Board Chair's Forum
The Importance of External Validation and New Proposals on HIV Specialists
Changes in Our Definition
In September 2002, the Academy Board chose to simplify the definition of an HIV Specialist (see article). In the process, the Academy retained the three crucial elements needed to demonstrate professional development: experience, education, and external validation.
Most of the current definitions of an HIV Specialist incorporate some combination of Continuing Medical Education (CME) units and clinical experience as the key criteria in evaluating knowledge and clinical competency. Like IDSA's HIVMA and many other organizations' definitions, the Academy's definition incorporates experience with HIV patients and ongoing education, and requires that frontline providers who wish to be considered HIV Specialists meet these qualifications on a recurrent basis.
The Academy's Difference: The Importance of External Validation
The Academy's definition uniquely incorporates a component for external validation through our exam, which is heavily based on the most recent Learning Objectives of the AAHIVM Core Curriculum, and evaluates a provider's up-to-date knowledge on HIV care. While this component of external validation is unique in the area of HIV medicine, it is certainly not unique in medical education.
Updates on the Specialty of HIV Medicine
While the Academy continues its credentialing efforts, IDSA's HIVMA has announced that they are supporting and working toward creating a certificate of added qualification (CAQ) for HIV medicine. In December, at a meeting of the Forum for HIV Collaborative Research on the quality of HIV care, Dr. Daniel Kuritzkes announced the details of that process. Specifically, an application will be written and submitted to the American Board of Internal Medicine (ABIM). For ID-certified providers, they propose strengthening the HIV portion of programs around the country. For non-ID internists, the proposed changes include an additional one year fellowship in HIV Medicine and a board exam. So, in the future, to practice as an HIV Specialist, you would have two choices: either choose ID and pass the new strengthened program, or complete a residency in Internal Medicine plus an additional year of HIV fellowship and pass the board exam. This proposal would exclude NPs, PAs, and physicians who are not board-certified, and is likely to exclude Family Practitioners.
The Academy continues to support and advocate the formation of an HIV Specialty and welcomes new approaches. It has always been a priority of the Academy to increase the number of HIV medical providers, and we have worked to provide tools and mechanisms to do so. It is our concern, however, that over time IDSA's proposal could actually decrease the number of HIV medical providers, because internists would be required to take additional education, and because of the exclusion of many others. This does not coincide with the goals of the Academy to improve the quality of HIV care and increase access to that care.
Depending on the source of the estimate, ID physicians currently account for approximately one third of the total HIV medical providers in the U.S. Any policy that limits the number of skilled practitioners of HIV medicine will have an impact on the availability of care. The Academy's definition of an HIV Specialist is not intended to limit access to care for patients with HIV or to exclude experienced practitioners from providing care to HIV patients. In fact, our intent is to lower barriers to entering HIV medicine by providing direct access to up-to-date knowledge and a credentialing process to provide external validation of that knowledge.
To date, more than 1,000 providers have obtained the HIV Specialist designation through the Academy. As always, the Academy welcomes suggestions on its credentialing process as it continues to move forward with its mission.
This article was provided by American Academy of HIV Medicine. It is a part of the publication The Nexus. Visit AAHIVM's website to find out more about their activities and publications.