Infectious Disease Doctors in Short Supply for COVID-19 Crisis

MARCH 2020 — As the coronavirus outbreak continues to spread, infectious disease specialists are in short supply and might be overwhelmed by the emergency, Thomas File Jr, MD, president of the Infectious Disease Society of America, told Medscape Medical News.

“Depending on the burden on our healthcare systems, we’re going to be at the center of caring for these patients,” said File, who is a practicing infectious disease specialist at Summa Health in Akron, Ohio.

“Also, we have to spend time communicating with the community to dispel some of the myths [related to the novel coronavirus]. So already, we’re seeing an increased workload because of this. And if COVID-19 spreads significantly — and I think we have to be prepared that it will — we’re going to need a larger workforce to deal with this,” he said.

Infectious disease specialists at Summa Health, File added, are overtaxed because of “a very active influenza season,” on top of helping the institution prepare for COVID-19 cases. This involves setting up a command center and creating protocols to diagnose and treat patients as they arrive.

In addition, ID specialists are on the front line of coping with “the public health crisis of antimicrobial resistance,” he points out. “We have to make sure we’re using antibiotics appropriately and promoting the development of new antibiotics so we’ll have them available for the future.”

File emphasized that COVID-19 is not the only emerging pandemic that ID specialists have had to deal with or will have to deal with in the future. He cited the threats that Zika and SARS posed in past years. “COVID-19 illustrates the need for more trained ID specialists, because we know we’re going to be seeing more outbreaks in the future.”

“Overworked and Underpaid”

Nevertheless, the number of physicians entering the field has steeply declined in recent years. According to a 2019 Merritt Hawkins report, “Between the 2009-2010 and 2016-2017 fellowship matches, the number of adult ID [infectious disease] programs filling all their positions dropped by 41% and the number of applicants decreased by 31%. In 2015, fewer than half of US ID fellowships filled their incoming classes.”

In 2017, there were 9122 infectious-disease specialists in the US, about 1% of the total number of American physicians, according to the American Association of Medical Colleges.

Asked why so few doctors are going into the specialty, File replied, “To put it simply, we’re overworked and underpaid.”

A 2019 Medscape survey shows ID specialists earned an average of $239,000 a year. That’s in the same range as the compensation of primary care physicians. However, File noted, it’s about $100,000 less, on average, than what other non–primary-care specialists earn.

The main reason for this, File said, is that ID specialists perform cognitive tasks rather than procedures and are thus compensated under the lower-paying evaluation and management codes. Yet ID specialists manage very complex cases and know how to administer specialized drugs that other physicians may have no experience using.

“We don’t do procedures, but we take care of very sick patients in the ICU, which may take hours, and we’re not going to be compensated for the value we’re providing,” File said.

Infectious diseases requiring complex care coordination are commonly observed in settings with high poverty, mental illness, addiction, and incarceration, the Merritt Hawkins report pointed out.

File admitted that some young doctors might be hesitant to enter the specialty because of that factor. He noted there has been a steep rise in infectious disease complications stemming from the opioid epidemic, including skin and bloodstream infections.

On the other hand, File said, there are many positive factors that should attract physicians to the infectious-disease specialty. These include the intellectual simulation of research, the opportunity to fight emerging infections in third-world countries, and the ability to cure very sick patients whom other doctors can’t help.

“The nice thing about infectious diseases, as compared to some of the other medical subspecialties, is we actually cure patients,” he said. “When I see a patient with life-threatening meningitis and we’re able to give him the appropriate medicine, he can be cured and leave the hospital perfectly fine. That’s very gratifying, and the patients are very appreciative of that as well.”

Several studies have shown that ID specialists not only improve outcomes for such patients but also reduce the cost of care, according to File. The Centers for Medicare & Medicaid Services (CMS) should recognize that and increase payments to ID specialists, he said.

As for the US response to the COVID-19 emergency, the ISDA president stated, “It’s important for infectious-disease specialists to be able to respond to infectious disease outbreaks and help prepare institutions to respond to them as well. Many of our members are also helping to develop vaccines and therapies. So our specialty is extremely important at this critical time to respond to this outbreak.”

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