Declining interest in ID: Paul Sax interviews Mike Edmond and Wendy Armstrong

Open Forum Infectious Diseases has a podcast feature, which I highly recommend. The latest installment is a very insightful discussion of the future of ID as a specialty, and how we should respond to the decline in fellowship applicants. We’ve covered many of these issues on this blog before, and I encourage you to either listen to (MP3 link) or read (transcript) this interview.


  1. Thanks to everybody for tackling this issue.
    A solution needs to start at the grass roots level, and we need help and support to do that.

    I have just a couple of comments.
    First, I think the role of the ID doc has to change to be worth the salary change implied in the interview
    -I believe we need to expand beyond the single patient consult which is the fee-for-service RVU model most institutions and payers are stuck with employing.
    -We need to utilize the electronic resources available and take responsibility more broadly for the entire target population. The best intervention/interaction may be a discussion with pharmacist, a call to hospitalist, a chart review and chart note, or a traditional consult. The triggers for our involvement may be a positive culture, a particular antibiotic or antibiotic combination order, serology, or a provider request. This would be analogous to the medical home concept except for ID.
    -Our services would be as crucial to hospital or network as pathology, radiology or anesthesia and be a value to our hospitalist/surgicalist colleagues.
    Second, hospitals need to break out of the “Fair market value” for “medical directors” and pay for what we do which is consultation.
    And third I think IDSA absolutely needs to help with the insurance and legislative roadblocks to this type of model. We need support to develop the community networks to research the sensitivity/specificity of the triggers for involvement and the outcomes of different interventions

    Just thinking….

    Sky Blue
    Boise ID

    1. Hello Boise, just making sure you see Dan's comments below. I'll just add the healthcare in the US is not based on simple supply-demand economics. It is closer to a soviet planned economy run by a group of CMS advisors that set reimbursement rates.

    2. Thanks, Eli! Seven years of blogging and I still don't know how to reply to comments. And I agree with your point about supply-demand economics! Dan

  2. Thanks, Sky,

    I agree with your thoughtful comments above. I highly recommend reading (and contributing to) the lively discussion that is currently going on at the IDSA listserve (IDea Exchange). The link to the discussions is here:

    Unfortunately, you must have an IDSA username and password to access the site.

    A couple of the emerging themes: (1) yes, shockingly, it really is about salary, and (2) we ought not to worry about it, it's a supply/demand issue and as soon as the number of ID docs falls below market needs, salaries will increase and the problem will fix itself.

    The IDWeek town hall could be very interesting, if the posts on the IDea Exchange are any indication.



Post a Comment

Thanks for submitting your comment to the Controversies blog. To reduce spam, all comments will be reviewed by the blog moderator prior to publishing. However, all legitimate comments will be published, whether they agree with or oppose the content of the post.

Most Read Posts (Last 30 Days)