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Demand for new HIV providers will outstrip supply by 2019
Although the number of HIV care providers appears to be increasing, recently published data suggested it will not be enough to match the growing HIV population and could result in a patient care capacity deficit of approximately 35,000 persons.
In addition, findings from the study suggested that 37% of HIV care providers are satisfied with their salary, one-third are satisfied with their administrative work hours, and more than half are satisfied with their overall work schedule and on-call responsibilities.
“In the United States, an estimated 1.2 million persons are living with [HIV] infection and because new infections outpace deaths of HIV-infected persons, this population is increasing by about 30,000 persons per year,” John Weiser, MD, MPH, medical epidemiologist at the CDC, and colleagues wrote. “Efforts are underway to increase the number of HIV-infected persons who are in care and virally suppressed, but achieving these objectives will require a workforce of HIV care providers with the capacity and qualifications to meet the needs of an expanded HIV in-care population.”
Despite this growing demand, previous reports have described potential issues facing the HIV workforce including racial diversity, provider satisfaction, qualifications and retiring HIV experts being adequately replaced by new providers, Weiser and colleagues wrote. To investigate these issues, they examined survey data from 1,234 U.S. HIV care providers collected through the 2013-2014 Medical Monitoring Project Provider Survey. Survey questions included demographics, qualifications, experience, practice characteristics and professional satisfaction. The researchers compared responses between providers working at Ryan White HIV/AIDS Program (RWHAP)-funded facilities and those at private practices, and they conducted an additional analysis stratifying respondents by three experience-based categories: those who had entered practice within the previous 5 years, those who planned to leave practice within 5 years, and those who were in practice for at least 5 years and had no plans to leave.
Respondents were 63% white, 11% black and 11% Hispanic. Fifty-eight percent met the criteria to be considered an HIV specialist, and 83% reported providing primary care. More than half of the respondents reported satisfaction with all areas of practice, with the exception of salary and reimbursement (37% satisfaction) and the time needed to perform documentation or administrative work (33% satisfaction). When compared with private practice, respondents from RWHAP-funded facilities were more often HIV specialists (71.5% vs. 43.2%; P < .0001) and were more likely to report leaving HIV care within the next 5 years (11.1% vs. 3.5%; P = .0004).
Based on their data, the researchers estimated 190 more full-time equivalent providers entered HIV care within the previous 5 years than are expected to leave within 5 years. Should these rates continue Weiser and colleagues predicted that HIV patient care capacity would increase by more than 65,000 persons by 2019; however, this increase would fall short of the additional 100,000 HIV patients expected to require care by the same time period.
“We project that the HIV care provider workforce will increase modestly over 5 years, assuming that the stable number of infectious disease and primary care post-graduate positions in the past decade is maintained,” they wrote. “However, this additional capacity will likely be outpaced by an increase in HIV prevalence of 30,000 annually if current incidence and death rates continue along with improvements in diagnosis and engagement in care. Even if the rate of the annual increase in HIV prevalence is reduced by one-third, this source of demand for care will still exceed the increased capacity to provide care.” – by Dave Muoio
Disclosure: Weiser and colleagues report no relevant financial disclosures.
Perspective
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This study examining the capacity of a limited specialized physician workforce to meet a growing demand for HIV care supports the need for immediate action to ensure the health and futures of Americans living with the virus. Finding that within the next 5 years the numbers of new physicians trained in HIV care will fall significantly short of the numbers necessary to provide appropriate treatment to an estimated 30,000 additional patients each year, it highlights both the value of the HIV specialty, and factors that discourage pursuing it.
While administrative burdens associated with HIV care provision remain substantial, salary and reimbursements for providing that care remain among the lowest in medicine, challenging outcomes and satisfaction in a field that physicians often have chosen for the opportunities it offers to improve patients’ lives. With infectious diseases-trained physicians accounting for the largest specialty represented among the HIV workforce, these findings also reflect the steep decline in applicants applying for fellowship slots in the specialty and the primary factors driving that downturn.
In addition, finding that the nearly half of HIV-trained physicians practice at facilities receiving Ryan White funding, providing care for nearly three-quarters of all patients with HIV, the study highlights the critical role of the Ryan White Program and the need for robust and sustained funding for the program. The rising number of people living with HIV is in part an indication of the success of appropriate and optimal treatment that must not be jeopardized.