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From hospital medicine to infectious diseases
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At the start of my career, I was intrigued and excited about commencing a career in infectious diseases. However, I was unable to apply for fellowship because of economic and family commitments. With these commitments now behind me and with the support of my family, colleagues and mentors, I recently participated in the ID match. After working for 10 years as an academic hospitalist and HIV specialist, I was matched into a desirable program. I enthusiastically look forward to this new career journey as I begin ID fellowship training this summer.
I eventually came to the realization that hospitalist and HIV medicine were not providing the complete professional and personal satisfaction I desired. I often felt like something was missing in my career, and I discovered that ID completed what was lacking for a myriad of reasons. I was fascinated with microbiology class in medical school and became intrigued with ID when I was an internal medicine resident. My fascination comes from the inherent challenge and complexity within the field. It involves questioning and examining patients as well as solving their complex infectious diseases. ID is an exciting field filled with various opportunities to explore, and my interests lie in antimicrobial stewardship and infection control. Recent events such as the Ebola outbreak in West Africa, antimicrobial resistance in the United States, and the measles outbreak in California have continued to stimulate and strengthen my enthusiasm for the field.
I am not surprised to hear the disappointing news that a large number of ID training programs did not fill during the most recent fellowship match. With increasing medical school debt in the U.S., it also is not astonishing that medical students and graduating internal medicine residents are initially choosing higher paying careers. Although money can be the primary motivating factor for many, we need to remind and emphasize the importance of having a deep passion for one’s chosen field to our medical students and residents. I realized that making more money does not necessarily guarantee more happiness and professional satisfaction. As a teaching clinician in two internal medicine residency programs, I have seen many graduating residents pursue careers in hospital medicine as well as in fellowships other than ID. Despite the fact that the initial hospitalist salary is higher than that of an ID specialist, graduating residents may not initially realize the importance of having a deep passion for one’s chosen specialty. Professional and personal satisfaction in one’s career generates a sense of long-term fulfillment, which is often not emphasized in medical education. The end result is that many new graduates with significant medical school debts are choosing higher-paying careers for greater financial rewards.
In the February 2015 issue of Infectious Disease News, I read with great interest the article “The power of mentoring: We all can help recruit more ID specialists,” by our past Infectious Diseases Society of America president Stephen B. Calderwood, MD. He stated, “We in the profession need to take to heart the tremendous power of mentoring, particularly in light of the continued decline in ID match results through the National Resident Matching Program.” I am wholeheartedly in agreement with his comments on the influential power of mentors in recruiting more applicants into the field of ID. Throughout my career, I worked closely with my academic ID colleagues and was given the opportunity to share and present some unique cases at the monthly local infectious diseases city rounds. Over time, my colleagues became my mentors, and they were very influential and supportive of my decision in returning to fellowship training and pursuing a full-time career in ID. Dr. Calderwood mentioned in his article that “becoming a hospitalist may seem like the smart move initially for financial reasons, but many hospitalists leave after several years, and some of them end up coming to ID anyway.” This certainly was the case for me. From my interviews at various programs, I discovered that I was not alone. I met other hospitalists who returned to fellowship training in ID after several years of practice. This may be a new trend for the ID community to consider as we need to reach out to those hospitalists who are interested in joining the field of ID.
The field is at a critical point in time where we need to promote the high value of this specialty to interested medical students, interns and residents. We need to stress to them the importance of passionately pursuing a career that will provide long-term fulfillment and professional satisfaction. I currently emphasize to my trainees that the overall job satisfaction over time for ID specialists is higher than that for hospitalists. Dr. Calderwood wrote in his editorial, “one thing we should not lose track of, however, is that career and job satisfaction in ID remains very strong, higher than for hospital medicine or other career choices. We can and should emphasize that to residents.” He also wrote that “Nearly 90% of ID fellows ... said mentors influence a resident’s decision to pursue a career in ID.” In the internal medicine residency program at Loma Linda University, a successful mentoring program was created for interns and residents interested in HIV medicine. Many of them have earned the HIV specialist certification by the American Academy of HIV Medicine and are pursuing careers in primary HIV or ID.
In order to reverse the continuing decline in the ID fellowship match results, greater engagement and encouragement by ID faculty as mentors and role models are needed for our trainees. Medical students, interns and residents should be encouraged to participate at local ID city rounds, to attend an ID conference, or to participate in a scholarly research project. The initiation and implementation of mentorship programs for students and residents at training institutions will also make a positive and significant difference. Dr. Calderwood concluded in his editorial that “We are, after all, the detectives of the medical world. There’s always a new challenge, a puzzle to solve, a patient in need. For the ‘typical’ medical student — smart, driven, inquisitive, altruistic — there is no more ideal specialty. And you can help them reach that conclusion.” Indeed, mentoring is an empowering tool that we can all use to help motivate and recruit more ID specialists.
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- Jon G. Persichino, DO, is an associate professor of medicine at Loma Linda University and the University of California, Riverside. He will be starting his infectious diseases fellowship training at Harbor-UCLA Medical Center in Torrance, California, in July.
Disclosure: Persichino reports no relevant financial disclosures.
Click here to read the editorial “The power of mentoring: We all can help recruit more ID specialists” by Stephen B. Calderwood, MD.