Faculty members in infectious disease fellowship programs across the country are lamenting the lower numbers of new doctors that matched into training positions this year, continuing a trend of waning interest in the subspecialty.
Emory University School of Medicine in Atlanta, which had five open positions, filled all but one slot in the match, according to Wendy Armstrong, MD, associate director of the division of infectious diseases there.
"It's very unusual for us not to fill," she told 乌鸦传媒, noting that the program filled the remaining open position outside of the match process. "Far too many programs, including long-established programs, were in a similar boat."
Daniel Bourque, MD, program director of the infectious diseases fellowship at Boston University, said that his program had multiple positions go unfilled. None of the program's three open fellowship positions were filled in the match this year.
"This was a huge surprise," he said. "I think seeing the number of spots that went unfilled across the country, in many other very strong programs ... it was shocking."
Just 56% of infectious disease fellowship programs filled all of their open positions this year, according to , with 74% of available positions filled during the match process. Fill rates sunk even lower this year compared with , in which 70% of programs and 82% of positions were filled.
Unlike other subspecialties of internal medicine, such as cardiology, critical care, and gastroenterology -- in which applicants practically have to fight for a spot -- low fill rates in infectious diseases have persisted for the past decade.
"It's disappointing," Carlos del Rio, MD, president of the Infectious Diseases Society of America (IDSA), told 乌鸦传媒. "The issue right now is that we have more positions offered than people."
During the first year of the COVID-19 pandemic, there was a slight increase in the actual number of trainees who matched into an infectious diseases fellowship. While the number of filled positions has typically hovered around 320, during the first pandemic year, 365 fellowships were filled in the match. While the number of positions available has increased by around 10% since 2018, the number of trainees -- despite that brief pandemic bump -- has stayed stagnant.
These numbers are alarming to infectious disease doctors because there is already a shortage of providers within this specialty. Nearly 80% of U.S. counties do not have a single infectious disease doctor, according to a 2020 study published in the .
"We are all very, very nervous about a declining workforce in the face of increasing need," Armstrong said, noting that developing hospital infection control policies, promoting antimicrobial stewardship, and creating public health guidelines are tasks that require the expertise of an infectious disease doctor.
Many cite compensation as a reason for fewer trainees flocking to this subspecialty. The average salary for an infectious disease physician was $295,000 in 2021, according to a . For subspecialties such as cardiology or gastroenterology, average salary was $500,000 and up.
Bourque said that providers in infectious diseases often point to compensation as one of the key drivers of waning interest, but salary may not explain the drop in this year's match results.
"That's been a long-term issue that's not a new issue," he added. "So, what has changed?"
Increased workload during the pandemic, physician burnout, and politicization may be contributing to why programs are not filling their positions, but Bourque noted that program directors and others within the subspecialty need a better understanding of the factors driving this trend. As this year's class was the first whose training occurred entirely during the pandemic, he said it's worth investigating what may have impacted residents' career choices.
The IDSA has promoted legislative initiatives that aim to address workforce issues, one of which targets medical school loan repayment. The BIO Preparedness Workforce Pilot Program, a provision included in the PREVENT Pandemics Act, would establish a loan repayment program for infectious disease doctors who choose to practice in rural areas or underserved communities. Two-thirds of U.S. adults agree that the federal government should assist medical students who focus on infectious diseases and choose to work in these communities, the IDSA said.
In addition to legislative efforts, del Rio said that program directors can boost interest at the local level by exposing residents to a broader range of responsibilities within the infectious diseases subspecialty.
Bourque said that next year's match will provide more context to help physicians uncover the reasons behind this trend.
"If this is related to the pandemic, what are the factors at play? Is it burnout, is it the stigma that has been brought out because of politicization?" he said. "I think, for me, that's the area that I want to better understand."