The Importance of the ID Physician-Scientist Workforce
- ID physicians make significant contributions to patient care, biomedical research, and public health.Their leadership saves lives and dollars. ID physician involvement in patient care is associated with significantly lower rates of mortality and 30-day readmission rates in hospitalized patients, shorter lengths of hospital stay, fewer intensive care unit (ICU) days, and lower Medicare charges and payments.A new study also found ID physician involvement improves outcomes for patients with severe sepsis or septic shock.
- ID physicians and scientists provide essential services, including:
- Life-saving care for patients with serious infections (such as HIV, sepsis, infections caused by antibiotic resistant bacteria, Clostridium difficile, hepatitis C, and transplant patients);
- Leadership of public health activities. This includes a critical national security role to prevent and respond to outbreaks and emerging infections, such as bioterrorism attacks, Middle East Respiratory Syndrome Coronavirus (MERS-CoV), Ebola and Zika virus disease and other emerging threats, antibiotic resistance, and foodborne illnesses.
- Research leading to breakthroughs and the development of urgently needed new antimicrobial drugs and other therapies, diagnostics, and vaccines.
Under-Valuing the ID Physicians
- Despite the importance of ID physicians’ work, their work is undervalued by the current payment system, which threatens the future ID workforce, their patients and the nation’s health, if not addressed.
- A 2014 IDSA survey of 600 Internal Medicine residents (in-training) found high interest in ID but other fields were chosen instead. Low salary was the most often cited reason for not choosing ID as the average starting ID salary is less than positions taken that do not require additional training.
- Average salaries for ID physicians are significantly lower than those for most other specialties and only slightly higher than the average salary of general Internal Medicine physicians, even though ID training and certification requires an additional two to three years of training.
- The number of residents applying for ID fellowship declined steadily from 2013 to 2016, and open training positions rose during the same period. While the number of residents applying for ID fellowships rose slightly in 2017, and open positions declined, these changes are attributable to administrative changes in the “match” program. Regardless, the data indicate a problem in the workforce pipeline.
- 90% of ID physician care is accounted for by evaluation and management (E/M) services. These cognitive encounters are undervalued by the current payment systems compared to procedural practices.
- Undervaluing E/M codes accounts for the significant compensation disparity between ID physicians and specialists who provide more procedure-based care, as well as physicians who provide similar E/M services but who have received payment increases because their specialty enrollment designation is as “primary care physicians.” Based on CMS data, cognitive E/M services comprise a higher percentage of services provided by ID physicians than those provided by primary care physicians such as Internal Medicine, Family Medicine or Pediatrics.
IDSA Congressional Recommendations for Robust Investment in the ID Physician-Scientist Workforce
- Ensure Centers for Medicare and Medicaid Services (CMS) undertakes research to re-value E&M codes that serve as the basis for Medicare payment for most ID and other cognitive services, as was requested in the 2017 omnibus funding bill passed by Congress;
- Provide payment increases for physicians that primarily provide E&M (cognitive) services;
- Support development of ID quality measures to allow ID physicians to utilize new payment models;
- Provide robust funding for the National Institutes of Health (NIH) to support ID physician-scientists;
- Provide mechanisms to appropriately pay physicians for important non-clinical services (such as care coordination, antibiotic stewardship, and public health activities);
- Provide loan repayment opportunities to ID physicians working primarily in public health.
- Provide robust funding for the Centers for Disease Control and Prevention (CDC) to support a robust public health workforce, including ID physicians.