Within the next 5 years, what is the estimated shortfall? A new study examines 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.
A probability sample of 2,023 U.S. HIV care providers in 2013-2014 was surveyed, including those at Ryan White HIV/AIDS Program (RWHAP)-funded facilities and in private practices. Estimated future patient care capacity by comparing counts of providers entering and planning to leave practice within five years, and the number of patients under their care.
Results
- 63% were white
- 11% black
- 11% Hispanic
- 16% other race/ethnicity
- 37% were satisfied/very satisfied with salary/reimbursement
- 33% were satisfied/very satisfied with administrative time
Compared to providers in private practice, more providers at RWHAP-funded facilities were HIV specialists (71% vs. 43%) and planned to leave HIV practice within five years (11% vs 4%). An estimated 190 more full-time equivalent providers (defined as 40 HIV clinical care hours per week) entered practice in the past five years than expected to leave in the next five years.
If these rates continue, by 2019 patient care capacity will increase by 65,000, compared to an increased requirement of at least 100,000.
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, the study 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 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 that 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 numbers of people living with HIV is in part an indication of the success of appropriate and optimal treatment that must not be jeopardized.
