Why ID? Experts Share The 'Why' That Drove Them to Pursue Infectious Disease Careers
JUL 24, 2019 | CONTAGION® EDITORIAL STAFF
Why ID? Contagion® interviewed physicians, pharmacists, and students to explore the driving factors behind the decision to pursue infectious disease as a career path. The result? Our #WhyID series. We'll post 2 testimonials a week, so be sure to check back as we add to our list.
Glenn Tillotson, PhD, consultant with GST Micro
"I think it's fair to say I came into the field of infectious diseases at the hey day of science discovering new pathogens. I'm going to date myself now, but I remember the emergence of Legionnaires' disease and when you see things like Legionnaires' disease and Clostridium difficile, you realize that this is a field that's going to continue to move and to change, and I was right. I had the choices, obviously, to go into surgery [or] cardiology, but I thought the 1 field that will constantly change, constantly be a challenge, is infectious diseases."
Renee Ackley, PharmD, PGY2 at Atrium Health
"I’m passionate about infectious diseases because I’m very interested in antimicrobial stewardship and how we can prevent the development of multidrug-resistant organisms and I feel like pharmacists can play a vital role in that."
Matthew Girgis, PharmD, PGY-2 at Boston Medical Center
"Why ID? I remember when I was in pharmacy school fourth year—I went to a straight-6 program out of high school so fourth year is the year that we took infectious diseases or virology. I remember it was that course that kind of separated the men from the boys as far as people passing and failing, and I just found it to be really interesting, specifically the stewardship aspect and the fact that there are growing resistance trends worldwide. Treating infections is not like treating another disease like hypertension. If you give another patient an antihypertensive, you treat them and you treat them individually, but when another person takes an antibiotic, you're treating them, yes, but you're also developing drug-resistant bacteria in that person even if you're using antibiotics for the right indication. Now, the literature shows that 50% of antibiotics used are inappropriate, so with that 50% we're harboring resistant bacteria in them and that person is now a surrogate and transmitting that bacteria to other people and really creating the huge resistance that we're seeing now. Using antibiotics appropriately is something that really interested me, as well as new drug development so what drugs, what niches, what holes are we missing where we can develop other antibiotics to fit our needs."
Kimberly Claeys, PharmD, Assistant Professor at Maryland School of Pharmacy
"So the reason I decided to pursue a career in infectious diseases was because I really like the fact that you can be so involved in research and be so impactful. I moved from being more clinically-based to more research-based. Part of that was doing a fellowship in ID and after that being faculty in the school of pharmacy, now I’m doing a PhD in epidemiology. There are just so many research opportunities in ID when you have a PharmD. I think that’s something that people don’t really think about when they’re in pharmacy school, but that’s how my career went - just going all into research."
Alice Margulis, PharmD, PGY-2 Pharmacy Resident at Jackson Memorial Hospital
"Why ID for me? ID is a huge puzzle and I love the challenges that that brings."
Brandon J. Smith, MD, PharmD, PGY3 Internal Medicine Resident, and Resident Chair ASP at UPMC Mercy
"That’s a wonderful question that I actually get asked quite frequently. Being completely honest with you infectious disease was kind of spurred on a lot by the TV show “House” which was quite popular whenever I was training in pharmacy school. I knew I wanted to specialize and I enjoyed the diagnostic side of medicine. House was board certified in ID and for fans of the show, they will also remember that he was board certified in nephrology, which I am not going to go that route as well. But his love of diagnostics and infectious diseases is probably one of the main reasons I ended up going into ID."
Alison Lew, PharmD, PGY2 Infectious Diseases Pharmacy Resident at University of Michigan
"I was really interested in infectious diseases because I think there's a lot of gray area. Being able to incorporate literature and clinical judgment in terms of PK/PD and different factors is something that's really appealing to me and just balancing clinical outcomes with reducing resistance."
Thomas Lodise, PharmD, PhD, professor at Albany College of Pharmacy and Health Sciences
"So why did I get into infectious diseases? I think it's simple; we look at antibiotics, they're life-saving medications. You know, we can you know argue the merits of certain medications across different disease states, but antibiotics save lives. For certain infections, without antibiotics, mortality would be near 100%. Our ability to use antibiotics has been limited by the emergence of drug resistance and, really, one of the primary reasons I got into this is to figure out ways and strategies to produce best patient outcomes in the area of drug-resistant bacteria. This is really what drove me into the infectious disease space and not only thinking about picking the right drug but optimizing dosing, a lot of pharmacokinetics and dynamic elements to it and also figuring out strategies to minimize the development of drug resistance. For these reasons combined are the reason why I got into infectious diseases."
Jonathan Edwards, PharmD, BCPS-AQ ID, BCGP, ID pharmacist at Huntsville Hospital in Alabama
"I originally got interested in infectious diseases because, with this patient population, you really do see the impact that you have very quickly. In other disease states, such as hypertension or diabetes management, there are kind of long-term goals and so you'll see benefits maybe 5 or 10 years out but, with infectious diseases, you see people turn around within 24 to 48 hours so it's very rewarding. Also it's nice treating a disease that's actually curable so whenever you're managing other diseases like hypertension, it's just managing them but whenever you actually see a patient that actually completely cures their disease it's very, very rewarding."
Monica Mahoney, PharmD, BCPS, (AQID), BCIDP, Clinical Pharmacy Specialist, Outpatient ID Clinics/OPAT Clinic at Beth Israel Deaconess Medical Center
"Why did I choose ID? The short answer is because I hated it in school. I think I’m not alone here and that everyone memorized the bugs and the drugs for the exam. As soon as the exam was over, that’s it we forgot it, in 1 ear and out the other. It wasn’t until residency that I met my infectious disease preceptor. There was a patient there that we were correlating all of the different organisms and antibiotics to and suddenly it made sense. And once it clicked I realized that there are so many people out there that it doesn’t click for. So, if I was able to hone in and really understand this 1 small area of medicine I would be able to help a lot of different people. Other people have said that infectious disease is like a puzzle, it’s a mystery, trying to figure out that exact combination and growing up I was a huge puzzle nerd. All of that kind of just fell into place and I found ID, I love ID. It keeps changing and evolving, just like bacteria. So, I’m here and I’m staying here."
Ryan K. Shields, PharmD, MS, associate professor of medicine at the University of Pittsburgh
"Why ID? For me, I like the bugs and drugs. In pharmacy school, this is something that I always thought was neat was that you could pick very specific drugs that had targeted therapy for specific bugs. So now I'm a kid in a candy store. I get to play with bugs and drugs for a living."
Mario V. Beccari, PharmD, BCPS, AAHIVP, PGY2 infectious diseases pharmacy resident, at Upstate University Hospital
"I decided to pursue a career in infectious diseases because, during my pharmacy school training as well as my first year residency training, I really realized how much the resistance rates for many antimicrobials were increasing and how impactful pharmacists can be in terms of optimizing therapy and improving outcomes in the field of infectious diseases."
Amy Fabian, PharmD, BCPS, PGY-2 infectious diseases pharmacy resident at St. Joseph's Health
“I started really falling in love with infectious disease as a pharmacy student and a resident because I just really enjoyed the challenge that the infectious disease patient poses. There’re a lot of different factors at play and, often, the patients are very gray [and] when we pull in the pharmacodynamics and kinetics of a drug, as well as patient-specific factors, and drug allergies, it’s just a field that’s changing all the time and I find it really exciting and there’re a lot of new opportunities.”
Jaime Wagner, PharmD, clinical assistant professor of pharmacy practice at the University of Mississippi
"I first got started in infectious disease my first year of pharmacy school. I was 1 of those unusual individuals that did not originally pursue pharmacy at all. I was in a biology field, though. And upon coming to pharmacy, 1 of the things I wanted to do was stay within research. I did research in undergrad and wanted to continue to do research. But I wanted to do it with something that was still biology related and the only thing that fit that criteria was microbiology. And so, I got into infectious disease research with Marc Scheetz out at Midwestern University and Northwestern Memorial in Chicago and that kind of sealed the deal for me with ID."
Jason C. Gallagher, PharmD, FCCP, FIDSA, BCPS, clinical professor at Temple University College of Pharmacy and editor-in-chief of Contagion®
"Why ID? I have always found infectious diseases to be a bit of a puzzle. I like the fact that you have to rely on different layers of information in order to successfully treat a patient. In some areas, like cardiology, you have large, multi-thousand patient studies that lead to results that seem pretty solid, that go into guidelines, that lead to stepwise approaches where you also have time to try 1 thing out before you pivot to another. In infectious diseases, we don't have the luxury of that. You have to look at each patient uniquely and take them, a combination of their risk factors, their past medical history, all the different things that are going on with them, the organism, the size of the inoculum, the type of infection, how frail they are, all this in order to decide on a regimen. I also like the fact that pharmaceuticals are the key therapeutic options in infectious diseases and that takes the expertise of a pharmacist to help optimize those successfully. There're many great therapeutic areas. I actually really liked cardiology even though I poke fun at it sometimes, but ID is where it's at and I have no regrets. It's been a good ride for me so far."
Kieu-Nhi (Nikki) Tran, PharmD, PGY1 Pharmacy Resident at Detroit Medical Center
"There are a million reasons that I want to do infectious disease. One of the most important reasons is that I find that the world of infectious disease is not black and white, it’s the world of gray area. You have to put in a lot of analysis and keeping up with the current literature and available new data out there in order to make the best decision for your patients.
Also, I’ve found that infectious disease is kind of like doing detective work. You have to look back into the history, looking at the whole picture of a patient in order to put all pieces of a puzzle together. And at the end your ultimate goal is, again, to optimize your patient care and what you can offer for your patients."
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