Wednesday, December 4, 2013

A specialty in decline?

It was “match day” today for the internal medicine subspecialties. For some fields, there are far more applicants than training positions. Thus hundreds of would-be gastroenterologists and cardiologists find themselves out in the cold, unable to pursue their chosen profession. Not so for infectious diseases (ID). This year marks a new record for unfilled ID programs (54), with many training programs unable to fill a single training spot in the match. Given current trends, we are approaching a situation in which half of all programs will have unfilled positions. As funds for graduate medical education become increasingly scarce, some of these programs will likely reduce the number of training positions they offer, or shut down altogether. 

There are several explanations for this trend, including reimbursement of ID specialists (train longer to make less!), the educational debt burden of trainees, the rise of the hospitalist, and reductions in research funding for academic careers. I have no easy answers, but it is urgent that we address this slow motion train wreck. Multiple drug resistant bacteria already far outnumber the contingent of ID doctors, and that situation is bound to get worse over the next several decades. Some things to work on: (1) perform studies to demonstrate the value provided by the ID specialist, (2) advocate for increased funding for ID research and training, and (3) provide role models who demonstrate that ID is an incredibly interesting and rewarding career!

7 comments:

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  2. Agree, Dan. ID is really in a hurt locker. And to make matters worse, I don't see much advocacy coming from IDSA on this issue. I think the problem is almost purely economic---we're asking young doctors with high debt burdens to do more training (at trainee wages) in order to take a pay cut AND work twice as many hours as a hospitalist. That's a really hard sell.

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    1. I attended a press conference today where the University of Iowa Health Alliance announced a $1 million donation to the Iowa Rural Physician Loan Repayment program. This program will repay student loans for up to 20 primary care MDs that practice in rural Iowa - up to 50k per year and 200k total.

      see: Cedar Rapids Gazette

      I wonder if a similar type program would be a cost-effective way to encourage residents to match in ID programs. I suspect it will come to something like that eventually. The way Medicare reimbursement rates are set these days, I doubt reimbursement will ever improve for ID consults.

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  3. I wonder if value based purchasing will help. If hospitals are reimbursed on quality outcomes as opposed to volume then the true value of what we do may become more apparent and perhaps rewarded. But it's somehow hard for me to imagine that happening.

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  4. I am a clinical pharmacist working at a community hospital. A new IDMD started. We became friends and I was shocked to learn that I made a higher salary than him!!

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  5. The profile of applicants for ID positions has definitely changed. Those looking for largely clinical, hospital-based consultation practices have migrated to Hospital Medicine. We have noticed that those still applying for ID are more likely to be looking for international experiences, masters in Public Health, or immunocompromised host ID. ID fellowship programs will have to adapt to successfully compete for these applicants.

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  6. Here is CA,

    We make good money, have plenty of respect and a good amount of freedom. As Warren Buffet said, "when you see people running away from something, that's the time to run toward it."

    The real problem is that the "hospitalist" job has made cognitive specialties less appealing as people can make 200K on a 7 on/7 off schedule with less training.

    BTW, anyone (ID) looking for a job in Los Angeles? We need more help!!

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