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New doctors aren't choosing to go into infectious disease

ARI SHAPIRO, HOST:

New doctors are not choosing to go into the specialty of infectious diseases. This year, programs saw an alarming decline in doctors entering the field across the U.S. NPR's Pien Huang looks into why.

PIEN HUANG, BYLINE: Infectious diseases like COVID have been front and center for the past few years. In 2020, as the pandemic flooded hospitals and shook society to its core, Dr. Boghuma Titanji at Emory University saw a spike of interest in the fields.

BOGHUMA TITANJI: We actually saw a little bit of what we called the Fauci effect. And a lot of us saw that as kind of a reinvigoration of interest.

HUANG: Now the Fauci bump looks like a blip. This year, 44% of infectious disease training programs went unfilled while most other specialties, like cardiology and critical care, were almost completely full. Dr. Carlos del Rio, head of the Infectious Diseases Society of America, says this is not what he wanted to see.

CARLOS DEL RIO: I'm bummed out, right? I mean, I love my field. I love what I do. And it's very concerning, I would say.

HUANG: Top programs were scrambling to fill open positions. At Boston Medical Center, Dr. Daniel Bourque said all their spots were empty after this year's match.

DANIEL BOURQUE: This is my first year as the program director, and I'm trying to tell myself it's not something that I've done. And I don't believe that's the case. I think it's obviously, like, goes beyond our programming. There's many other programs that also didn't fill at all.

HUANG: Infectious disease doctors say their work has been so public and so important through the COVID pandemic and flu and mpox. They stop outbreaks in hospitals and guard against the rise of drug-resistant bacteria. They have high job satisfaction, and their work is never boring. So why don't new doctors want to join their fields? The most obvious reason, says Dr. Titanji from Emory, is the pay. The average salary is $260,000 a year, which is more than most U.S. workers make but far less than doctors in other specialties.

TITANJI: Well, we're talking about a six-figure pay difference. And for some people coming out of medical training with a whole lot of debt, there are important economic considerations that folks have to make for themselves and their families.

HUANG: It can even pay worse than some doctor jobs that require less training. Dr. Paul Pottinger at the University of Washington says that's because of how the medical payment system works.

PAUL POTTINGER: The way people get paid for their medical practice in the United States, it is a fee-for-service system that we have. It has really been about procedures.

HUANG: Pottinger says that's not what infectious disease doctors do.

POTTINGER: What we do is we examine patients, and we talk to them, and we talk to our colleagues. We think for a living. And because we don't have a surgery to do, I think that's where this legacy of reduced pay has come from.

HUANG: The other problem is that infectious disease doctors have worked very, very long hours during the pandemic. Dr. Jasmine Marcelin at the University of Nebraska says the current crop of doctors who trained during the pandemic might have gotten a skewed view.

JASMINE MARCELIN: You know, in non-pandemic times, we certainly work really hard, but we still get to go home. We still get to spend time with our families. You know, we still get to do things that we enjoy.

HUANG: Still, she says, the field has long been understaffed. Even before the pandemic, 80% of U.S. counties did not have a single infectious disease physician. It's a bad cycle, says del Rio from the Infectious Diseases Society. The field needs more people to share the burden of the work, but the heavy workload is turning people away.

DEL RIO: It's long hours and low pay. And long hours and low pay are a dreadful combination, if you ask me.

HUANG: He and others in the field are asking Congress for loan forgiveness and for infectious disease doctors to be paid more. He says more specialists are needed to help keep outbreaks and future pandemics at bay. Pien Huang, NPR News. Transcript provided by NPR, Copyright NPR.

Pien Huang is a health reporter on the Science desk. She was NPR's first Reflect America Fellow, working with shows, desks and podcasts to bring more diverse voices to air and online.