Questions about Practicing ID

[docgarr]

Hello. I am an MS1 and I am very interested in practicing ID in the future. I was wondering if anyone who has been on rotations through ID, are current residents, or are actually practicing ID could tell me about what it is like practicing ID in the hospital. I was able to shadow inpatient ID for a day, but it didn't quite answer all my questions. Any info would be awesome.

Also, I really dislike research. Would I be able to practice 100% clinical?

---

Members don't see this ad.

 

[FrisbeeDocIM]

I'm a PGY-3 applying to ID (matching tomorrow!).

ID can be very different depending upon where you practice. On the inpatient side, it's 99% consulting (there are some academic institutions where there is still an ID primary service, where all patients w/ HIV are admitted, but this is becoming less common). As a consultant at an academic institution, you could be doing general ID, immunocompromised hosts (i.e. transplant patients, LVADs, BMT), or both depending on the size of your transplant population. At private institutions, there are far less immunocompromised hosts and you'll see more "bread-and-butter" ID, such as osteomyelitis, pneumonia, etc. Consults can be very busy.

Additionally, some people take an extra year after fellowship to do a subfellowship in clinical microbiology, and then end up running the microbiology department. Better hours, but less direct patient care. You can also do outpatient ID, which is primarily HIV care, but also OPAT (outpatient parenteral antibiotic therapy), traveler's clinic, and general ID clinic (recurrent MRSA skin infections, follow up for chronic osteo, etc.).

After fellowship, it's absolutely possible to do 100% clinical, but this would most likely steer you toward the private institutions. Also, for any fellowship research is pretty much mandated, so be aware of that. It doesn't have to be bench/basic science research, but you have to do something.

Hope this helps, and keep your interest in ID! It's a great, highly rewarding field.

 

[dr wolverine]

I'm currently a 2nd year ID fellow. Yes, research is an essential part of fellowship (typically 12 months) but does not need to be part of your career goal. I am planning working in a community hospital after completing fellowship and will not likely have any research activity. Most ID practices have several members who rotate "on service" for 1-2 weeks (occasionally a whole month) at at time seeing the inpt consults. Service is usually quite busy but very interesting. The remaining time is spent on outpt clinic and additional activities such as infection control/prevention or antimicrobial stewardship. The IDSA has a good outline of different possible careers in ID which can be found here. ID is nice given these several options and is more flexible than some other specialties in terms of career flexibility. I would recommend doing an elective in ID during your clinical training and trying to see both the inpt and outpt side of the job.

 

[Jaundice101]

Ditto FrisbeeDoc and Dr Wolverine.

I am a practicing ID doc, completed my fellowship two and a half years ago, and from seeing it done at a few different hospitals now I can definitely say inpatient ID is one part general ID (i.e. the bread and butter mentioned above) and one part or more whatever else your patient population may dictate (i.e. HIV medicine, transplant ID, tropical medicine, etc.) If you work in a small community hospital in North Dakota your practice will be entirely different than a large urban hospital in Los Angeles.

 

[docgarr]

Any other ID docs or fellows want to share experiences?

Also, on consults, how many of those are to diagnose patients as opposed to just to help manage and develop a treatment plan for a known infection?

 

[Mantis05753]

I'll respond as a current second-year ID fellow soon to be transplant ID attending...

ID is in a interesting and difficult place right now. Fellowships are having difficulty filling their spots, even some of the top programs, due to the low reimbursement. I think the demand for ID docs will only grow given our role in antimicrobial stewardship and infection control, as well as the growing field of transplant ID. Thus, via supply and demand, at some point reimbursement will increase and ID will become a more competitive fellowship.

As it stands currently, you will be very busy as an ID doc due to the general shortage of ID specialists...consults are a mixed bag. There are many consults where the diagnosis is known (i.e. cellulitis, pneumonia, osteomyelitis, etc.) where the team just wants you to basically setup the discharge for them. These are not educational and become somewhat draining. However, this is offset by another large portion of your consults which are on patients who have a likely infection and are immune compromised and the diagnosis is unclear. These diagnostic dilemmas are our speciality and also the most rewarding part of ID. Like any other speciality, we have our less exciting consults but the core of what draws people in medicine to ID remains. The focus has switched from HIV/AIDS to transplant with our improved antiretrovirals, but there remains a strong demand for internists who are specialized in the art of diagnostics and can diagnose and treat both common and esoteric infections in sick, high-risk patients. I think going into ID now will payoff in the future if it is truly a field that interests you.

 

[D elegans]

I'll respond as a current second-year ID fellow soon to be transplant ID attending...

ID is in a interesting and difficult place right now. Fellowships are having difficulty filling their spots, even some of the top programs, due to the low reimbursement. I think the demand for ID docs will only grow given our role in antimicrobial stewardship and infection control, as well as the growing field of transplant ID. Thus, via supply and demand, at some point reimbursement will increase and ID will become a more competitive fellowship.

As it stands currently, you will be very busy as an ID doc due to the general shortage of ID specialists...consults are a mixed bag. There are many consults where the diagnosis is known (i.e. cellulitis, pneumonia, osteomyelitis, etc.) where the team just wants you to basically setup the discharge for them. These are not educational and become somewhat draining. However, this is offset by another large portion of your consults which are on patients who have a likely infection and are immune compromised and the diagnosis is unclear. These diagnostic dilemmas are our speciality and also the most rewarding part of ID. Like any other speciality, we have our less exciting consults but the core of what draws people in medicine to ID remains. The focus has switched from HIV/AIDS to transplant with our improved antiretrovirals, but there remains a strong demand for internists who are specialized in the art of diagnostics and can diagnose and treat both common and esoteric infections in sick, high-risk patients. I think going into ID now will payoff in the future if it is truly a field that interests you.

This gives me hope!

 

[docgarr]

Anyone have updates on where they are now?

 

[Levo]

I know I'm going to take flack for posting in the resident forum as a med student, but could someone please comment on how the job market is for ID? If someone is willing to work for relatively little pay, are they going to be able to find work in desirable markets, or is ID like nephrology where the jobs just aren't there?

 

[drfunktacular]

I know I'm going to take flack for posting in the resident forum as a med student, but could someone please comment on how the job market is for ID? If someone is willing to work for relatively little pay, are they going to be able to find work in desirable markets, or is ID like nephrology where the jobs just aren't there?

To get the obligatory out of the way... finish med school and spend some time doing rotations in IM residency before you get set on what you want to do as a fellowship.

That said, ID seems like it's very much in a state of flux. One of my colleagues who is ID told me today that nearly half of ID fellowship spots last year went unfilled. So the supply is decreasing, but the amount of work seems to be decreasing as well as hospitalists take over a lot of their own inpatient antibiotic management (whether that's a good or bad thing is a different discussion). I suspect there will always be need for ID specialists in academics and in industry (drug development) but it seems harder to predict what the market will be like by the time you would actually finish your training. Maybe by that time the world will be ravaged by MDR superbugs because of poor stewardship and ID will be roaring back in demand.

 

[thierryhenry]

To get the obligatory out of the way... finish med school and spend some time doing rotations in IM residency before you get set on what you want to do as a fellowship.

That said, ID seems like it's very much in a state of flux. One of my colleagues who is ID told me today that nearly half of ID fellowship spots last year went unfilled. So the supply is decreasing, but the amount of work seems to be decreasing as well as hospitalists take over a lot of their own inpatient antibiotic management (whether that's a good or bad thing is a different discussion). I suspect there will always be need for ID specialists in academics and in industry (drug development) but it seems harder to predict what the market will be like by the time you would actually finish your training. Maybe by that time the world will be ravaged by MDR superbugs because of poor stewardship and ID will be roaring back in demand.

Plenty of jobs out there, whether this be private practice or in academics. Not at all like Nephrology. Amount of work is not decreasing, rather likely increasing especially with Antibiotic Stewardship Projects being mandated federally. The above posting by a Rheumatologist is not an accurate reflection of the current or future ID job market.

 

[FrisbeeDocIM]

That said, ID seems like it's very much in a state of flux. One of my colleagues who is ID told me today that nearly half of ID fellowship spots last year went unfilled. So the supply is decreasing, but the amount of work seems to be decreasing as well as hospitalists take over a lot of their own inpatient antibiotic management (whether that's a good or bad thing is a different discussion). I suspect there will always be need for ID specialists in academics and in industry (drug development) but it seems harder to predict what the market will be like by the time you would actually finish your training. Maybe by that time the world will be ravaged by MDR superbugs because of poor stewardship and ID will be roaring back in demand.

Could you send these magical hospitalists my way?

As thierryhenry said, there is plenty of work out there for ID. Hospitalists definitely do not manage their own antibiotics (at least not where I did residency or am currently doing fellowship - you'd be amazed at some of the consults you'll get). There are many different types of jobs available to you within ID, so if the subject material interests you, continue to pursue it.

 

[Raryn]

Plenty of jobs out there, whether this be private practice or in academics. Not at all like Nephrology. Amount of work is not decreasing, rather likely increasing especially with Antibiotic Stewardship Projects being mandated federally. The above posting by a Rheumatologist is not an accurate reflection of the current or future ID job market.

That said, some cities seem to have a pretty tight job market for ID. I was friends with a few of the ID fellows when I was in residency, and the ones who wanted to go to popular cities couldn't find a good job doing ID only full time, they mixed in some primary care as well. No idea what proportion of the time that ends up happening though.

 

[heroes31]

What kind of job offers are ID fellows getting in the NY tristate area/ long island? Low 200s? More or less than hospitalist salaries?

 

[MSTP18]

Could you send these magical hospitalists my way?

As thierryhenry said, there is plenty of work out there for ID. Hospitalists definitely do not manage their own antibiotics (at least not where I did residency or am currently doing fellowship - you'd be amazed at some of the consults you'll get). There are many different types of jobs available to you within ID, so if the subject material interests you, continue to pursue it.

MS3 here, was on ID consult team and we got consulted to screen a patient for TB before switching biologics (switching being a key word there). For some reason the primary team couldn't handle asking the patient things like where are you from, where have you lived, anyone you know have TB, ever been tested for TB before, etc.

 

[drfunktacular]

MS3 here, was on ID consult team and we got consulted to screen a patient for TB before switching biologics (switching being a key word there). For some reason the primary team couldn't handle asking the patient things like where are you from, where have you lived, anyone you know have TB, ever been tested for TB before, etc.

That must be an institutional/local thing. I've worked with biologics in several places and never seen an ID consult for that. Most rheumatologists do their own routine TB screening. Many of them manage their own treatment of LTB as well.

I personally refer patients to my ID colleague down the hall for treatment of latent TB if warranted. I guess it's because I saw several cases of INH hepatitis as a trainee, a few of them fatal, so I would rather ID monitor things.

 

[IM2GI]

That must be an institutional/local thing. I've worked with biologics in several places and never seen an ID consult for that. Most rheumatologists do their own routine TB screening. Many of them manage their own treatment of LTB as well.

I personally refer patients to my ID colleague down the hall for treatment of latent TB if warranted. I guess it's because I saw several cases of INH hepatitis as a trainee, a few of them fatal, so I would rather ID monitor things.

As a GI who prescribes a lot of anti-TNF, Im not treating latent TB if I pick it up. Gotta give those ID guys some business.

 

[MSTP18]

That must be an institutional/local thing.

I don't think so. At least neither the fellow nor the attending seemed to think this was a remotely ordinary request. What is institutional/local is "The ID stamp of approval" where the team has already 100% made up its mind about what to do and consults ID just to hear them say yes.

 

[drfunktacular]

I don't think so. At least neither the fellow nor the attending seemed to think this was a remotely ordinary request. What is institutional/local is "The ID stamp of approval" where the team has already 100% made up its mind about what to do and consults ID just to hear them say yes.

Well, never rule out the possibility of people doing silly things for bad reasons

 

[gutonc]

I don't think so. At least neither the fellow nor the attending seemed to think this was a remotely ordinary request. What is institutional/local is "The ID stamp of approval" where the team has already 100% made up its mind about what to do and consults ID just to hear them say yes.

Which fellow and attending? The consulting or the consulted?

Every program/specialty/hospital/practice/office has "that guy" (and yes...it's always a dude) that likes to "load the boat". You eventually learn to just roll with it, no matter which side of the equation you're on.

As for the "stamp of approval", sometimes that's a hospital policy that none of the stakeholders agreed to but all are held responsible for. And sometimes it's just loading the boat.

 

[IM2GI]

Which fellow and attending? The consulting or the consulted?

Every program/specialty/hospital/practice/office has "that guy" (and yes...it's always a dude) that likes to "load the boat". You eventually learn to just roll with it, no matter which side of the equation you're on.

As for the "stamp of approval", sometimes that's a hospital policy that none of the stakeholders agreed to but all are held responsible for. And sometimes it's just loading the boat.

"Yea, I'd like a GI consult please. No, I don't have a specific question, we just want you guys on board"

 

[MSTP18]

Which fellow and attending? The consulting or the consulted?

Every program/specialty/hospital/practice/office has "that guy" (and yes...it's always a dude) that likes to "load the boat". You eventually learn to just roll with it, no matter which side of the equation you're on.

As for the "stamp of approval", sometimes that's a hospital policy that none of the stakeholders agreed to but all are held responsible for. And sometimes it's just loading the boat.

Consulted - i.e. the ID fellow/attending
Definitely not hospital policy - been on teams that didn't do it.