AMA Policies on Resident Physicians and HIV. JAMA. 1998;280(1):102B. doi:10.1001/jama.280.1.102
Prepared by Ashish Bajaj, Department of Resident Physician Services, American Medical Association.
The American Medical Association (AMA) has adopted several policies
concerning the training of resident and fellow physicians and patients infected
with human immunodeficiency virus (HIV). The following policies discuss educational
and patient care considerations, as well as the teaching institution's responsibility
to a resident who may have been exposed to HIV.
In Assessing the Impact of AIDS on Residency Training (policy H-20.971),
the AMA urges teaching institutions and medical educators responsible for
the education of medical students and resident physicians to ensure that:
The educational program includes the scientific, ethical, and
social aspects of the epidemic of HIV infection.
The resident physician is instructed in practice techniques that
will minimize the risk of acquiring HIV from patients.
The educational institution develops support systems to help resident
physicians cope with the difficulties associated with the study and treatment
of patients with HIV infection.
The variety of patient illnesses necessary for the educational
experience is not distorted by a responsibility for caring for an excessive
patient population with HIV infection.
An institutional policy is in effect that addresses how the institution
educates a resident physician infected with HIV.
An institutional policy is in effect that addresses the institution's
responsibility to indemnify a resident physician who has been infected with
HIV as a result of contact with assigned patients.
The AMA strengthened the point about indemnifying an HIV-seropositive
resident physician in another policy, Health and Disability Insurance for
Medical Students (H-295.948). The policy expresses the AMA's belief that all
medical schools and residency programs should offer insurance policies that
include health and disability coverage for HIV infection. The policy also
states that the residency programs should require that residents enroll in
insurance plans that provide coverage for HIV infection.
Two related but broader policies, AMA HIV Policy Update (H-20.966) and
AMA 1990 (H-20.954), discuss the responsibilities, both to patients and to
the institution, of the health care worker who may have been exposed to HIV.
In these policies, the AMA:
Encourages health care workers who perform invasive procedures
and have reason to believe they are infected with HIV to determine their serostatus
and/or to act as if their serostatus were positive.
Encourages an infected health care worker who performs invasive
procedures to request that an ad hoc committee be constituted to consider
which activities he or she can continue to engage in without an identifiable
risk of infection to patients. The ad hoc committee should establish a confidential
review system to monitor the health care worker's fitness to engage in invasive
health care activities.
Encourages restricting knowledge of the health care worker's serostatus
to those few professionals who have a medical need to know it. In all other
cases, information on the serostatus of the health care worker must be held
in the strictest confidence.
Encourages that the infected health care worker be permitted to
provide services as long as there is no identifiable risk of infecting patients
and no compromise in the physical or mental ability of the worker to perform
the required health care procedures.
Encourages employers of health care workers to provide, at the
employer's expense, serologic testing for HIV infection to all health care
workers who have documented occupational exposure to HIV.
For more information on any of these or other AMA policies, please contact
the AMA Department of Resident Physician Services at (312) 464-4743.