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Number of infectious disease specialists declining
In this Ask the Experts feature, Infectious Disease News Editorial Board member Michael L. Tapper, MD, explores why the infectious disease field may be facing a manpower shortage in the next few years.
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There doesn’t seem to be a lot of discussion in the media about this — but is there a coming shortage of infectious disease professionals in America and abroad?
To get a sense of the manpower concerns in the infectious diseases specialty, we need to recognize that there are a number of infectious disease fellowship training programs that are not filling with graduates of American residency programs. Some of these programs are trying to recruit graduates from non-American schools, and some of them are not even successful at doing that. The problem is complex: fewer American graduates are choosing primary care specialties like internal medicine and pediatrics. Therefore, the pool of residents who might elect to subspecialize in infectious diseases is diminishing. These are cyclical trends that medical educators have seen before. Within internal medicine, many residents are more attracted to the procedure-oriented specialties such as gastroenterology and interventional cardiology.
If internal medicine candidates aren’t interested in pursuing infectious disease as a subspecialty, what are they doing instead?
There is a genuine push for specialties that may allow for a somewhat more controlled lifestyle, in the sense that there may be less emergency work, less evening work, and more predictable working hours. Certainly, many women who may have deferred starting their families may understandably want that more controlled life style after years of schooling and postgraduate training.
What might be other reasons for the decline in the numbers of residents going into the profession?
Many are attracted to subspecialties that are perceived as more remunerative than infectious diseases. That is also understandable considering the enormous burden of debt that many young physicians accumulate during medical school and residency.
Will this lack of manpower translate into fewer advances in the field?
I wouldn’t want to draw that straight line. It’s hard to say that because there are less people coming into the profession in 2011 that there will be less research available in 2020.
What about how a shortage might impact patient care?
That’s the real issue — whether there will be a manpower crunch in terms of clinical care. We want to make sure the needs of the population are met. We hope that the lack of interest in internal medicine as a trend will reverse itself. There are pendulum swings in medicine, and interest in both general internal medicine and its subspecialties like infectious diseases may increase again in the future. If it all translates into a decreasing manpower pool, then you can visualize fewer ID specialists available for either primary care or consultative care.
What if infectious disease specialists could be remunerated more?
What has happened in general is that the payers have started ratcheting down payments for the kinds of consultative work that infectious disease specialists do. It’s not that infectious disease specialists are starving to death, but the way they earn their income is clearly dissimilar to a model such as that of medical fields like gastroenterology or interventional cardiology, where physicians are doing a high volume of procedures that traditionally have been remunerated at relatively high rates, compared to cognitive specialties like infectious diseases. But I don’t think people only choose their specialties based on financial considerations; they also choose what they’re interested in.
What is being done to create more interest in the field?
The Infectious Diseases Society of America is very concerned and has a number of initiatives to reach out to create more enthusiasm for the field. There is a need for trainees throughout this field — in clinical medicine, in bench research, and in the pharmaceutical industry. The IDSA is trying to build interest in the field across all these areas. The IDSA is also trying to get better recognition from government and private payers for cognitive specialties such as infectious diseases to improve reimbursement schedules. But in an era where people are coming out of medical school and postgraduate training with several hundred thousands of dollars of debt you can’t ignore the fact that some medical fields are more remunerative than others.
Michael L. Tapper, MD, is the Hospital Epidemiologist and Director of the Division of Infectious Diseases, at Lenox Hill Hospital in Manhattan.
Disclosure: Dr. Tapper has no relevant financial disclosures.