Coming to terms with the era of AIDS: attitudes of physicians in U.S. residency programs

Abstract

Purpose: To examine factors associated with residents' willingness to provide care to persons with AIDS.

Patients and methods: Survey of all senior residents in internal medicine and family medicine in ten geographically representative states in early 1989.

Results: Preferring not to care for persons with AIDS was less common in the western United States and more common among those with more conservative politics, men physicians, Asian physicians, and foreign medical graduates. Multivariate analysis revealed scores on six attitudinal scales (homophobia, dislike of intravenous drug users, professional responsibility, fear of AIDS, futility of providing AIDS care, and clinical difficulty of AIDS care) to be strong independent predictors of willingness to care for persons with AIDS (adjusted R2 = 0.42). The authors postulated a model in which these six fundamental attitudes functioned as intervening variables between demographic characteristics and expressed willingness to provide AIDS care. Regression results supported the hypothesis that the associations between demographic characteristics and willingness to provide AIDS care were mediated via these attitudes. However, having had ambulatory experience in AIDS care during residency was associated with future intentions to provide such care, independent of negative attitudes.

Conclusions: Physician willingness to care for persons with AIDS is inversely related to fear of acquiring AIDS, viewing treatment as futile or difficult, dislike of certain risk groups, and a lower sense of professional responsibility. These results identify concerns and stresses that should be addressed by residency programs, and emphasize the need for attention to the ethics and ideals of the profession in medical education.