{"id":4640,"date":"2013-09-27T13:55:49","date_gmt":"2013-09-27T17:55:49","guid":{"rendered":"http:\/\/blogs.nejm.org\/?p=4640"},"modified":"2015-06-04T14:33:01","modified_gmt":"2015-06-04T18:33:01","slug":"yes-an-economic-justification-for-id-specialists","status":"publish","type":"post","link":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/yes-an-economic-justification-for-id-specialists\/2013\/09\/27\/","title":{"rendered":"Yes! An Economic Justification for ID Specialists"},"content":{"rendered":"

\"16839354_blog\"<\/a>We’re currently in the middle of fellowship interview season, and I overheard the following conversation between two of my colleagues as they contemplated their upcoming interviewees:<\/p>\n

ID Doctor #1: <\/strong>\u00a0He seems like a great candidate — wants to study hospital and community epidemiology of highly drug-resistant bacterial infections, and has already made major contributions to his hospital’s quality assurance program.
\nID Doctor #2:<\/strong> Listen to this applicant: \u00a0She’s been working in [insert resource-limited country here] since junior year in college, even continuing to go there part-time during her residency. She apparently started an HIV screening program in rural healthcare settings that has reduced perinatal HIV infections by 50%!
\nID Doctor #1:<\/strong> \u00a0My next interviewee has his PhD in yeast genetics. I can’t understand his work, but he has three first-author papers in [insert three highly prestigious basic science publications here], and he won the “Top Clinical Resident” at his program last year, proving he’s not just a science drone.
\nID Doctor #2:<\/strong>\u00a0 He sounds terrific. But should we ask these young doctors the really tough question about ID fellowship: Will\u00a0they be willing to work hard in a medical specialty that pays so poorly?<\/strong><\/em><\/p>\n

Look, I get it. We just don’t — and can’t — do the obvious things that bring revenues to U.S. medical providers. First, we do essentially no procedures. Second, the very nature of our patient population makes it impossible to churn through high volumes of clinical visits, either in the inpatient or outpatient setting. And third, for those ID doctors who focus on HIV, the demographics of the patients will almost invariably skew toward the indigent.<\/p>\n

Now all of this makes us ID doctors, sniff, feel relatively underappreciated, at least from a financial perspective. You should see the red carpet (salaries, office space, advertising, yachts — OK, not yachts) rolled out for our interventional radiologists who treat varicose veins. Meanwhile, we struggle to find funding for the food at our weekly educational conferences.<\/p>\n

Is that fair? Of course not.<\/p>\n

But what we ID doctors do must<\/em> have some value, right? Otherwise why does the demand for ID consults seem infinite, increasing all the time? Does our expertise in management of highly complex medical and surgical patients improve patient outcomes and — gasp — even reduce costs?<\/p>\n

“Yes!” says this in-press paper in Clinical Infectious Diseases.<\/em><\/a><\/p>\n

The final corrected proof is not yet available, but set aside your “let’s wait for the final published paper” tendencies, and contemplate these incredible findings about those who get ID consults versus those who don’t:<\/p>\n