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Resident Forum
July 1, 1998

AMA Policies on Resident Physicians and HIV

Author Affiliations
 

Prepared by Ashish Bajaj, Department of Resident Physician Services, American Medical Association.

JAMA. 1998;280(1):102B. doi:10.1001/jama.280.1.102

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.

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