The delusion continues

There's a new paper in Clinical Infectious Diseases on the highly anticipated survey of Internal Medicine residents to solve the enigma of why no one is going into infectious diseases. It never seemed to be a mystery to me, but having data is always helpful, providing that you interpret it correctly. And here that caveat concerns me a great deal.

The survey results were divided into three groups: those applying or intending to apply to ID fellowship, those interested in ID but deciding not to apply, and those with no interest in ID. Of those who had an interest but didn't apply (the group that we should have some hopes of capturing), the number one reason for not going into ID was SALARY. Moreover, when asked what is the most important factor to increase interest in ID, all three groups said SALARY. For those going into ID and those who considered it, the percent responding salary was two-fold higher than the next most commonly cited factor (early exposure to the field of ID).

So no surprises here. But what was both surprising and alarming to me was that the discussion in the paper and the accompanying editorial both seemed to downplay salary as a factor in the current dearth of applicants to ID. The authors wax eloquently on career choice models, pedagogical techniques, the importance of mentors, etc. Salary is buried in half a paragraph of the eight paragraph discussion. The authors of the editorial even seem somewhat astonished that the top career choice of those who considered ID but didn't apply was general internal medicine, a specialty that they note "is not typically considered a high remuneration specialty." I think there's no surprise here either for two reasons: (1) hospitalists make significantly more money on a per hour basis than most infectious diseases doctors, particularly in the academic setting, and (2) whatever that difference in salaries is, it's magnified by the fact that two more years of training (at least) results in a lower salary. That is, you are punished economically for additional training, which many folks find too unpalatable to move beyond.

My bet is that the paper and editorial are nicely in line with IDSA's thinking since IDSA sponsored the study. And I suspect that IDSA will continue to pretend that all is well while the dumpster fire burns away. Once we get the microbiology courses in medical schools to stop making the students memorize so much, the students will come racing to ID!

Carry on then.


  1. I wonder if the reason IDSA and ID physicians rarely discuss salary is that it's beyond our control. We can control mentoring and other local factors, but apart from quitting the field, which many have, we can't do much about salary. I also wonder if ID docs are embarrassed to make high salaries.

    On that note, I heard a story this week about an ID physician who refused to take a salary over the NIH cap, even as a full professor. The ID docs salary was way below an assistant professor in Cardiology, who would have no trouble accepting the salary the system provided him/her. Thus, I wonder if there is also some inherent aversion to renumeration among ID docs and others in public health. You see this play out in the political field where some folks want a strong safety net and support higher taxes and others want lower taxes as a number one priority. It appears to me that ID docs are inherently averse to the very factors that will keep the field alive in the future. It is like we refuse to reproduce - something that will lead to our own extinction.


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