HIV and ID Observations

Over on NEJM Journal Watch — love that new name — I reviewed a paper on the demographics of people living with AIDS in San Francisco.

Bottom line — more than half are now older than 50.

Implication — that’s so old!

First, it really isn’t, 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’s face it, that was one of the true horrors — maybe the horror — of this new disease.

Second, this aging of the HIV population is of course really a good thing, since it means fewer people are dying of AIDS.

Third, what does it say about us, the HIV providers?  The doctors, nurses, PAs, PharmDs, social workers, case managers, etc. who have been at this for quite some time now.

Obvious answer: We’re getting older too. Even older than 50.

(Yes, for the record, you could say that I’m speaking from personal experience here.)

In fact, this paper prompted one of my colleagues to ask me about our successors. What happens when we oldsters decide to do something else? Who’s going to take our place?

I’ve heard anecdotally that in some parts of the country it’s been difficult to attract young clinicians to HIV/ID, with multiple reasons cited — 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.

Let’s take these one at a time:

• Not enough revenue: 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’s not as if anyone went into HIV/ID primarily for cash to begin with. Hey, this is not orthodonture, folks!
• HIV/AIDS lacks the drama it used to have:  Certainly fewer premature deaths means less drama — but is this is the kind of drama anyone really wants? I wouldn’t trade the current HIV treatment era for the early 1990s in a million years.
• The patient population has changed: In fact, it really hasn’t — 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’s about it.
• All young people are now interested in only international work: 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 — especially while simultaneously trying to start a family. Which means they also want to work here, or even predominantly want to work here.
• There are no jobs. Well, there will be when we retire — that’s the point of this discussion!

So is it true that we won’t be able to find new HIV/ID providers to care for HIV patients when we stop doing it?