HIV: OPTIONS FOR MEDICAL CARE-PHYSICIANS: AIDS PHYSICIANS
AIDS physicians are physicians who devote most of their time to caring for people with HIV infection. By strict definition of the word specialist there is no such person as an “AIDS specialist”: rather, some physicians simply adopt the treatment of AIDS and HIV infection as a special interest.
A little background on what makes a specialist:
Physicians practice in a variety of specialties, including family practice, pediatrics, internal medicine, surgery, and obstetrics and gynecology. Becoming a physician requires graduating from medical school, doing postgraduate training as a resident, passing standard tests, and getting a license through the state licensing board. By law, a physician requires a license to practice medicine. The type of postgraduate training determines the specialty.
Becoming a certified specialist requires certification by a professional specialty board within the American Board of Medical Specialties. Certification requires postgraduate training for a specified number of years in an approved training program, followed by passing an examination in the specialty called a board examination. To be certified as a cardiologist, for example, the physician must take three years of postgraduate training in internal medicine, then pass the board examinations to be certified as a specialist in internal medicine, then take three additional years of postgraduate training in cardiology, and then pass the board examinations in cardiology to be certified in cardiology. Any physician can claim to be a cardiologist, but only those who satisfy these requirements can call themselves board-certified cardiologists.
There are no recognized accredited training programs for specializing in HIV infection and no board examinations to certify competence in treatment of HIV infection. This means there is no medical specialty in HIV infection, and there is not likely be one in the foreseeable future. Instead, physicians with different kinds of training and with different specialties have adopted AIDS as a special interest. To repeat, these are physicians informally called AIDS physicians.
The specialty that has provided most of the AIDS physicians is infectious diseases, which, like cardiology, is a subspecialty of internal medicine. Specialists in infectious diseases become AIDS physicians because HIV infection is an infectious disease, and because most of the
opportunistic infections are those commonly encountered during infectious disease training. Some specialists in infectious diseases primarily treat people with HIV infection; some treat people with other infectious diseases plus people with HIV infection. Most infectious disease specialists have the appropriate expertise to treat people with HIV infection.
Other medical specialties also supply AIDS physicians. Some specialists treat AIDS because of the nature of their specialties: oncology, pulmonary medicine, dermatology. Others, like gay physicians, treat AIDS for more personal reasons.
AIDS physicians keep current with this fast-moving field by attending medical meetings dealing with HIV infection and by subscribing to several of the forty to sixty medical journals devoted to HIV infection. Their practices may be limited almost exclusively to people with HIV infection, and they are themselves often leaders in the community in social, medical, and political issues that relate to HIV infection.
Treatment of HIV infection has attracted some of the country’s most competent and compassionate physicians. It has also attracted some physicians who promote what many other physicians would consider ill-advised or even risky treatments. Remember, any physician can claim to be an AIDS physician, and no reputable professional group has certification requirements by which to substantiate the claim.
Unfortunately, at present, the numbers of AIDS physicians are inadequate to serve the increasing numbers of people with HIV infection. As a result, many people with HIV infection receive medical care from primary care physicians who call on AIDS physicians to help with the more difficult complications of the disease. This plan for medical care will work well as long as the supply of physicians for both early care and later complications keeps pace with the epidemic.