Pride, Primary Care, and Changing Millions of Lives

Back in 1983, when Bruce Olmscheid, MD ’87, ’90, was beginning his undergraduate medical education, AIDS was on the cover of TIME Magazine. Dr. Olmscheid, a gay man from Sauk Centre, MN who had recently come out, didn’t know at the time that his career and life would be defined by the AIDS/HIV epidemic. 

By the end of 1983, AIDS was beginning to become a household term. Although only 3,064 people were confirmed to have AIDS, 42% of those people had died, according to a CDC surveillance report. While AIDS was on Dr. Olmscheid’s radar while he was a student, it wasn’t a focus of his studies. He attended the University of Minnesota Medical School planning to become a family medicine physician. Having seen family medicine doctors in action in his rural community, he was drawn to their generalist, patient-centered approach to healthcare.

The broad education and clinical experience of family medicine prepared him for his first job out of residency as an emergency physician — before ER doctors had to be board certified. He felt that his U of M Medical School training prepared him for being able to be flexible and go in different directions. This came in handy three years later when he moved to New York City to join his future husband. There, in 1993, Dr. Olmscheid joined a Midtown Manhattan practice and soon fell into caring for patients who had AIDS. This was well before the term “living with HIV” was coined, he recalled. 

“They were all being admitted to NYU and dying. I wanted to take care of my people,” Dr. Olmscheid said. 

Dr. Olmscheid learned about the disease one patient at a time as well as from his clinical colleagues, and from people in the pharmaceutical industry who were working hard to develop treatments. His work caring for these patients led to a job opportunity at St. Vincent’s Hospital in NYC, which was known as the AIDS epicenter. It housed the first and largest AIDS ward on the East Coast and was one of the first institutions to address and treat HIV and AIDS in the 1980s. 

Working at St. Vincent’s, Dr. Olmscheid began to see his purpose. His primary care training had turned into “a blessing” as his focus shifted to the whole body disease that is AIDS. On the wards, he felt like he was back in family medicine again. And as hard as this work was at a time when the diagnosis was basically a death sentence, he remembers the good times just as easily as the difficulties. 

“We were out! We were gay! The waiting room was filled with sick, thin, wasting away men, but we were using our gay culture to make the experience better for them. When we called out names, we often sang them over the microphone,” Dr. Olmscheid said. 

This was the turning point in his career — he soon became the Director of AIDS Education and Training Program, working with the New York State Department of Health AIDS Institute and other federally funded programs to create and deliver curriculum to doctors working outside of large, urban centers, to allow them to care for people who had AIDS in their local communities. 

“I was a small-town kid from the U of M Medical School, seeing patients and on staff at St. Vincent’s Hospital, who became the first family medicine doctor to be credentialed in the internal medicine department because they didn’t have family medicine — I couldn’t believe it,” Dr. Olmscheid said. 

Part of this work involved serving as the lead investigator for a new drug — tenofovir disoproxil fumarate (TDF) — being investigated for treatment of HIV. This drug went on to get approved and quickly replaced the older, more toxic medications like AZT, that had been in use for many years. TDF was later combined with another drug to form Truvada, which is now one of the mainstays of treatment for HIV. 

In 1999, Dr. Olmscheid was invited onto the McNeil Lehrer NewsHour, a nationally syndicated prime-time show. His segment was titled “AIDS in 2000,” and Dr. Olmscheid recalls, “This was really the time when we stopped using the term ‘AIDS’ and started using HIV/AIDS.” This was a turning point for the gay community as HIV had become a manageable condition. Dr. Olmscheid said that with a better understanding of the disease pathways and drugs that could suppress the virus and prevent the development of AIDS, people were beginning to live with HIV.

His experience working with Gilead Sciences during the clinical trials of TDF paired with the burnout he was feeling after six years of caring for severely ill patients opened Dr. Olmscheid up to an opportunity to join Gilead full-time in 2001 to develop and lead a Medical Affairs program. While he struggled with the decision to leave patient care, he took solace in the fact that he was going to be helping millions of people in a similar way. In his nine years with Gilead, as the director of Medical Affairs, he built teams of doctors to serve as Medical Science Liaisons, along with leading the Phase IV clinical trials program. It was in that role that he was involved with the studies of Truvada for HIV prevention.  He also especially enjoyed the time he served as the Interim Global Medical Director, expanding Gilead’s reach into Europe. 

In 2012, Truvada was approved for use as pre-exposure prophylaxis (PrEP). Truvada, taken by people who don’t have HIV but are at higher risk of exposure to HIV, marked a second major development in the fight against HIV. “We now have the ability to prevent HIV infection. It’s become part of the culture,”Dr. Olmscheid said. “You’ll see ‘On PrEP’ in dating profiles, and this tells other men, ‘I don’t have HIV, I’m responsible, and I see my doctor every three months.’”

While he did well in the corporate environment, the treadmill in pharma goes fast, and after nine years, Dr. Olmscheid was ready to see what his next phase had in store for him. He joined a medical startup, One Medical, in 2012. Dr. Olmscheid became medical director, working to open up offices around the San Francisco Bay Area and later in Southern California. One Medical specializes in delivering primary care, and Dr. Olmscheid continued to develop a practice with a focus on LGBTQ health within his primary care practice.  

“Gay patients are so happy to have a gay doctor. Understanding each other makes all of the difference in the world,” Dr. Olmscheid said.

As of June 2021, Dr. Olmscheid has made yet another practice shift, returning to his roots as a family medicine practitioner in the Twin Cities at Park Nicollet. One of his first weeks on the job, he encountered a colleague who shared with him that her gay son was on Truvada. “She said, ‘We are so grateful that you’re here. We need you here for this community in Minneapolis,’”Dr. Olmscheid said. 

Dr. Olmscheid plans to be there for more than just his patients — he is looking forward to serving as a clerkship site for U of M Medical School learners. 

“Although it’s much easier to be out now than it was in 1983, these physicians in their 20s and 30s still need mentors and help,” Dr. Olmscheid said. “I owe it to those before me to give back in the same ways I was during my time at the U of M Medical School.”