[That was an important edit — please see Dan’s comments below.]<\/p>\n
When I cited this alarming figure, it generated a\u00a0spirited email exchange about the ID match with Emory’s Wendy Armstrong, the source of the\u00a0“historic bad” quote in the title. Wendy is also IDSA\u00a0Chair of the Task Force for Recruitment to ID, so has thought a lot about this issue.<\/p>\n
She acknowledged the\u00a0trend is worrisome:<\/p>\n
The\u00a0bulk of our exchange, however, was about the reasons<\/em> for this alarming trend.<\/p>\n Her view:<\/em>\u00a0 It’s multifactorial: Limited ID\u00a0teaching\u00a0in medical school, with declining numbers of dedicated microbiology\/ID courses.\u00a0A\u00a0significant proportion of preclinical curricula are led by microbiologists alone. ID faculty have less exposure to medical students in the hospital. There are fewer clinical electives for residents. There are fewer ID clinicians acting as attendings on medical services. It’s the money.<\/p>\n My view: \u00a0<\/em>It’s the money. At least, it’s mostly<\/em> the money.<\/p>\n Yes, the factors listed by Wendy are part of it.\u00a0But since several apply to other medical subspecialties — how many cardiologists or gastroenterologists attend on general medical services? — I’m not sure they are playing much of a role.<\/p>\n Why is the money issue important, and why is it particularly bad for ID? A few thoughts:<\/p>\n ID doctors\u00a0are always the ones at the hospital late at night working at our hospital. And not compensated for it they way they should be. Many are of retirement age. Only a few younger guys.<\/p><\/blockquote>\n Could it be that potential applicants see ID doctors staying late in the hospital, coming in during the weekends and holidays, and wonder — why should I do that and get paid so (comparatively) poorly? The contrast with cardiology, gastroenterology, and intensivist doctors from a reimbursement perspective is obvious.<\/li>\n I worked in HIV clinic in urban city in NJ and couldn’t believe what a new grad starts at…one did his fellowship at our hospital and was offered $85k in a private practice and the other was offered $110 as a assistant director so a lot of administrative, teaching, and research in addition to seeing patients. He had to moonlight in the prison system just to make his student loan payment!<\/p><\/blockquote>\n Certainly\u00a0here in Boston, and anecdotally elsewhere, PCPs start at a significantly higher salary than ID doctors.<\/li>\n Reading the above, you might think I’m pessimistic about the future of our speciality, but — call me crazy — in fact the opposite is true. Having one dominant cause to the problem is in many ways easier than a highly complex, multifactorial situation. Fix the money problem, and the interest in ID will rebound nicely.<\/p>\n![\"programs](\"http:\/\/blogs.nejm.org\/hiv-id-observations\/wp-content\/uploads\/sites\/2\/2015\/12\/programs-unfilled-nrmp.jpg\")
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