Severe shortage of infectious disease specialists in the US, for ‘complex’ reasons

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According to the Infectious Diseases Society of America (IDSA), a medical society based in Arlington, Virginia, the United States is facing an acute shortage of infectious disease specialists.

“Infectious disease (ID) physicians have repeatedly demonstrated their importance during critical global crises, such as with HIV/AIDS, the COVID-19 pandemic and Mpox (formerly Monkeypox),” said Dr. Cindy Whitener to UKTN News Digital.

Whitener is chief of the infectious disease division at Penn State Health Milton S. Hershey Medical Center in Hershey, Pennsylvania.

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“In the course of their day-to-day work, ID physicians prevent deaths in patients with antibiotic-resistant organisms and prevent outbreaks in hospitals” — just to name a few examples of their value,” she also said.

But the next generation of doctors is not showing a strong interest in the field, leading to concern among many.

According to data, just over half of adult infectious disease training programs were completed in the most recent hiring cycle.
(iStock)

While numerous other specialty slots were filled during the most recent recruiting cycle, just over half of adult infectious disease training programs were filled, according to data from the National Resident Matching Program (NRMP).

“When the ‘match’ results are released to programs and applicants on ‘Match Day,’ the NRMP will also provide a list of unmatched applicants for those programs that have not been filled, as well as a list of unfilled programs for those applicants who didn’t match,” Jeanette L. Calli, chief of match operations at the National Resident Matching Program in Washington, D.C., told UKTN News Digital.

A worrying shortage of infectious disease doctors is expected over the next 10 years, especially in rural areas.

“It is up to the applicants and programs to contact each other to fill the remaining vacancies,” she said.

Many programs work hard to fill their open positions by recruiting mismatched applicants; they also hope to attract other residents who often receive training in the same university hospitals.

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The decline in ID grant applicants this year is notable, as Stat News noted, as interest in the field increased during the first two rounds in the pandemic era — a trend seen in other areas related to public health and representing the “Fauci effect.”

Dr.  Anthony Fauci speaking at the White House in Washington, DC on Wednesday, December 1, 2021.  Today, some experts are surprised that fewer doctors are focusing on the infectious disease specialty.

Dr. Anthony Fauci speaking at the White House in Washington, DC on Wednesday, December 1, 2021. Today, some experts are surprised that fewer doctors are focusing on the infectious disease specialty.
(UKTN Photo/Susan Walsh)

As Stat News put it, “The critical nature of public health careers has never been more apparent than during the pandemic, and educators said they saw a wave of people drawing inspiration from that.”

But this is not the case now.

Shortage especially in rural areas

According to a study published in October 2020 in Annals of Internal Medicine, a medical journal, in 2017, some 208 million U.S. citizens lived in counties that either had no infectious disease coverage at all — or had an inadequate number of infectious disease physicians. .

The study estimated that 80% of U.S. counties did not have even one infectious disease specialist.

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“In addition, nearly two-thirds of all Americans live in the 90% of counties with substandard or no ID physician access, and these counties encompass vast — largely rural — portions of the country,” the study said.

A doctor with a patient.  Some critics say certain physician positions have recently gone unfilled, in part because infectious disease fellowship programs have expanded too quickly in recent years.

A doctor with a patient. Some critics say certain physician positions have recently gone unfilled, in part because infectious disease fellowship programs have expanded too quickly in recent years.
(iStock)

However, it noted that its “analysis did not consider other professions capable of providing public health or ID-specific care (such as epidemiologists, advanced practice providers, pharmacists and infection prevention).”

Yet recent models from the federal Health Resources and Services Administration (HRSA) predict a worrying shortage of infectious disease physicians over the next 10 years, especially in rural areas.

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The same agency expects that by 2035 there will be a demand for 15,130 infectious disease specialists. Still, it estimates that by that year only 14,000 doctors will be working in the specialty.

Experts surprised by ‘match’ results

Some experts are surprised that fewer doctors are specializing in infectious diseases – given record numbers of applications for medical training, due in part to the pandemic and the ‘Fauci effect’.

According to the Association of American Medical Colleges (AAMC), approximately 62,000 people enrolled in medical school in the 2021-2022 cycle — a new record, with the actual number enrolled exceeding 22,000 for the second consecutive year.

Only 44% of infectious disease physicians felt they were fairly reimbursed in 2021.

However, some critics argue that job openings have gone unfilled in part because infectious disease fellowship programs have expanded too quickly in recent years.

In the 2018 cycle, there were approximately 394 positions available at 151 programs to train for adult infectious disease practice.

"In the past, residents had much more exposure to ID [infectious disease] doctors in their training.  In today's training environment, this is less and less the case."

“In the past, residents had much more to do with ID [infectious disease] doctors in their training. In today’s training environment, that is less and less the case.”
(iStock)

That’s in contrast to the most recent contest, which saw roughly 441 positions across 175 programs, according to the NRMP.

Relatively low fees are a big problem

“I think the situation is quite complicated,” Dr. Carlos del Rio, president of IDSA, to UKTN News Digital.

“There are several factors that go into the decision of residents in both internal medicine and pediatrics not to choose [infectious disease] as a specialty,” added del Rio, who is also an infectious disease physician and professor of medicine at Emory University School of Medicine in Atlanta, Georgia.

“[Infectious disease] is one of the few specialties, if not the only specialty, where you earn less after training than before,” said del Rio.

“The person who graduates from internal medicine can get a higher salary than someone who graduates from ID with an additional two to three years of training.”

“In other words, the person who graduates from internal medicine can get a higher salary than someone who graduates from ID with an additional two to three years of training.”

Only 44% of infectious disease physicians felt they were fairly compensated in 2021. According to Medscape, that is the lowest of the approximately 30 specialties studied.

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“But there are other things at play,” Del Rio notes. “In the past, residents had much more to do with VB doctors during their training. In the current training environment, that is less and less the case.”

Interns see infectious disease physicians routinely work longer hours for lower compensation compared to other medical specialties — and often perform additional administrative duties “without appropriate pay,” said Whitener of Pennsylvania.

“Additional disincentives that have existed for years but were exacerbated during the COVID-19 pandemic,” she added, “are burnout, due to long-term underemployment and chronically long hours.”

"It should be recognized that typical financial measures do not reflect contributions made" by many infectious disease doctors, one expert said.

“It should be recognized that typical financial measures do not reflect the contributions made” by many infectious disease physicians, one expert said.
(iStock)

Experts also blame the pandemic for polarizing the specialty — as many faced “the potential for personal risk of being harassed or threatened for publicly expressing ID opinions or advice on topics becoming politicized,” Whitener noted on.

To reverse the trend, she suggests closing the compensation gap for ID physicians — and improving physician workforces to reduce burnout.

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“It should be recognized that typical financial metrics do not reflect the contributions of many ID physicians, including administrative and clinical support roles and indirect clinical revenue,” she added.

Does the ‘law help prevent pandemics’?

President Biden signed the Prepare for and Response to Existing Viruses, Emerging New Threats and Pandemics Act, also known as the PREVENT Pandemics Act, on Dec. 29, 2022, designed to increase the nation’s preparedness for the next pandemic, the AAMC said.

The IDSA advocated for the bill to be passed.

It noted that the legislation includes a measure called the BIO Preparedness Workforce Pilot Program that would reduce medical school debt.

“Especially this [pilot] The IDSA program would help make the field of ID a more financially viable choice for new physicians and increase the availability of infectious disease experts in underserved communities through a loan repayment program,” the IDSA said. in a recent statement.

“Together, they need to agree on the right data to generate — likely a combination of genomic, environmental, mobility, and consumer data from traditional and non-traditional sources.”

“PREVENT will also strengthen medical supply chains, improve disease data collection and strengthen the nation’s overall preparedness infrastructure.”

However, in a jointly-written op-ed titled “Here’s How We’re Preventing the Next, Inevitable Pandemic,” published last spring by UKTN News Digital, two authors — Rick A. Bright, CEO of the Pandemic Prevention Institute at The Rockefeller Foundation, and Esther Krofah, executive director of FasterCures and the Center for Public Health at the Milken Institute — argued, “Global leaders from the public and private sectors must engage in robust dialogue” regarding advanced planning and preparedness for future pandemics.

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“International organizations, regional institutions and community groups are also all essential.”

They also wrote, “Together, they need to agree on the right data to generate — likely a combination of genomic, environmental, mobility, and consumer data from traditional and non-traditional sources.”

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They added: “Together, they need to identify data collection gaps and prioritize investments.”

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