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COVID-19 Resource Center

Source: Healio Interviews
Disclosures: Adalja, Armstrong, Cervantes, Fauci and Pai report no relevant financial disclosures.
September 23, 2021
9 min read
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‘Fauci effect’: ID experts could inspire new generation of doctors

Source: Healio Interviews
Disclosures: Adalja, Armstrong, Cervantes, Fauci and Pai report no relevant financial disclosures.
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In the wake of the COVID-19 pandemic, data indicate that there has been a surge in interest among U.S. college students in pursuing medicine as a career.

The phenomenon has popularly been called the “Fauci effect” — named for Anthony S. Fauci, MD, director of the National Institute for Allergy and Infectious Diseases and presidential medical advisor, whose frequent appearances on news networks and in White House briefings have made him one of the most recognizable faces of the pandemic.

Anthony S. Fauci, MD
An increase in medical school applications in the United States has been attributed to the visibility of National Institute of Allergy and Infectious Diseases Director Anthony S. Fauci, MD

Source: Official White House photo/Chandler West

“You know, it’s flattering that people have interest in going to medical school in greater numbers because of the kinds of things they see people like me do,” Fauci said in an interview with Infectious Disease News. “They [call] it the ‘Fauci effect’ ... but I think it goes beyond Fauci.”

“People are seeing that the medical community — not only physicians, but nurses and various hospital personnel — have really been the heroes and the heroines of this outbreak,” he said. “They see me on television and in the newspapers and they hear me on the radio, so they’ve latched on to some person with whom they can identify, but there are thousands and thousands of physicians, nurses and health care providers who are the real heroes working hard in the trenches.”

Infectious Disease News spoke with Fauci and other experts about how the visibility of medical experts may have impacted medical school applications and whether interest in infectious diseases has also increased.

“Historically, infectious diseases has been an underserved subspecialty. If indeed the inflow of new ID specialists improves, it will have an all-around beneficial effect on health care,” said Infectious Disease News Editorial Board Member Gitanjali Pai, MD, AAHIVS, FIDSA.

Applications at all-time high

According to the Association of American Medical Colleges (AAMC), applications to U.S. medical schools hit an all-time high for 2021, increasing 18% compared with last year. Some schools are seeing even larger increases, with nearly two dozen medical schools reporting at least a 25% increase in applications in 2020.

According to NPR, medical school admissions officers began calling the surge in applications the “Fauci effect.” The surge came on the heels of data reported by the AAMC last year that indicated the U.S. could see an estimated shortage of around 54,000 to 139,000 physicians by 2033.

The question is whether the increased visibility of medical experts led to the increased interest in medicine as a career.

In an editorial published in the Journal of Investigative Medicine, Jorge Cervantes, MD, PhD, an assistant professor of microbiology at Texas Tech University Health Sciences Center, argued that several factors could have fueled interest, including Fauci.

“Dr. Fauci has been an inspiring and a trusted figure during the pandemic, and now many people want to make a difference similar to what Dr. Fauci is doing,” he wrote. “Whether directly triggered by Dr. Fauci or not, the increase in applications could be a result of people becoming informed of what is currently happening in the world.”

He said Fauci “has been an icon for physicians, scientists and other public health leaders because he represents a voice of reason during a time when there is so much misinformation regarding science and medicine.”

Gitanjali Pai, MD, AAHIVS, FIDSA
Gitanjali Pai

“Physicians everywhere aspire to use science to advance the health of their patients, and Dr. Fauci’s example has been extraordinary in terms of his clarity, grace, and expertise,” Cervantes wrote.

However, he also noted that medical school applications have gone up before, usually “during situations when the economy or society may be struggling, or when popular culture, such as television, puts the health care industry in the spotlight.”

“It is certainly possible that this increase may not be related with Dr. Fauci’s presence in the media during the pandemic. Considering practically all admission processes and interviews have been conducted virtually this year, without requiring travel and related costs, it has become easier or at least more accessible for people to apply to medical school,” he wrote.

In interviews with Infectious Disease News and other outlets, Fauci has downplayed his role.

“I’m visible, and I’m a very active participant in all of this,” Fauci told Infectious Disease News. “They’re calling it the ‘Fauci effect,’ but I think it probably should be ‘the medical profession effect.’”

‘A whirlwind’

Among medical professionals, ID experts are as visible as ever — on TV, online, and in print, they can contextualize new data and explain emerging issues in an ever-evolving pandemic.

Amesh A. Adalja, MD, FIDSA, FACP, FACEP, a senior scholar at Johns Hopkins Center for Health Security, is frequently asked for his input on the pandemic.

“It has been a whirlwind for me being on television basically every day knowing that I am giving people information that they may rely on,” Adalja said. “It has been very tiring keeping up with media, patient care and my policy work. However, this is a huge opportunity to actually get things right when it comes to pandemic preparedness, so I do not want to squander it.”

The field has struggled to attract medical students in recent years, in part because ID physicians are underpaid for the role they play in public health, experts have argued.

According to Wendy Armstrong, MD, professor of medicine at Emory University and board member for the Infectious Diseases Society of America and HIV Medicine Association, medical students’ interest in ID reached a low point around 5 years ago, but there are signs that interest has increased.

According to the National Resident Matching Program, around one-fourth of the 165 participating ID programs went unfilled in 2021, and there were 404 total ID applicants to the program. Those are improvements over 2015, when more than half of the 138 participating ID programs remained unfilled, and there were just 254 applicants to the program’s ID specialty.

Although the numbers have improved, Armstrong said ID programs still fill fewer spots than specialties such as cardiology, critical care medicine and gastroenterology.

“The lack of interest by residents in the infectious disease specialty has been worrying. At best, the interest has been cyclic, depending upon the dominant epidemic or disease prevailing at that time,” said Pai, the chief medical officer for the Oklahoma State Department of Health and an infectious disease physician at Memorial Hospital and Physicians’ Clinic in Stilwell, Oklahoma.

Pai said pandemics of influenza and plague have changed the course of history, but “we had to wait for a mercilessly lethal disease like HIV to bring the ID specialist to the center stage.” A familiar face helped navigate the U.S. through the early years of the AIDS epidemic, Pai noted.

“We were fortunate that when HIV struck with full force, we had Dr. Fauci at the helm,” she said. “The inclusive approach to developing medicines, the flexibility of approach that Dr. Fauci showed in striking a balance between a traditional approach and initiatives like ‘parallel track,’ and nowhere compromising the principle of ‘primum non nocere,’ are the stuff that legends are made of.”

According to Pai, interest in ID picked up after HIV — thankfully, too, because epidemics of SARS, avian influenza, swine influenza, Zika and Ebola followed.

Wendy Armstrong, MD
Wendy Armstrong

“And then came SARS-CoV-2, or COVID-19, which brought the world to a standstill, bringing the need for infectious disease specialists into sharp focus,” she said.

“Before this past year, I’m not sure anybody could name an infectious disease doctor, and most frequently, I got very quizzical looks when I told people that’s what I was,” Armstrong said. “Now everybody in the U.S., at least, and probably around the world can name at least one infectious disease doctor — Anthony Fauci. I hope that this has shown our value, but for those of us in this specialty, this is part of what we do and why we went into this specialty.”

Armstrong is not sure that the “Fauci effect” could explain an increase in interest in ID because the timing does not line up.

“Applications get submitted in the July, August time frame, which was very early in the pandemic, so I think it’s relatively unlikely that people change their career plans in a couple of months’ time,” she said.

There are some data that back her up.

Armstrong and colleagues interviewed or surveyed nearly 600 graduating internal medicine residents for a study published in 2016 that showed that 65% of respondents chose a specialty while still in medical school, or even earlier.

“What I think is going to be really interesting is looking in several more years at what the medical students right now — living through the COVID-19 pandemic — end up doing,” Armstrong said. “They will go to medical school, then a residency and then apply for fellowships. With that cohort, we won’t know for a few years.”

Regardless of what has caused the increased interest, Adalja hopes medical students are watching and taking notes.

“I hope medical students who see me and other infectious disease experts on television understand how important it is to be a trusted source of information,” he said. “I hope they also realize that you really need to know your subject to be able to speak to people about it in the manner the media desires.”

The future of ID

Today, ID experts are some of the busiest professionals in medicine, Pai said.

“Just when we thought we could relax a bit, the new variant of the virus causing COVID-19 has started wreaking havoc,” she said, adding that the learning curve over the last year has been “exponential.”

Adalja believes the field will be transformed over the next 10 years as people see its increased value.

“Infectious disease will also integrate with the technological revolution, and hopefully our ability to prepare for, predict, prevent and respond to infectious disease emergencies will be greatly augmented,” Adalja said. “This will have a downstream effect on public health, as infectious disease medicine is tightly bound to public health and many of the people in either field have dual roles.”

Medical school applications increased during pandemic

Fauci said ID “has a little bit of a different flavor” than other medical specialties. What sets it apart, he said, is that it not only involves individual patient care — “that’s what you train for, the abilities to give each individual patient the optimal care that you can give them” — but also has broader implications that go beyond the individual patient, “the epitome of which is a historic, global pandemic.”

Armstrong hopes the expanded public understanding of the value of ID leads to other changes — namely, a focus on the economics of being an ID specialist.

“Infectious disease is among the most poorly compensated specialties, and it becomes a challenge for people with loans from medical school and so on,” she said. “I hope that with increased recognition of [our] value that there’s more attention to how infectious disease is compensated and how we think about recruiting more people into the specialty, because it is critical to our future survival.”

Fauci is hopeful.

“Infectious disease is one of the most visible specialties in medicine and one of the most important and impactful specialties in medicine,” he said. “I believe that the momentum that it’s gotten now is going to draw more people — more talented people, more young, fresh minds, people with new ideas — into infectious disease, and I think it’s going to have a very positive impact on the entire field as you get more talented people enthusiastic about this subspecialty.”

Click here to read the At Issue, "Has the government done enough to help strengthen the ID workforce?"