title: At the coalface and the cutting edge: general practitioners' accounts of the rewards of engaging with HIV medicine.
abstract: BACKGROUND
  HIV has become a chronic manageable infection in the developed world, and early and lifelong treatment has the potential to significantly reduce transmission rates in the community. A skilled and motivated HIV medical workforce will be required to achieve these health management and prevention outcomes, but concerns have been noted in a number of settings about the challenges of recruiting a new generation of clinicians to HIV medicine.
  
  
  METHODS
  As part of a larger qualitative study of the HIV general practice workforce in Australia, in-depth interviews were conducted with 31 general practitioners accredited to prescribe HIV medications in community settings. A thematic analysis was conducted of the de-identified transcripts, and this paper describes and interprets accounts of the rewards of pursuing and sustaining an engagement with HIV medicine in general practice settings.
  
  
  RESULTS
  The rewards of initially becoming involved in providing care to people living with HIV were described as interest and inspiration, community calling and right place, right time. The rewards which then supported and sustained that engagement over time were described as challenge and change, making a difference and enhanced professional identity. Participants viewed the role of primary care doctor with special expertise in HIV as occupying an ideal interface between the 'coalface' and the 'cutting edge', and offering a unique opportunity for general practitioners to feel intimately connected to both community needs and scientific change.
  
  
  CONCLUSIONS
  Approaches to recruiting and retaining the HIV medical workforce should build upon the intellectual and social rewards of this work, as well as the sense of professional belonging and connection which is imbued between both doctors and patients and across the global and national networks of HIV clinicians. Insights regarding the rewards of engaging with HIV medicine may also be useful in enhancing the prospect of general practice as a career, and strengthening retention and job satisfaction among the existing general practice workforce.
authors.affiliation: National Centre in HIV Social Research, The University of New South Wales, Level 3 John Goodsell Building, Sydney, NSW, 2052, Australia. c.newman@unsw.edu.au
authors.forename: Christy E
authors.initials: CE
authors.lastname: Newman
authors.forename: Asha
authors.initials: A
authors.lastname: Persson
authors.forename: John B F
authors.initials: JB
authors.lastname: de Wit
authors.forename: Robert H
authors.initials: RH
authors.lastname: Reynolds
authors.forename: Peter G
authors.initials: PG
authors.lastname: Canavan
authors.forename: Susan C
authors.initials: SC
authors.lastname: Kippax
authors.forename: Michael R
authors.initials: MR
authors.lastname: Kidd
mesh_terms: D000328:Adult; D001315:Australia; D002321:Career Choice; D005260:Female; D058005:General Practitioners / Q000523:psychology*; D015658:HIV Infections / Q000628:therapy*; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D009042:Motivation; D010819:Physician's Role; D012201:Reward; D013038:Specialization