Newest doctors shun infectious diseases specialty

Thousands of doctors, ready to continue their training, celebrated match day Nov. 30 for specialty fellowships, but one group bemoaned the results: infectious disease physicians. Despite its central role in the Covid pandemic, the infectious diseases specialty saw 44% of its training programs incomplete.

“I’m bummed,” he says Dr. Carlos del RioProfessor and President at Emory School of Medicine Infectious Diseases Society of America. “I love my field, I love what I do. And it hurts to know that my field is not as attractive to trainees as I would like it to be.”

at the University of Washington, one of the nation’s Top rated programs, administrators were scrambling to find suitable candidates for the two fellowship spots that were still open after the match process. “It’s uncomfortable,” said Dr. “Typically, we match our full eight slots on the first trip,” says Paul Pottinger.

At Boston Medical Center, affiliated with Boston University, none of their three fellowship positions were filled at this year’s match — a “challenging” and unprecedented situation. Dr. Daniel Bourquewho runs their fellowship program: “The number of applicants dropped this year, and that drop appears to be a trend.”

Becoming an infectious disease specialist takes years of training. Typically, after four years of medical school, followed by several years in medical residency, aspiring ID physicians apply for at least a two-year fellowship program. Field hit a low point In recruitment for fellowship in 2016. Over the past five years, it has been somewhat stable, with about 65%-70% of training programs filled.

But 2020 was an exception, when a flood of applicants achieved record match rates — a phenomenon known as the “Fausee effect.” As infectious diseases dominated the news, “many of us saw it as one [sign of] The pandemic sparked a resurgence of interest in ID,” says Boghuma Tittanji Dr, an infectious diseases physician at Emory University. But since slide – off by This year’s “terrible fall” – shows that promoting epidemics can be a blip in the long-term struggle for specialization.

Despite guiding colleagues and the public through the Covid pandemic and the recent Mpox outbreak; Despite their life-saving work to keep infections difficult to treat in hospitals; However High job satisfaction And a profession that many have described to NPR as “never boring”: new doctors don’t like to specialize in infectious diseases.

It’s a decline that has top experts in the field looking for an explanation.

More training for less pay

The most obvious reason is that salaries are low relative to other specialties, says Emory University’s Titanji. Jennie’s tweet Started a strong debate about match day results. “We’re talking about a six-figure pay gap,” she says, citing 2022 Medscape Report That infectious disease specialists earn an average of $260k a year, which is less than $100,000 less than the median salary for all specialists.

In some cases, doctors specializing in infectious diseases earn less than they should Before An additional two to three years of training—for example, as a hospitalist, a doctor of internal medicine who sees patients in a hospital. One can Become a hospitalist – Earn between $200,000-$300,000 a year – after completing medical school and residency training, with no additional specialty fellowship required. “I get paid less for working longer hours than I do as a hospitalist.” Dr. Hanna Nam, an infectious diseases physician at UC Irvine, tweeted. “My student debt isn’t going anywhere. Don’t regret my choice but don’t blame anyone for not choosing it.”

Titanji and others say the pay disparity is in the structure of the US medical system. “A lot of the medical reimbursement system is based on doing procedures or interventions that are highly compensated,” Titanji says.

Infectious disease doctors, on the other hand, examine patients and interview and consult with colleagues — “We think for a living,” says Pottinger of the University of Washington, “and because we don’t have to do surgery, I think. Less. That’s where this legacy of pay came from.”

Even if the pay is less than other specialties, “it is Still very good,” says Pottinger. “There’s a lot of money in it, both academically [settings] and in private practice, and our salaries are increasing over time.”

However, the prospect of additional training for a reduced salary deters many from choosing the field. “Medical education in the US is incredibly expensive,” says Emrina Del Rio. “If you graduate with a lot of debt, you’re not going to go into a specialty that doesn’t pay as much as others.”

Long hours and public criticism

The salary is relatively low Not the only issue, experts say. The sector has long been understaffed, leading to long hours – a problem supercharged by the stress of the pandemic. “Every infectious diseases doctor can tell you that the first year of the pandemic felt like being on call 24/7 because everyone was calling you — and relying on the knowledge you had — to be able to respond to this, ” says Titanji.

The current class of doctors mostly began their post-graduate residencies in the summer of 2020. All of their training took place during the Covid pandemic, noted Boston Medical Center’s Bourque. The long hours and poor work-life balance they saw in ID doctors—and The doctors left Burnout may have reduced appeal—increasing the field. “Long hours and low pay are a horrible combination,” Del Rio says.

The Covid spotlight made leading ID doctors targets for bitter vitriol from those who disagreed with them. “Many of us, myself included, have been attacked in the media and elsewhere for sharing thoughts on Covid,” says Del Rio. Dr. Anthony Fauci, the top COVID adviser to President Donald Trump and President Biden, was a lightning rod for criticism — and even death threats. “People [considering the field] Understand that there is personal risk. When the top infectious diseases doctor for the nation has to have bodyguards, it doesn’t necessarily make you think, ‘Oh, this is a great profession,'” says Del Rio.

Loan forgiveness can help

Infectious diseases also had recruitment problems before the pandemic: 2016 was a particularly frustrating year, recalls Marceline at the University of Nebraska, where she was undergoing her specialty training at the time. that year, 57% of programs Incomplete. “A lot of the conversations that happened then are happening again now,” says Marceline.

It generated some soul-searching for the field, as well Researchers are trying to figure out How to attract more doctors. On the financial front, medical organizations viz IDSA has lobbied Congress for a student loan repayment program to reduce medical school debt for doctors who choose the field. They are also advocating High reimbursement rate ID for the work that doctors do. If the wage gap for infectious diseases narrows, “it may make it more worthwhile for trainees to consider it as a career path,” Titanji says.

They have also accelerated efforts to bring in grants and new candidates in the field of infectious diseases. Mentoring programs. However, over the past five years, “despite our recruitment and mentoring efforts, we have made minimal progress in reversing this trend,” IDSA leaders Wrote a letter to Congress earlier this year. In 2020, A research paper Dr. Co-authored by Rochelle Walensky, then chief of the Division of Infectious Diseases at Massachusetts General Hospital and now director of the CDC, found that 80% of U.S. Counties do not have infectious disease doctors – including most counties that have been hit hard by Covid. first year.

“What I’m learning is that there’s a long way to go,” says Marceline at the University of Nebraska.

And the stakes are high, leaving the nation unprepared for outbreaks and health crises. “If we don’t have enough infectious disease physicians going forward, it will affect our ability to deal with everything from identifying and diagnosing disease, informing the public, creating guidance and administering appropriate treatment,” says Marcelin. Then there are the less visible effects—disease outbreaks in hospitals that could have been prevented in consultation with ID physicians; Deaths from treatment-resistant bacterial and viral infections that could have been prevented by ID physicians.

While the Covid pandemic has not yet inspired more doctors to move into infectious diseases, it may not be the end of it, says Bourque, looking back on the galvanizing effect the HIV/AIDS crisis had on the field. “There was a point in time where it felt like that [infectious diseases] May be a dying subspecialty, and then HIV/AIDS highlighted the importance of infectious disease specialists and actually spawned a generation of doctors, including Bourque, to choose it as a career. He says the effects of Covid are still unfolding: “Covid has had a tremendous impact on human life, and continues to have an impact. I believe it can and should inspire people to pursue careers in infectious diseases.”