Brian Schwartz, an infectious diseases physician at UCSF, wrote an important comment on Paul Sax’s blog yesterday. What do you think are the major barriers to getting more internal medicine residents interested in ID?
Paul – Thank you for another thoughtful and well-written post. I whole-heartedly agree that ID is exhilarating and it should easily attract students and residents. It may be that numerous students and residents initially enthusiastic about ID (for all the reason you laid out) become disinterested once they find out about our lower reimbursement. However, I think we need to give serious consideration to the idea that we are not doing a good job selling our field to students and residents in the first place. To successfully sell a product you need both exposure to potential buyers and good salesmanship. This leads me to ask three questions:
1. Are students/residents having adequate exposure to all the cool parts of Microbiology/ID as you described?
2. Are students/residents having adequate exposure to ID physicians for positive role modeling to occur?
3. When ID physicians have direct exposure to students/residents are they effective role models/teachers as to attract new members?
We need to gather more data over the coming years to better understand this but two recent ID Week abstracts suggest that improving our sell to medical students may be beneficial. Bonura et al revealed that most IM residents interested in ID became interested during medical school and found their pre-clinical medical student micro courses as a very positive experience. Friedman et al revealed that microbiologists predominant as pre-clinical medical student microbiology course directors and micro curriculum are facing dwindling teaching hours overall, challenges integrating micro into other curriculum, and struggles balancing basic and clinical science content.
I think we need to find more ways for students/residents to be exposed to our stimulating content and for these learners to work with ID docs in our varied roles. Ideally we need to be speaking at medicine noon-conference and morning reports, attending on the medicine wards, and find ways to give the extra “chalk-talk” while on a busy ID consult service.
However, most ID divisions across the country are small and their physicians are stretched. Therefore, ID physicians cannot be asked to do more on top of already demanding schedules. They need to be supported by leadership (locally and nationally) for this teaching time and provided faculty development to enhance their teaching skills. Yes, reimbursement is an important piece to our recruitment problem but it is only one piece. We should not overlook the importance of brainstorming new ways we can gain exposure to students/residents and ways we can be more effective role models/teachers.
Bonura et al: https://idsa.confex.com/idsa/2015/webprogram/Paper51309.html
Friedman et al: https://idsa.confex.com/idsa/2015/webprogram/Paper51522.html