Weiser John, Beer Linda, West Brady T, Duke Christopher C, Gremel Garrett W, Skarbinski Jacek
Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia.
Survey Research Center, University of Michigan.
Clin Infect Dis. 2016 Oct 1;63(7):966-975. doi: 10.1093/cid/ciw442. Epub 2016 Jun 29.
The human immunodeficiency virus (HIV)-infected population in the United States is increasing by about 30 000 annually (new infections minus deaths). With improvements in diagnosis and engagement in care, additional qualified HIV care providers may be needed.
We surveyed a probability sample of 2023 US HIV care providers in 2013-2014, including those at Ryan White HIV/AIDS Program (RWHAP)-funded facilities and in private practices. We estimated future patient care capacity by comparing counts of providers entering and planning to leave practice within 5 years, and the number of patients under their care.
Of surveyed providers, 1234 responded (adjusted response rate, 64%): 63% were white, 11% black, 11% Hispanic, and 16% other race/ethnicity; 37% were satisfied/very satisfied with salary/reimbursement, and 33% were satisfied/very satisfied with administrative time. Compared with providers in private practice, more providers at RWHAP-funded facilities were HIV specialists (71% vs 43%; P < .0001) and planned to leave HIV practice within 5 years (11% vs 4%; P = .0004). An estimated 190 more full-time equivalent providers (defined as 40 HIV clinical care hours per week) entered practice in the past 5 years than are expected to leave in the next 5 years. If these rates continue, by 2019 patient care capacity will increase by 65 000, compared with an increased requirement of at least 100 000.
Projected workforce growth by 2019 will not accommodate the increased number of HIV-infected persons requiring care. RWHAP-funded facilities may face attrition of highly qualified providers. Dissatisfaction with salary/reimbursement and administrative burden is substantial, and black and Hispanic providers are underrepresented relative to HIV patients.
美国感染人类免疫缺陷病毒（HIV）的人群数量每年约增加3万（新增感染病例减去死亡病例）。随着诊断水平的提高和医疗服务参与度的提升，可能需要更多合格的HIV护理提供者。
我们在2013 - 2014年对2023名美国HIV护理提供者进行了概率抽样调查，这些提供者包括接受瑞安·怀特HIV/艾滋病项目（RWHAP）资助的机构以及私人诊所的人员。我们通过比较未来5年内计划进入和离开该领域的提供者数量以及他们所护理的患者数量，来估计未来的患者护理能力。
在接受调查的提供者中，1234人做出了回应（调整后的回应率为64%）：63%为白人，11%为黑人，11%为西班牙裔，16%为其他种族/族裔；37%对薪资/报销情况感到满意/非常满意，33%对行政工作时间感到满意/非常满意。与私人诊所的提供者相比，接受RWHAP资助机构的更多提供者是HIV专科医生（71%对43%；P <.0001），且计划在5年内离开HIV护理领域（11%对4%；P =.0004）。在过去5年中，预计进入该领域的全职等效提供者（定义为每周40小时HIV临床护理工作时间）比预计在未来5年离开的多190人。如果这些比率持续下去，到2019年患者护理能力将增加6.5万，而相比之下至少需要增加10万。
预计到2019年劳动力的增长无法满足需要护理的HIV感染者数量的增加。接受RWHAP资助的机构可能面临高素质提供者的流失。对薪资/报销情况和行政负担的不满情绪较为严重，而且相对于HIV患者而言，黑人和西班牙裔提供者的占比不足。
