Infectious-disease specialist shortage

Because of the increasing prevalence of “superbugs”—drug-resistant bacteria and fungi—it behooves us to have experts who know how to diagnose and treat infections caused by these organisms. But such experts are in short supply. According to the National Resident Matching Program, training spots for infectious-disease specialists go unfilled. Between 2009 and 2017 training positions dropped by more than 40 percent. It’s because this specialty does not pay well. While infectious disease specialists care for some of the most complicated illnesses in the health care system, their pay can be even worse than that of a general practitioner!

The specialty is poorly paid because of the way our insurance system reimburses doctors. Doctors are paid on the basis of the thousands of services that doctors provide—services as lowly as taking blood pressure, but of course also including surgery and everything else. Each service has a code and each code represents a monetary value. In the words of one doctor, “the formula prioritizes invasive procedures over intellectual expertise.” Infectious-disease doctors don’t do procedures: they consult. That consultation can include speaking with the primary care doctors and specialists, reviewing x-rays, and examining cells—all non-paying activities. Infectious-disease specialists are often the only medical people who not only know how to identify the disease-causing pathogens, but also know which of the new antibiotics to use. When such specialists aren’t available, doctors just wing it.

I read an account of a teen-age boy who became terribly ill with a myriad of symptoms, including painful and swollen testicles. Because he was traveling with his family, he went to lots of different doctors and hospitals in the US and Europe. None could diagnose his problem. Most gave him antibiotics. Finally, back home, he saw an infectious-disease specialist. It turns out he had dengue fever, which he’d contracted from a mosquito in Hawaii. Dengue fever is caused by a virus which, as you know, is unaffected by antibiotics. Everyone had been winging it.

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