Monday, May 21, 2018

Infectious Diseases in Troubled Waters

ID Consults in the hospital: long hours, (relatively) low pay
I have been giving this a lot of thought recently, particularly as I battle with my institution's compensation plan to preserve salaries (note: not increase salaries) and set realistic revenue generation (RVU) expectations. 

Infectious diseases is in troubled waters. In many respects, infectious disease clinical practice is a market failure.

It should surprise few people that infectious diseases specialist are some of the lowest paid physicians, as highlighted here.  Our current healthcare system heavily rewards volume of care and procedures.  Many infectious diseases consults are high complexity, low volume.  We do not perform billable procedures.  None of this bodes well for us.

This NEJM Blog on Why Experienced HIV/ID Doctors Leave Clinical Practice- the push for high volume work and the growing demands of the electronic medical record do not help.

Couple the above with competing expectations to supervise learners and publish academic work, morale plummets.

Academic infectious diseases is in jeopardy, as explored here by Drs. Wenzel and Edmond.

Until there is a fundamental change in the US healthcare system such that the primacy of volume and procedures no longer drives reimbursement, and until universities comprehend the limitations of compensation plans for certain specialties, I see no immediate relief in sight.

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