The smoldering dumpster

I’m a bit delayed this year in commenting upon the ID Match results—go here for our prior posts on this topic (and the broader issues affecting recruitment into our specialty).

IDSA has a good summary of the results, and the figures below are taken from that article. The overall message is: the dumpster fire is no longer raging, but the dumpster is still smoldering! We’ve basically held steady since the new “all-in” Match started last year, with similar percentages of programs and positions filled. 

How to interpret the numbers? I think the “all-in” rules have reduced some (most?) of the outside-the-match ‘strategery’ that some programs and applicants were practicing. Thus after a couple years of “all-in”, we have a more accurate picture of the supply-demand relationship for ID training. This picture is far from pretty—a third of programs are going unfilled, representing one in five of our training spots. Clearly, “train longer to make less” is still a difficult reality to overcome, even for a specialty as fascinating and fulfilling as ID.

So we have a lot of progress to make, and it will have to be made against some pretty stiff headwinds. Easily lost in the numbers is the substantial proportion of positions filled by international medical graduates. This is a great thing in my view, bringing diverse experience and perspective to our programs—but it also makes demand for ID training highly vulnerable to corrosive political forces that may make it less inviting to come to the U.S. for training and employment. If IMG numbers fall, the dumpster fire will rage anew.

Finally, the political landscape will undoubtedly also shape the U.S. healthcare system in ways that are unpredictable, but which could reverse some of the trends favorable to ID (e.g. focus on population health and value, with requirements that promised to provide more fulfilling job options for ID—stewardship and infection prevention among them). The strong anti-regulatory mood of the current administration, along with increases in the uninsured population, could reduce incentives for healthcare systems to invest heavily in quality and safety. 

To sum up, this year’s match should serve as a continued call-to-action, as we still have huge challenges ahead as a specialty.

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The delusion continues (part 2)

A few hours after I posted yesterday on the survey of Internal Medicine residents on why they won't pursue training in Infectious Diseases, a reader alerted me to another new paper on ID physician salaries in Open Forum Infectious Diseases (free full text here with additional data available on the IDSA website requiring a membership password). This study was also sponsored by IDSA. The title of the paper is ID Physician Compensation--An Improved Perspective.

From this survey of nearly 1,900 ID physicians, we learn that the median salary of a full-time physician that is focused on patient care is $210,000. The data are sliced and diced in many ways, and are interesting to review.

The spin in the discussion (alluded to in the title of the paper) is that things are really not as bad as we thought. The authors point out that the often quoted Medscape survey has a small sample size and underestimates the true salary of ID docs. And while that is true, we still need to maintain perspective.

We know that our biggest competitor is hospital medicine. So let's take a look at hospitalist salaries. In 2013 (2 years before the IDSA survey), the overall median compensation for hospitalists was $254,000. So for an additional 2 years of training, the Infectious Diseases doctor will earn $44,000 less than his/her hospitalist colleague. And don't forget, full time for a hospitalist is, on average, 40 hours per week. How many ID doctors work 40 hours weekly?

Unfortunately, for most internal medicine residents, this decision is a no-brainer and I doubt this new survey will have much impact. Spin on, IDSA, spin on.

Infectious Diseases and the Terrible, Horrible, No Good, Very Bad Match

Here we go again. Another internal medicine subspecialty “match day” and another record (bad) day for ID. How bad? The previous record (set last year) for unfilled ID programs was 54. This year 70 programs went unfilled, meaning that for the first time ever there were more programs that didn’t fill than that did. Almost 100 funded ID training positions unfilled in a single year!

We’ve blogged about this trend before, here and here, and discussed some of the reasons that ID is in decline as a specialty (along with some suggestions for how to turn this around). I don’t have any new insight, except to make the point that this is now beyond a crisis situation for our specialty. It’s a dumpster fire.