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Compensation for ID physicians ‘not a simple issue to fix’

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October 30, 2018

Matthew Zahn
Matthew Zahn

Compensation policy changes are needed to attract more medical students and residents to the field of infectious diseases, where physicians are underpaid for the valuable role they play in protecting public health, experts argued.

As data has showed that fewer young physicians are applying for ID training, casting doubt over the next generation of ID care, many experts have pointed out the disparity in compensation between ID and other specialties as one of the core reasons why.

“It’s not a simple issue to fix,” Matthew Zahn, MD, medical director in the division of epidemiology and assessment for the Orange County (California) Health Care Agency, told Infectious Disease News. “We have seen drops in number of applications to infectious disease fellowship programs around the country. We have to realize this is a holistic problem and the answers to the issue are not simple.”

Pay gap

Writing in Clinical Infectious Diseases, Zahn and colleagues noted a report that showed the median salary of a specialty physician is approximately $316,000 and an Infectious Diseases Society of America survey revealing that ID physicians makes an average of about $215,000 a year. The same survey showed that public health physicians working full time make even less, about $189,500 per year.

The first report showed that educational debt for the average medical student is approximately $200,000. According to Zahn and colleagues, over a 5-year period ending in 2016, the disparity between debt and compensation was a “significant contributor” to a 21.6% decline in applicant numbers to infectious disease fellowship training programs.

In their paper, Zahn and colleagues give “concrete examples” of contributions that ID physicians make to public health, which they said can be used to lobby policymakers at the federal, state and local levels for more investments in the field.

“It is essential that ID physicians promote the value this subspecialty brings to public health to affect the policy changes necessary to secure the future of the field,” they wrote.

Unique contributions

ID physicians have unique expertise that make them effective in a broad number of roles, including as clinicians, educators, epidemiologists, public health leaders, directors of antimicrobial stewardship or infection prevention and control programs, researchers, administrators and policymakers, Zahn and colleagues wrote. Many of these responsibilities come with minimal or no compensation.

As leaders in population health, they said ID physicians are crucial to community-based interventions, providing expertise in infectious disease management and prevention, outbreak detection and response and guidance on vaccine allocation. Zahn and colleagues said ID physicians can limit the spread of infectious diseases and are a resource for public education on communicable diseases and prevention methods.

In the health care setting, ID physicians are leaders in infection control and prevention and health care epidemiology, as evidenced by the important role they played in establishing special biocontainment units at multiple sites in the United States during the West African Ebola epidemic, Zahn and colleagues noted. ID physicians have helped identify and investigate outbreaks related to medical devices and compounded drugs and are able provide scientific and clinical knowledge that can bolster emergency preparedness and response in hospitals, they said.

At the global level, Zahn and colleagues argued that ID physicians play a crucial role in implementing International Health Regulations and have the skills to recognize disease outbreaks, assist with in-country training and help create epidemic disease control, diagnostics and preparedness partnerships.

Zahn noted that studies have showed that consultation with an infectious disease physician leads to better and more appropriate care of patients, and that having an ID physician on staff at a hospital impacts practice standards and the overall education of a facility.

“That’s a tremendous benefit, but it’s not necessarily easily billed for,” he said.

According to the paper, IDSA has implemented initiatives to increase the number of ID applicants, including mentorship programs, scholarships, meetings and medical school ID interest groups. However, Zahn and colleagues said there are other options to attain proper compensation for ID physicians.

They recommend the establishment of loan repayment options for ID physicians working in public service, such as in local, state or federal health departments, and financial compensation for those working in public service or whose work offers broad public health benefits, such as physicians performing infection control and antimicrobial stewardship work. They believe that compensation for ID physicians should reflect their added value to public health and that local, state and federal public health agencies should be fully funded. Furthermore, they highlighted the critical need for a proper, competent workforce.

“Appropriate compensation for ID service in all of these forms will have significant positive effects on individual patient care, nosocomial infections, and community public health, ensuring that the future ID workforce has enough of an incentive to pursue this vital field,” they wrote. – by Marley Ghizzone

Disclosures: The authors report no relevant financial disclosures.

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