With more than five million infected by COVID-19 in the US, the pandemic has illuminated the cracks in American healthcare and public health. As the virus continues to sweep the nation, shortages rage on. The public learned a hard lesson in basic economics — the concept of scarcity of resources. Tests, swabs, personal protective equipment, ventilators, medications continue to out-demand the limited supply.
However, there is one resource that is becoming so scarce that it could be classified as ‘endangered’ in the medical ecosystem: infectious disease specialists. A recent study in the Annals of Internal Medicine claimed that of the total 3,142 counties in the US, 79.5% of them did not have a single infectious disease physician. In other words, about 208 million Americans are living in counties hardest hit by COVID-19 with no or very few infectious disease doctors.
Despite being one of the most frequently consulted services in most hospitals, the number of new infectious diseases physicians is not keeping up with the need. Last year, according to the National Resident Matching Program statistics for physician fellowship match, 84 (21%) of 406 available infectious diseases trainee positions in the US went unfilled, compared with the two of 1,010 cardiology positions and two of 615 oncology. There needs to be a focused and systemic attempt to create more ID physicians if we are to protect our health society’s future.
My face shield whistled with noise as it brushed against my thin yellow gown. Bright monitors surrounded me, chirping like cardinals in the summer. A slow exhale felt comfortably warm against my N-95 mask. Treading down the river of COVID-19 patients as a second-year infectious disease fellow, I knew this was exactly where I needed to be. Even beneath these protective barriers, I could look left, right, and straight ahead with clear, unobstructed vision.
When I wrote Part 1 of this post in April 2019 — I wrote to medical students and residents considering their career options. I prophesied one reason to consider a career in infectious disease (ID) is because it is one of the only fields where a threat to someone else’s well-being is a threat to your well-being, and that it is a global calling. In contrast to the implausibility of a large-scale myocardial infarction that would threaten humanity, infectious diseases have the potential to cause a real “end of the world” scenario. The infectious disease specialists are at the forefront, ready and waiting to defend against threats.
… and then COVID-19 happened.
The pandemic made the importance of infectious disease crystal clear. Infectious disease physicians are leading vaccine development efforts, creating clinical trials of novel treatment regimens, researching policy implementation and advocacy, working on infection prevention and antimicrobial stewardship, all while caring for COVID-19 patients. I have actually seen an ID faculty member enthusiastically work on all of these things in a single day — a truly unparalleled career diversity.
Leadership in public health is often by ID specialists, and their impact extends well beyond the bounds of individual patients for whom they provide care. The world needs truth tellers, it is desperate and hungry for reliable information. I turn on the news and see ID leaders like Drs. Anthony Fauci and Carlos Del Rio providing some of that information. After all, ID training provides critical skills that may be necessary to adequately understand pandemics. These skills can benefit health systems in state and local health departments, as well as national institutions like the Centers for Disease Control and Prevention and the National Institutes of Health.
Within hospitals, ID physicians have tangible benefits — consultation often results in shorter stays, lower costs, and lower mortality. At academic hospitals, ID physicians comprise crucial teaching faculty, leading the next generation of young physicians.
With increasing global travel, antibiotic-resistant organisms, and continued emergence of new and old infectious diseases, the role of infectious disease physicians in society will only increase. Now more than ever, the world needs infectious disease doctors.
When COVID-19 is conquered, a new threat will emerge. Will you step-up and be amongst those ready to fight it?