{"id":4426,"date":"2013-08-01T14:24:52","date_gmt":"2013-08-01T18:24:52","guid":{"rendered":"http:\/\/blogs.nejm.org\/?p=4426"},"modified":"2015-06-04T14:33:18","modified_gmt":"2015-06-04T18:33:18","slug":"poll-will-there-be-a-shortage-of-hiv-providers","status":"publish","type":"post","link":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/poll-will-there-be-a-shortage-of-hiv-providers\/2013\/08\/01\/","title":{"rendered":"Poll: Will There Be A Shortage of HIV Providers?"},"content":{"rendered":"<p><a href=\"http:\/\/blogs.nejm.org\/hiv-id-observations\/wp-content\/uploads\/sites\/2\/2013\/08\/shuffleboard1.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"alignright size-medium wp-image-4435\" alt=\"shuffleboard\" src=\"http:\/\/blogs.nejm.org\/hiv-id-observations\/wp-content\/uploads\/sites\/2\/2013\/08\/shuffleboard-300x1881.jpg\" width=\"300\" height=\"188\" \/><\/a>Over on <a href=\"http:\/\/www.jwatch.org\/\" target=\"_blank\"><em>NEJM Journal Watch<\/em><\/a> &#8212; love that new name &#8212; I reviewed a paper on the demographics of people living with AIDS in San Francisco.<\/p>\n<p>Bottom line &#8212; <a href=\"http:\/\/www.jwatch.org\/na31802\/2013\/08\/01\/epidemic-ages-so-do-patients\" target=\"_blank\"><strong>more than half are now older than 50.<\/strong><\/a><\/p>\n<p>Implication &#8212; <em>that&#8217;s so old!<\/em><\/p>\n<p>First, it really isn\u2019t, unless you compare it to the dismal era 20+ years ago, when so many of the sick and dying with AIDS were young men and women. Let\u2019s face it, that was one of the true horrors \u2014 maybe\u00a0<em>the<\/em>\u00a0horror \u2014 of this new disease.<\/p>\n<p>Second, this aging of the HIV population is of course really a <em>good<\/em> thing, since it means fewer people are dying of AIDS.<\/p>\n<p>Third, what does it say about us, the HIV providers? \u00a0The doctors, nurses, PAs, PharmDs, social workers, case managers, etc. who have been at this for quite some time now.<\/p>\n<p>Obvious answer: We&#8217;re getting older too. <em>Even older than 50.<\/em><\/p>\n<p>(Yes, for the record, you could say that I&#8217;m speaking from personal experience here.)<\/p>\n<p>In fact, this paper prompted one of my colleagues to ask me about our successors. What happens when we oldsters decide <a href=\"https:\/\/www.google.com\/search?q=old+people+playing+shuffleboard&amp;tbm=isch&amp;tbo=u&amp;source=univ&amp;sa=X&amp;ei=hpH6UZ-uAY2tqAG8zYHICA&amp;ved=0CC8QsAQ&amp;biw=1308&amp;bih=651#tbm=isch&amp;sa=1&amp;q=older+people+playing+bingo&amp;oq=older+people+playing+bingo&amp;gs_l=img.3...41929.42692.4.42900.6.6.0.0.0.1.117.427.5j1.6.0....0...1c.1.23.img..6.0.0.ShdWwYMudFs&amp;bav=on.2,or.r_cp.r_qf.&amp;bvm=bv.50165853%2Cd.aWM%2Cpv.xjs.s.en_US.seW1cfrvSKg.O&amp;fp=4e8197104eb10f69&amp;biw=1308&amp;bih=651&amp;imgdii=_\" target=\"_blank\">to do something else?<\/a>\u00a0Who&#8217;s going to take our place?<\/p>\n<p>I&#8217;ve heard anecdotally that in some parts of the country it&#8217;s been difficult to attract young clinicians to HIV\/ID, with multiple reasons cited &#8212; not enough revenue, HIV\/AIDS lacks the drama it used to have, the patient population has changed, all the young people are now interested in only international work, there are no good jobs available.<\/p>\n<p>Let&#8217;s take these one at a time:<\/p>\n<ul>\n<li><span style=\"line-height: 13px\"><strong><em>Not enough revenue<\/em><\/strong>: I guess there is some truth to this, especially in a health care system that values volume and procedures over complexity. But this has hardly changed, so it&#8217;s not as if anyone went into HIV\/ID primarily for cash to begin with. Hey, this is <a href=\"http:\/\/work.chron.com\/much-orthodontists-make-yearly-3105.html\" target=\"_blank\">not orthodonture,<\/a> folks!<\/span><\/li>\n<li><strong><em>HIV\/AIDS lacks the drama it used to have<\/em><\/strong>: \u00a0Certainly fewer premature deaths means less drama &#8212; but is this is the kind of drama anyone really wants? I wouldn&#8217;t trade the current HIV treatment era <a href=\"http:\/\/blogs.nejm.org\/index.php\/aids-quilt-the-early-1990s-and-sadness\/2012\/07\/25\/\" target=\"_blank\">for the early 1990s<\/a> in a million years.<\/li>\n<li><strong><em>The patient population has changed<\/em><\/strong>: In fact, it really hasn&#8217;t &#8212; HIV\/AIDS has disproportionately struck gay men (all races\/ethnic groups) and heterosexual racial\/ethnic minorities for decades now. There are fewer new infections from injection drug use and hemophilia, but that&#8217;s about it.<\/li>\n<li><strong><em>All young people are now interested in only international work:<\/em> <\/strong>Yes, some of the trainees are truly committed to establishing a research and\/or clinical base in regions that have a far worse HIV\/AIDS problem than we do. But for many this initial enthusiasm fades once they realize how difficult it is to do this successfully &#8212; especially while simultaneously trying to start a family. Which means they also want to work here, or even <em>predominantly<\/em> want to work here.<\/li>\n<li><strong><em>There are no jobs.<\/em><\/strong> Well, there will be when we retire &#8212; that&#8217;s the point of this discussion!<\/li>\n<\/ul>\n<p>So is it true that we won&#8217;t be able to find new HIV\/ID providers to care for HIV patients when we stop doing it?<\/p>\n<div id=\"polls-13\" class=\"wp-polls\">\n\t<form id=\"polls_form_13\" class=\"wp-polls-form\" action=\"\/index.php\" method=\"post\">\n\t\t<p style=\"display: none;\"><input type=\"hidden\" id=\"poll_13_nonce\" name=\"wp-polls-nonce\" value=\"053adc9992\" \/><\/p>\n\t\t<p style=\"display: none;\"><input type=\"hidden\" name=\"poll_id\" value=\"13\" \/><\/p>\n\t\t<p style=\"text-align: center;\"><strong>True or false -- we will soon be facing a shortage of HIV providers.<\/strong><\/p><div id=\"polls-13-ans\" class=\"wp-polls-ans\"><ul class=\"wp-polls-ul\">\n\t\t<li><input type=\"radio\" id=\"poll-answer-40\" name=\"poll_13\" value=\"40\" \/> <label for=\"poll-answer-40\">True -- once the old guard steps down, not enough younger clinicians will be available to take their place.<\/label><\/li>\n\t\t<li><input type=\"radio\" id=\"poll-answer-41\" name=\"poll_13\" value=\"41\" \/> <label for=\"poll-answer-41\">False -- there are plenty of youngsters out there ready and willing to take over.<\/label><\/li>\n\t\t<\/ul><p style=\"text-align: center;\"><input type=\"button\" name=\"vote\" value=\"   Vote   \" class=\"Buttons\" onclick=\"poll_vote(13);\" \/><\/p><p style=\"text-align: center;\"><a href=\"#ViewPollResults\" onclick=\"poll_result(13); return false;\" title=\"View Results Of This Poll\">View Results<\/a><\/p><\/div>\n\t<\/form>\n<\/div>\n\n","protected":false},"excerpt":{"rendered":"<p>Over on NEJM Journal Watch &#8212; love that new name &#8212; I reviewed a paper on the demographics of people living with AIDS in San Francisco. Bottom line &#8212; more than half are now older than 50. Implication &#8212; that&#8217;s so old! First, it really isn\u2019t, unless you compare it to the dismal era 20+ [&hellip;]<\/p>\n","protected":false},"author":6,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[3,4,5,6,8],"tags":[353,423,482,498],"class_list":["post-4426","post","type-post","status-publish","format-standard","hentry","category-health-care","category-hiv","category-infectious-diseases","category-medical-education","category-patient-care","tag-fellowship","tag-hiv","tag-id-fellowship","tag-infectious-diseases"],"post_mailing_queue_ids":[],"_links":{"self":[{"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/posts\/4426","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/users\/6"}],"replies":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/comments?post=4426"}],"version-history":[{"count":0,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/posts\/4426\/revisions"}],"wp:attachment":[{"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/media?parent=4426"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/categories?post=4426"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/tags?post=4426"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}