‘Ominous formula’: Complexity, low pay hurt ID recruitment
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Key takeaways:
- ID has struggled to recruit new physicians.
- New research indicates that the complexity of the specialty coupled with low compensation make it more difficult.
Researchers compared infectious diseases with three other similarly sized, primarily cognitive medical specialties and found that ID led the pack in the number of published journal articles, guidelines and new FDA-approved drugs.
But ID ranked last in a fourth category: compensation.
The perceived drawbacks of a career in ID — including a high rate of burnout and lower pay compared with other specialties — have frequently been cited as barriers to recruiting physicians to a field whose importance has seemingly grown in recent years.
Despite a general feeling that the COVID-19 pandemic may actually attract new physicians, ID experienced another disappointing recruitment period last year, with more than 44% of programs going unfulfilled by Match Day.
In a new study published on the eve of IDWeek, Brian Grundy, MBBS, MPH, at the University of Colorado, and Eric Houpt, MD, from the University of Virginia, used UpToDate to compare ID with the specialties of endocrinology, nephrology and rheumatology in terms of journal articles, practice guidelines, new FDA approvals and pay.
What they found was that ID published up to 77% more journal articles than the other three specialties — 1,402 for ID compared with 848 for endocrinology, 837 for nephrology and 794 for rheumatology.
Likewise, guidance produced by the Infectious Diseases Society of America had far more recommendations (1,903) compared with guidance produced by Kidney Disease: Improving Global Outcomes (1,270), the Endocrine Society (756) or the American College of Rheumatology (550).
Grundy and Houpt also found that, among the nearly 1,200 new entities approved by the FDA since 1985, 189 had an indication for ID compared with 92 for rheumatology, 87 for endocrinology and 77 for nephrology.
Paradoxically, the average starting salary for an assistant professor was $197,152 for ID compared with $199,925 for endocrinology, $204,418 for rheumatology and $232,120 for nephrology.
“Our message is not that the fields of endocrinology, nephrology, and rheumatology are simple. Their knowledge bases are also large, and we all take care of patients with extremely complicated disease processes and comorbid conditions,” the authors wrote, citing a large study that found nephrologists see the most complex patients. “Rather, our argument is that the knowledge base required of the ID physician is increasingly complex.”
They noted that the IDSA is “well aware” of the compensation gap and has written a letter to Congress citing the discrepancy between ID pay and the specialty’s outsized importance to patient health.
“The increasing body of ID knowledge content coupled with a flat or declining number of specialists is an ominous formula,” Grundy and Houpt wrote. “These systemic trends will likely continue, and clinical care stands to worsen without significant structural reform.”
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