IDSA: What--me worry?
Yesterday, we witnessed another disastrous match for Infectious Diseases, nicely (and sadly) described by Dan here. I just went to the IDSA website to look for the official response of our professional society. Guess what? There is no response! I was, however, encouraged to find a tab on Workforce and Training. Here's what it contains:
Wow--look at those efforts to support a robust infectious diseases workforce! Obviously, this is a top priority given that the most recent statement is from 2013 and it doesn't even address the current problem. Alfred E. Neuman is clearly in charge at IDSA. In all seriousness, could a professional society be more disinterested in its own future?
Hi Mike, Thanks for the post. Here in Seattle, we were waiting for the match results with high hopes but also prepared for less than optimal outcomes. Fortunately the match went really well! I would like to call your attention (and that of your many readers) to the work that IDSA is doing on this topic (full disclosure- I am an IDSA member and was, until October, a member of the Clinical Affairs Committe). During my time on that committee, the issue of the match trend has been prominent at every single meeting and discussion that we have had over the last several (or more?) years. Although more remains to be done, we have been engaging the fellows during the annual fellows conference to understand what brought them into ID and what they have heard that could be barriers. One possibility is around perceptions of ID income, which led to the IDSA salary survey, and which I believe is being analyzed now. The committee is also working who to engage and how to generate interest in an ID career in medical students and trainees. I agree with you that there is a problem, but I would also argue that IDSA is working hard on figuring our why this problem exists and what can be done. At the same time, IDSA can do a better job of getting the message out about what has been done, what is being done and what will be done. Based on my personal conversations, I know that they care about ID and those practicing in this fantastic field of medicine. Thanks, John Lynch
ReplyDeleteI have just tried to post the following letter on the blog but my posting is rejected by Google mail.
ReplyDeleteThere is much about electronic media I don't understand.
Can you post it for me? Thanks, and let me know.
Johan
Hi Mike,
I can assure all IDSA members and other health care providers who are concerned about the future supply of well-trained ID physicians that the ID future manpower issue is one of the top priorities on the strategic plan that IDSA formulated at our strategic planning meeting last June. IDSA has for several years actively worked on how to attract more talented young physicians to our field, starting as early as medical school. We are currently trying to effect changes to the microbiology teaching programs for medical students, in oreder to elevate the awareness and evoke interest to our field at an early stage of training. You are probably aware of the survey that was conducted among IM residents last spring and summer by Wendy Armstrong and Erin Bonura to try to understand the factors that influence young physicians in choosing a career in medicine; the survey results are still being scrutinized. Once the final data analysis has been completed we will inform all our members on the conclusions and recommendations. We were gratified to see a record attendance of medical students and residents at ID Week this fall (> 400 combined) which indicates a growing interest for our field.
There is no question in my mind that the financial student loan burden and inadequate reimbursement for ID services are major disincentives for young physicians contemplating a career in ID. IDSA alone does not have the power or means to rectify the problem, but we are working very hard with legislators and policy makers on Capitol Hill to educate them about the possibility that America soon may not have the necessary workforce in public health to tackle future epidemic outbreaks, researchers to combat antibiotic resistance, inadequate supply of active antibiotic drugs due to lack of R & D, inadequate supply of trained ID physicians to direct the mandated ASPs in long term care facilities and (soon to come hospitals) as well as provide excellent care for complicated patients with severe infections, chronic HCV and HIV infections and so on, unless the reimbursement structure for services be legislatively improved. The financial solution to these issues lies in the hands of our elected lawmakers, and IDSA will continue to advise our members of Congress on these issues. Pivotal to this point Congress needs to find a solution that can ease or solve the loan repayment burden for young physicians, to make it attractive for them to choose a career in ID.
Next year all ID fellowships will be distributed via the all-in process, which will provide equity and fairness to the selection process and give us truer numbers of who and how many of the residents end up in an ID fellowship.
All the issues I have outlined and how IDSA plans to tackle these problems were discussed by Steve Calderwood, IDSA past president, at the IDSA business meeting in San Diego last October, continue to be worked on by the IDSA staff and members of the IDSA board of directors. Please be assured that we hear your concerns are doing all we can to ensure that our future workforce will grow to handle all the ID challenges that lie ahead.
Johan S. Bakken
President, IDSA
As Chair of the Task Force for Recruitment into ID, Chair of the PD Committee for IDSA and an ID fellowship PD myself, I was disappointed by the ID match numbers this year. I can assure you that we are quite concerned and have been thinking about these issues nonstop for a while. The problem is multifactorial and the solutions will take time before an impact is seen. IDSA leadership has been incredibly supportive of these efforts and it is a priority item. Salary is no doubt an important factor. Advocacy around that issue is ongoing at multiple levels, and needs to continue. Salary is, however, not the only issue. Erin Bonura and I presented this study (https://idsa.confex.com/idsa/2015/webprogram/Paper51309.html) at IDSA examining factors associated with subspecialty choice, and it is clear that a multi-faceted approach is needed. The Task Force is pursuing and/or supporting several initiatives:
ReplyDelete• Medical school curricula are important, exposure to medical students and residents is critical and mentorship relationships make a difference.
• We have increased mentorship opportunities and trainee attendance at IDSA (the Mentors program, Posters in the Park, etc) and these efforts are increasing annually.
• Brian Schwartz and others are spearheading efforts to improve ID-related medical school curricula.
• We are supporting the development of ID interest group support at local institutions.
• The development of alternative training paradigms including combined training programs is under consideration.
Importantly, we are discussing better ways to market ID and expose trainees to the diverse career opportunities in ID which I believe are under-recognized (industry, public health, global health, etc,.).
Infectious Disease is the most dynamic, challenging and exciting career in medicine. Our specialty is more relevant than ever in this time of antimicrobial resistance, emerging infections, quality outcome measures, bioterrorism, ongoing public health challenges, etc. Most importantly, we must all be good ambassadors for ID as ultimately nothing makes a greater difference than personal relationships with trainees. I urge all to join in that effort, convey the enthusiasm for what we do, and please give me feedback (IDrecruitmentTF@gmail.com) with additional thoughts as the Task Force continues to tackle these issues. This will not change overnight, but I am confident that working together we can be successful.
Wendy Armstrong MD
Mike,
ReplyDeleteIDSA is interested in addressing the issues of compensation for ID specialists. As the Chairman of the Clinical Affairs Committee, it is my belief that compensation and work-life balance are key factors in the choices that medical students and young doctors make. There are many resources out there (MGMA, Medscape, etc.) that individuals in training use as resources of how specialties are compensated that are inaccurate regarding compensation for ID Specialists. We have been working hard to correct this misinformation so that students and residents can see that as ID physicians, they can make a good living and have a good work-life balance. As a first step, IDSA fielded a survey this past summer and had almost 1900 respondents (this number was nearly an order of magnitude greater than the respondents in other surveys.) The results can be found on the IDSA website here [http://www.idsociety.org/uploadedFiles/IDSA/Manage_Your_Practice/Physician_Payments/What_ID_Physicians_are_Paid/Physician%20Compensation%20Survey_Report_FinalOct2015.pdf]
This is only a small part of what the IDSA has been doing to address your concerns behind the scenes.
Thank you,
J Trees Ritter, DO
Chairman, IDSA Clinical Affairs Committee
Mike,
ReplyDeleteI can fill in a few more gaps about the efforts underway at IDSA. As Johan points out, “The Future of ID” was number one on the hit parade at the strategic planning review this summer. No question that money, lifestyle, respect, and opportunities for career development are factors that trainees put into the equation when they choose a path. Toward bolstering those pieces of the ID experience, we are uncovering what we have always known to be true: that ID specialists bring measurable value to patient care and the health system. Last year, the Value Task Force published an IDSA-sponsored analysis of a large swath of CMS data comparing mortality, length of stay, and costs for patients with significant infections (http://cid.oxfordjournals.org/content/58/1/22.full). Outcomes were better when ID specialists were involved, which is a great result for claims data. We have taken these data out to meetings of hospital CEOs and administrators, been interviewed for and published in their trade journals and websites, surveyed them to hone the message, and assembled tools for ID specialists to use for shaping negotiations with hospitals and payers (http://www.idsociety.org/Templates/Landing.aspx?id=32212257054). We are now replicating the value analysis with a large commercial database to find different kinds of confirmatory data.
On the policy front, IDSA continues to engage at the level of the AMA CPT and RUC valuation processes, fighting for the position of cognitive care. We have joined with other cognitive specialties in a coalition to bring additional power to lobbying CMS and members of Congress. IDSA continues to advocate for research funding to support academic careers and advance the field.
These are difficult times to ask for resources in medicine and IDSA is not unrealistic about the difficulty of the task. We cannot go hat in hand expecting a spare dollar to be given. We as a society and specialty must tangibly demonstrate our value in patient care, research, epidemiology, and stewardship. If we do this, we can make the case for ID specialists as leaders in helping hospitals shape care affordability, develop research careers, bargain for appropriate compensation, and tangibly share in the cost savings we help generate. We need all of ID to help develop the value equation for clinical and non-clinical efforts, so that the answer to the question "Why ID?" is obvious to payers, administrators, and potential trainees.
Why IDSA? Because the society is composed of and led by many passionate individuals who care a great deal about the future of the field and are working together to secure it. Thank you for bringing your time, energy, and ideas to the cause.
Steve Schmitt MD, FIDSA
Cleveland, OH
IDSA Board of Directors