medicine residents and to publish their findings. The research, published in the Journal of General Internal Medicine, revealed that there might be an opportunity somewhere between primary care and specialized medicine for a new way to train residents.
Mortality rates among individuals infected with HIV are falling, although there are still an estimated 50,000 new cases each year in addition to the 1.2 million individuals already living with the virus in the United States. The problem, according to the report, is that first-generation clinicians specializing in HIV are retiring, and applications to infectious disease fellowships are also dropping, raising concerns about a shortage of qualified practitioners to care for HIV-infected patients in the future. While primary care physicians are “well positioned” to manage the needs of patients with HIV, the paper notes that there are sometimes unique challenges in this population that require additional training.
“People living with HIV have better outcomes when cared for by practitioners with more experience managing their complex needs,” the paper notes.
The study goes on to state that general physicians who manage smaller numbers of patients with HIV “performed significantly worse on HIV-related quality measures, including engagement in care, viral load testing, and virologic suppression,” and that internal medical residents often lack the time to develop the continuity of care that these patients really need.
A new training track
The training track developed by the research team is a three-year program called the HIV Primary Care Track, and provides training for internal medicine residents on HIV medicine and LGBT health. The track was tested at Beth Israel Deaconess Medical Center (BIDMC)/Fenway Health in Boston and funded with a five-year grant from the Health Resources and Services Administration (HRSA). Four residents were enrolled in the program annually between 2011 and 2015 plus additional work by interns. Residents held weekly clinics at Fenway Health and provided care to at least 20 patients with HIV, participated in a weekly conference including management and care topics and were encouraged to take outpatient elective courses focused on HIV care. At the end of the program, residents were required to complete and present a project at an academic meeting, as well as take the American Academy of HIV Medicine certification exam. The program was novel, according to the paper, because of the way it intertwined both HIV and primary care.
“It is possible to teach medical residents who have interest in the field to be competent HIV practitioners as part of their training experience. It requires the availability of faculty teaching expertise and access to an HIV-infected patient population,” Libman said. “Because of the increasing gap between the number of HIV practitioners and HIV-infected patients, it is important to teach new primary care practitioners to be engaged in this work in the future. Our approach is one way to accomplish this goal. Competence in the field does not necessarily require infectious disease specialty training.”