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Saskia v. Popescu, MPH, MA, CIC, is a hospital epidemiologist and infection preventionist with Phoenix Children's Hospital. During her work as an infection preventionist she performed surveillance for infectious diseases, preparedness, and Ebola-response practices. She is currently a PhD candidate in Biodefense at George Mason University where her research focuses on the role of infection prevention in facilitating global health security efforts. She is certified in Infection Control.

The Infectious Disease Physician Well Is Running Dry

APR 17, 2019 | SASKIA V. POPESCU
There is a growing shortage of infectious disease physicians in the United States, according to The New York Times. In a time of growing antimicrobial resistance, emerging infectious diseases, and continued outbreaks of vaccine-preventable diseases, infectious disease physicians are a critical asset to the medical and public health communities. 

A review of the National Resident Matching program found that there are 2 medical specialties that are struggling to fill their training spots. When medical students graduate school and move on to their residencies, the match to their preferred specialty will help guide not only their career, but the future of that field. But training progrsms for nephrology and infectious disease are failing to fill up. The Times' review found that from 2009 to 2017, hospitals able to fill all of the adult infectious disease training programs fell by 40%. These gaps are reportedly due to challenges with insurance reimbursement and the fact that infectious disease physicians are consult-only providers. Ultimately though, what does this shortage mean?

Right now, there is an Ebola outbreak raging in the Democratic Republic of the Congo (DRC), measles spreading throughout many states due to increased rates of vaccine exemptions, and resistant microorganisms continuing to spread globally. These are just a few of the infectious disease concerns we face, but that doesn’t paint a full picture of the nuanced care these physicians provide—from complex secondary infections to health care-associated infections, there is a desperate need to fix this problem. We rely on infectious disease physicians for managing complex antibiotic regimens with comorbidities. Moreover, they are often the only providers with experience in identifying these vaccine-preventable diseases. In terms of future needs, consider the threats we know vs the ones we haven’t really experienced. Pandemics, novel diseases, newly resistant organisms, nefarious uses of synthetic biology, and even bioterrorism—these are all events or scenarios that we worry about in biodefense, and infectious disease physicians play an absolutely critical role. 

Each year, 2 million Americans experience an antibiotic-resistant infection, 23,000 of whom will die. Poor antimicrobial stewardship is a critical part of resistance and, increasingly, poor prescribing practices are carried out by non-infectious disease physicians. Roughly 30% of antibiotics prescribed in outpatients are unnecessary. Outpatient clinics lack infectious disease physicians and even in hospitals, the hospitalist or primary provider must request a consult before an infectious disease physician can assist with a patient. As control measures against antimicrobial resistance struggle, the role of infectious disease physicians will grow, especially as they are often the only providers with the skills to utilize newer antimicrobial medications. 

Another avenue that this shortage impacts is likely 1 that few are discussing—infection prevention and control (IPC) programs. These hospital-based programs require a medical director, often an infectious disease physician. We heavily rely on them for anything from case reviews to policy guidance and even physician communication. The peer-to-peer communication alone is a necessary tool IPC medical directors can provide as they are often the only trusted medical resource for discussing antibiotic prescribing and diagnostic testing. Too many times have I seen an infectious disease physician get called to consult on a case and then end up playing a critical role in saving the patient. IPC programs rely on their guidance for health care-associated infections, as well as other daily nuances like discontinuing isolation precautions. The shortage of infectious disease physicians has global implications in our fight against infectious disease threats, whether they originate from nature, laboratory accidents, or intentional acts of terror. 
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Big advances in treatment can't make up for an inability to stop new infections, which number 5,000 per day worldwide.
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