Blog | Monday, January 6, 2014

A subspecialty in decline?

It was “match day” today for the internal medicine subspecialties. For some fields, there are far more applicants than training positions. Thus hundreds of would-be gastroenterologists and cardiologists find themselves out in the cold, unable to pursue their chosen profession. Not so for infectious diseases (ID). This year marks a new record for unfilled ID programs (54), with many training programs unable to fill a single training spot in the match. Given current trends, we are approaching a situation in which half of all programs will have unfilled positions. As funds for graduate medical education become increasingly scarce, some of these programs will likely reduce the number of training positions they offer, or shut down altogether.

There are several explanations for this trend, including reimbursement of ID specialists (train longer to make less!), the educational debt burden of trainees, the rise of the hospitalist, and reductions in research funding for academic careers. I have no easy answers, but it is urgent that we address this slow motion train wreck. Multiple drug resistant bacteria already far outnumber the contingent of ID doctors, and that situation is bound to get worse over the next several decades. Some things to work on: (1) perform studies to demonstrate the value provided by the ID specialist, (2) advocate for increased funding for ID research and training, and (3) provide role models who demonstrate that ID is an incredibly interesting and rewarding career!

Daniel J. Diekema, MD, FACP, practices infectious diseases, clinical microbiology, and hospital epidemiology in Iowa City, Iowa, splitting time between seeing patients with infectious diseases, diagnosing infections in the microbiology laboratory, and trying to prevent infections in the hospital. This post originally appeared at the blog Controversies in Hospital Infection Prevention.