Strengthening the HIV Provider Workforce Through a Residency Pathway: Outcomes and Challenges

BACKGROUND: HIV medicine pathways within residency programs are designed to help address the shortage of trained HIV providers in the United States, but little is known about outcomes following graduation from residency. In 2015 we surveyed University of Washington (UW) internal medicine residency HIV pathway graduates about practice habits and found a high proportion continued to provide primary care for people living with HIV (PLWH). Here, we aim to reassess pathway graduates’ practice patterns two years later. METHODS: In March 2017 we sent an anonymous, electronic survey to pathway graduates. We asked if their pathway training had prepared them adequately to provide primary care for both HIV-infected and HIV-uninfected patients and inquired as to whether they continue to provide care for PLWH. RESULTS: All participants responded to the survey, and 12/12 (100%) felt their pathway training prepared them well to provide primary care for PLWH. Ten of 12 (83%) felt their pathway training was adequate to provide primary care for HIV-uninfected patients; two felt they lacked sufficient training in women’s health and geriatric medicine. Although in our prior survey all anticipated care for PLWH to be an important part of their careers, currently only 2/12 (17%) graduates provide care for greater than 20 PLWH, as compared with 5/7 (71%) of graduates in 2015. Six graduates (50%) currently provide care to less than 20 PLWH. The most common barrier cited for either finding or sustaining jobs in HIV primary care was lack of fellowship training in infectious diseases. CONCLUSION: Graduates of the UW internal medicine residency HIV pathway feel confident caring for PLWH and generally feel their internal medicine training is sufficient. However, we observed a marked decrease in graduates caring for greater than 20 PLWH between 2015 and 2017. We need further assessments of the barriers to sustaining jobs in HIV primary care and suggest that other residency training programs assess graduate employment outcomes. Given HIV provider workforce shortages, we must address practice barriers for primary care providers trained in HIV medicine and create mechanisms to support the career development of residency pathway graduates. DISCLOSURES: All authors: No reported disclosures.