Despite its central role in the COVID pandemic, the infectious disease specialty has seen 44% of training programs for doctors go unrealized.
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Thousands of doctors willing to continue their training celebrate Match day for a specialty fellowship on November 30, but one group lamented its results: infectious disease doctors. Despite its central role in the COVID pandemic, the infectious disease major has seen 44% of its training go unfulfilled.
“I’m disappointed,” said Dr. Carlos Del Rioa professor at Emory School of Medicine and president of Infectious Diseases Society of America. “I love my field, I love what I do. And it’s sad to hear that my field may not be as appealing to interns as I would like.”
At the University of Washington, home to one of the nation’s top universities top rated show, administrators are scrambling to find suitable candidates for the two scholarships that are still open after the struggle. “It’s worrisome,” said Dr Paul Pottinger, director of UW’s infectious disease fellowship training program.
At Boston Medical Center, affiliated with Boston University, none of their three fellows positions were filled in this year’s Match – a “challenging” and unprecedented situation for Dr. Daniel Bourquewho runs their scholarship program: “The number of people applying this year has been down, and that drop seems to be a trend.”
Becoming an infectious disease specialist takes years of training. Generally, after four years of medical school, followed by several years of medical residency, an aspiring ID doctor will apply for a fellowship program of at least two years. one-on-one school bad score in recruiting scholarships in 2016. Over the past 5 years, this rate has been relatively stable, with about 65%-70% of training programs filled.
But 2020 was an exception, as a flurry of candidates yielded record match rates – a phenomenon known as the “Fauci effect”. As infectious diseases dominate the news, “a lot of us see it as a .” [sign of] interest returns to ID” due to the pandemic, says Dr. Boghuma Titanji, an infectious disease physician at Emory University. But sliding ever since – limited by this year “alarming decline” – suggests that the pandemic surge could be a bright spot in the profession’s long struggle.
Despite guiding colleagues and the public through the COVID pandemic and the recent mpox outbreak; despite their lifesaving work in preventing difficult-to-treat infections from spreading in hospitals; even though high job satisfaction and a profession many describe with NPR as “never boring”: new doctors don’t choose to specialize in infectious diseases.
It is the decline that has led leading experts in the field to search for an explanation.
Train more to get paid less
Titanji at Emory University says the most obvious reason is the low salaries compared to other majors. Whose tweets? started a lively discussion about the results of Match Day. “We are talking about a six-figure pay gap,” she said, quoting a Medscape Report 2022 that infectious disease specialists earn an average of $260k a year, $100,000 less than the median salary of all professionals.
Infectious diseases have had a tough match this year with 44% of positions not being filled.
I would choose ID again if I had to do it again but obviously we need to do more to recruit interns into this exciting but low-paying major.
ID is fun don’t cut it!— BK Titanji #IAmAscientist🇨🇲 (@Boghuma) December 1, 2022
In some cases, doctors who specialize in infectious diseases end up making less money than they could have before add two to three years of training – for example, as a hospital physician, as an internist examining patients in a hospital. They can become a hospital – earn $200,000 to $300,000 a year – upon completion of medical school and residency training, no additional specialty scholarships are required. “I get paid less when I work longer hours than when I work in a hospital,” Dr. Hannah Nam, an infectious disease 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 either.”
Titanji and others say the pay disparity stems from the way the US health system is structured. “A lot of medical compensation systems are based on performing highly reimbursable procedures or interventions,” says Titanji.
Infectious disease physicians, on the other hand, examine, interview patients, and consult with colleagues — “we think for a living,” says Pottinger, at the University of Washington, “And because they I don’t have surgery to do, I think that’s the source of this pay cut legacy.”
Even if the salary is less than other majors, “it still good,” said Pottinger. “There’s a lot of money in it, academically [settings] and in private practice, and our wages are going up over time.”
However, the prospect of further training for a pay cut discourages many from choosing this field. “Medical education in the US is extremely expensive,” said Del Rio from Emory. “If you graduate with a lot of debt, you won’t go to a major that doesn’t pay as well as other people.”
Long time and public criticism
Relatively low salary is not the only problem, experts say. The sector has long been understaffed, leading to long working hours – a problem exacerbated by the strain of the pandemic. “Every infectious disease doctor can tell you that the first year of a pandemic, you feel like you’re on call 24/7 because everyone’s calling you — and relying on knowledge,” says Titanji. knowledge that you have – to be able to deal with this.”
The current class of doctors largely begins graduate residency in the summer of 2020. All of their training takes place during the COVID pandemic, notes Bourque from Boston Medical Center. The long working hours and poor work-life balance they observed in ID doctors – and the doctor is gone fields flooded due to burnout – may have cut off appeal. “Long hours and low pay is a bad combination,” del Rio said.
The attention of COVID has also made prominent ID doctors the target of bitter slurs from those who disagree with them. “Many of us, myself included, have been attacked in the media and elsewhere,” for sharing thoughts on COVID, del Rio said. Dr. Anthony Fauci, the top COVID adviser to President Donald Trump and President Biden, is a lightning rod for criticism – and even death threats. “People [considering the field] recognize there is a personal risk. When the nation’s chief infectious disease doctor has to have a bodyguard, 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 disappointing year, recalls Marcelin at the University of Nebraska, who was undergoing specialist training at the time. That year, 57% program was not filled. “A lot of the conversations that were happening then are happening again,” Marcelin said.
It spawned several souls seeking this field, with Researchers are trying to figure out How to attract more doctors. In terms of money, medical associations like IDSA has been lobbying Congress for student loan repayment programs, to reduce medical school debt for doctors who choose this field. They are also campaigning for higher return rate for the job ID the doctor does. If the pay gap for infectious diseases narrows, “it could lead interns to see it as a more worthwhile career path,” Titanji said.
They have also stepped up efforts to bring new candidates into the field of infectious diseases, with grants and mentoring program. Over the past five years, however, “despite our recruiting and mentoring efforts, we have made minimal progress in reversing this trend,” IDSA leaders said. wrote to Congress this early year. In 2020, a research paper Co-authored by Dr Rochelle Walensky, then chief of the infectious disease department at Massachusetts General Hospital and now director of the CDC, found that 80% of US counties do not have an infectious disease physician – including includes most of the counties that were hit hard by COVID in the first year.
“What I’ve learned is that there’s still a long way to go,” said Marcelin at the University of Nebraska.
And the risk is high, leaving the nation unprepared to fight outbreaks and health emergencies. “If we don’t have enough infectious disease doctors in the future, that will affect our ability to do everything from recognizing and diagnosing diseases, to informing the public,” Marcelin said. , to the creation of guidelines and the implementation of appropriate treatments”. Then there are the less visible effects – hospital outbreaks that could have been prevented in consultation with ID doctors; deaths from drug-resistant bacterial and viral infections that ID doctors could have prevented.
Bourque says that the COVID pandemic has yet to inspire more doctors to delve into infectious diseases which may not be the end of it, considering the positive impact the HIV/AIDS crisis has had. out in this field. “There was a moment when it felt like [infectious diseases] possibly a dying subspecialty, and then HIV/AIDS proved the importance of the infectious disease specialist and actually spawned a generation of doctors”, including Bourque , chose it as a career. He said the impact of COVID is still happening: “COVID has had a tremendous impact on people’s lives, and it continues to have an impact. I believe that can and will inspire people to pursue careers in infectious diseases.”
