I can’t imagine a more fascinating, challenging and fulfilling career than specializing in infectious diseases, and every day I’m thankful for the mentors who pointed me in that direction. As a medical student, I was fascinated by microbiology. I knew I wanted to care for patients, but I just didn’t see the connection. Then I started my core third-year medical rotation, and my eyes were opened, thanks to some fantastic ID mentors.
As a medical student at Massachusetts General Hospital, I was fortunate to have as my first attending, Morton N. Swartz, MD, one of the most revered ID specialists this country has ever had. I was impressed by his ability to gently interact with patients, his encyclopedic knowledge, and by always allowing us to think we had reached our own conclusions.
I also observed in awe as two other attendings, Robert Moellering Jr., MD, and A.W. Karchmer, MD — also ID specialists — obtained complete information from patients about their exposures, sometimes going back 20 years, and combined that with an exam and labs to make diagnoses that others had not considered. I thought it was such an impressive way to approach medicine and so different from other specialties, where the possibilities are more limited and are focused on technological procedures and much less patient-oriented. Two days into my core medicine rotation I told my wife: “I want to go into the field of ID.”
And I’m not unique. Nearly 90% of ID fellows who participated in an Infectious Diseases Society of America (IDSA) survey said mentors influence a resident’s decision to pursue a career in ID (and 47% said they have a “great impact”).
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 (NRMP). In the most recent cycle, 99 of the 327 positions offered through NRMP were not filled (30%). Several ID colleagues took a close look at the decline and recently published their observations. They identified several likely factors, including — no surprise here — the relatively low pay compared with other internal medicine-based specialties, as well as the dwindling pool of international medical graduates (due to difficulties in securing visas for permanent residency), concerns about the job market and more recently, the rise of the hospitalist. Unlike specializing in ID, becoming a hospitalist requires no additional training yet comes with higher pay ($165,000 starting salary for hospitalists vs. $158,000 for ID physicians, according to a 2011 survey of 40,000 new physicians). 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.
And the match doesn’t tell the full story. Data from the American College of Graduate Medical Education and the American Board of Internal Medicine show that ID fellowship slots are being filled, just apparently not through the match. Further analysis of these data is under way.
IDSA has long been concerned about the number of residents choosing ID and is working diligently to attract people into our field as well as advocate for higher pay for ID specialists through a number of initiatives, including:
- Spreading the word about the value of ID: First-of-its-kind research based on Medicare data from nearly 130,000 hospitalized patients published in Clinical Infectious Diseases shows that involving ID specialists in the care of patients with infections saves lives and money. This is the kind of information that resonates with governmental agencies, insurers and administrators. IDSA promoted the study and created a Value Toolkit incorporating that research — including presentations, videos and documentation — that IDSA members can use to make the case for better compensation to their employers, hospital administrators and health plan executives.
- Working with governmental agencies and decision makers: IDSA has a strong lobbying program that works closely with the government and its agencies to pass important legislation and adopt key public health initiatives. For example, IDSA has pushed CMS to require that hospital antimicrobial stewardship programs be run by ID physicians. IDSA has joined with other professional societies to advocate for reversing funding cuts and has encouraged the White House and Congress to commit more of the federal budget to ID research and public health.
- Courting the best and brightest: IDSA now has a membership category for students and residents, and hosts two fellows’ meetings every year, one focused on patient care and the other on research. The IDSA Education and Research Foundation provides scholarships to medical school students, and the HIV Medicine Association of IDSA offers minority clinical fellowships. At IDWeek 2014, IDSA launched a new mentorship program in which students, residents and fellows were teamed up with seasoned ID specialists to explore the meeting, discuss various careers in ID and make key personal connections.
- IDSA’s board and various committees are brainstorming ways to ensure that we have the right number of doctors going into ID and to attract young physicians to the field, such as looking at the length of training and the job opportunities becoming available. We continue to work on these issues, and we welcome new ideas and thoughts on ways to address the problems as quickly as possible.
IDSA’s board and various committees are brainstorming ways to ensure that we have the right number of doctors going into ID and to attract young physicians to the field, such as looking at the length of training and the job opportunities becoming available. We continue to work on these issues, and we welcome new ideas and thoughts on ways to address the problems as quickly as possible.
The IDSA has made this a priority. But we need your help. It is clear that our best tool is and may always be mentoring. The truth is, all of us could have pursued another specialty and probably made more money. But if you, like me, chose ID because it’s a highly satisfying specialty that impacts patient care and one in which we truly can make a difference, please pass on that message — and enthusiasm.
There are many opportunities for mentoring. Whether you are in an academic setting, a hospital, a laboratory or private practice, you meet medical students and fellows at work or meetings. Maybe your friend’s daughter is considering a medical career. And if you truly have no opportunity to meet or influence medical students, volunteer to work on an IDSA mentoring initiative. If you meet a student who is considering becoming a hospitalist vs. an ID specialist, you might note 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.
Be sure to mention that ID expertise, insight and wisdom are increasingly necessary by pointing out that it’s a rare day that goes by without infectious diseases in the news, whether it’s Ebola, antibiotic resistance or a measles outbreak. Note that the career possibilities are varied and exciting, from patient care, to cutting-edge research, to conducting outbreak investigations and pandemic responses — both domestically and globally — to developing new vaccines and medications, to improving public health. 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.
2010 IDSA Fellows Survey on file.
Chandrasekar P. Clin Infect Dis. 2014:59;1593-1598.
Profiles. The online database of graduating physicians. Available at: www.profilesdatabase.com. Accessed Jan. 13, 2015.
Schmitt S. Clin Infect Dis. 2014;58:22-28.
For more information:
Stephen B. Calderwood, MD, is president of the Infectious Diseases Society of America; Morton N. Swartz, MD, Academy Professor of Medicine, Harvard Medical School; chief, division of infectious diseases, vice chair, department of medicine, and director, undergraduate medical education, Massachusetts General Hospital, Boston.
Disclosure: Calderwood reports no relevant financial disclosures.