How Competitive is Infectious Disease?

[AlbinoHawk DO]

I'm curious how competitive this field is. Some of my colleagues in IM say Nephrology and ID are really easy to match even coming from a community program. How real is it that ID is easy to match? I've seen the data, but I don't know if there are other variables like self-selection and such

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[NITRAS]

ID doctors make less then IM doctors who do two years less of training. Nephrology training is generally a bear and isn't’ as lucrative as it used to be.

I know at least a few ID and nephrology docs who practice as hospitalists.

 

[Renal_Prometheus]

You are doing these noncompetitive specialties out of personal interest. If money is important, don't waste your time doing these specialties.

 

[AlbinoHawk DO]

Yeah, I'm not asking about income when it comes to the specialty. I'm asking about how competitive they are to enter

 

[Chemist0157]

Nephrology is an easy match. It is my understanding that ID is as well.

EDIT: Looks like ID had a match rate of 91% in 2020. Nephrology 88%. AMG from a community program will have a better chance than those numbers.

 

[Chemist0157]

To piggyback on this, how competitive is ID/CC or Nephro/CC?

I don’t know about ID/CC. I have not encountered that. Nephro CC has seen rise in popularity. I’m not sure if any data is readily available. The people I know who wanted it got it, but they tended to remain at the program where they did renal to do the critical care year afterward.

 

[InternistDO]

If you don't have visa problems or board failures you should have no problem matching ID somewhere. The competitive places like MGH are still competitive, of course, but nowhere near the level of cards/pulm/gi. Remember that around 25% of ID positions didn't fill this year.

 

[AlbinoHawk DO]

Thanks, guys.

You think it's worth it to put in the time to do research when all i want is to match?

 

[Kaustikos]

Thanks, guys.

You think it's worth it to put in the time to do research when all i want is to match?

Hell no. Don't waste a spot for someone who actually wants to do ID if all you want is to have a specialty. Realize that ID isn't for everyone. And you'll know if you enjoy ID. Asking if it's competitive is the worst question to ask. You'll be miserable. If you enjoy the infectious disease process/diagnosing and treating? That's a good start. But also realize you'll be dealing with HIV/Hepatitis clinics on the outpatient basis. Outpatient OM patients 2/2 noncompliance for their DM.

And ID/CC is beyond competitive because there are only a few programs that offer them. Add to that; people who are wanting to go ONLY into critical care are applying for these tracks as well to get INTO critical care.

 

[Kaustikos]

ID doctors make less then IM doctors who do two years less of training. Nephrology training is generally a bear and isn't’ as lucrative as it used to be.

I know at least a few ID and nephrology docs who practice as hospitalists.

That was the first question the director asked me...and where I'm going to, ironically. It was an easy answer for me because I had enough experience in ID that I loved it and would gladly take the income hit.

Plus, if I REALLY need to, I can side roll as a Hospitalist, as you said. But I have no interest in that.

 

[AlbinoHawk DO]

Hell no. Don't waste a spot for someone who actually wants to do ID if all you want is to have a specialty. Realize that ID isn't for everyone. And you'll know if you enjoy ID. Asking if it's competitive is the worst question to ask. You'll be miserable. If you enjoy the infectious disease process/diagnosing and treating? That's a good start. But also realize you'll be dealing with HIV/Hepatitis clinics on the outpatient basis. Outpatient OM patients 2/2 noncompliance for their DM.

And ID/CC is beyond competitive because there are only a few programs that offer them. Add to that; people who are wanting to go ONLY into critical care are applying for these tracks as well to get INTO critical care.

I actually like it and also nephrology, but i switched into IM late after being offered finishing PGY1 in neuro. Being this late into the game i have to be realistic with applying if it's competitive or not. Even if tomorrow i woke up loving GI (i don't), i accept there's no chance

 

[Chemist0157]

Thanks, guys.

You think it's worth it to put in the time to do research when all i want is to match?

I don’t think you need research unless you are shooting for a top program.

 

[rokshana]

ID is not competitive most programs...top programs of course are still competitive,but generally not out of reach of you have built a good cv.

realize ID, as well as most other non procedural sub specialties are t competitive because they don’t make gobs of money and the people that go into it go into the specialty because they like the subject matter...if you specialize, make sure it’s because you like ID.

 

[GastriqueGraffin]

Yeah, I'm not asking about income when it comes to the specialty. I'm asking about how competitive they are to enter

Uh...what? The two are very strongly linked.

 

[AlbinoHawk DO]

Uh...what? The two are very strongly linked.

I mean, yeah for the most part I agree, but there are things like sports med or allergy that aren't exactly making bank that still have a degree of competitiveness

 

[Drrrrrr. Celty]

I mean, yeah for the most part I agree, but there are things like sports med or allergy that aren't exactly making bank that still have a degree of competitiveness

I think allergy makes a decent buck. It's probably got one of the better pay per hours in IM.

 

[I-dont-do-source-control]

If you don't have visa problems or board failures you should have no problem matching ID somewhere. The competitive places like MGH are still competitive, of course, but nowhere near the level of cards/pulm/gi. Remember that around 25% of ID positions didn't fill this year.

Agreed, I think ID is much more competitive at the top than Nephro. I think ID attracts alot of micro/immuno/basic science MD/PhD types from top MSTP places filling MGH/BWH, JHH, Penn, Colorado for MTB, UTSW MD Anderson for Txp ID etc. For Nephro, residents from my program with minimal research/IMG (mid tier privademic midwest) were matching their #1 rank at MGH, Columbia, JHH. For ID I got plenty of interviews and matched well, but I cant imagine walking into top places like they did.

If you just want to match somewhere, have a pulse there are alot of relatively dead end fellowships at community hospitals that will take you even post match since they never fill. Depends on the type of practice you want to have.

 

[InternistDO]

Agreed, I think ID is much more competitive at the top than Nephro. I think ID attracts alot of micro/immuno/basic science MD/PhD types from top MSTP places filling MGH/BWH, JHH, Penn, Colorado for MTB, UTSW MD Anderson for Txp ID etc. For Nephro, residents from my program with minimal research/IMG (mid tier privademic midwest) were matching their #1 rank at MGH, Columbia, JHH. For ID I got plenty of interviews and matched well, but I cant imagine walking into top places like they did.

If you just want to match somewhere, have a pulse there are alot of relatively dead end fellowships at community hospitals that will take you even post match since they never fill. Depends on the type of practice you want to have.

Yeah, i remember being surprised when I saw the average Step scores for USMDs applying ID were similar to those applying for cards and GI.

I hope ID continues to get more respect/compensation as time goes on and more and more studies show the significant benefits from early ID consultation. But I also hope that holds off for a few more years until I apply to ID fellowship haha.

 

[mszzeta]

I mean, yeah for the most part I agree, but there are things like sports med or allergy that aren't exactly making bank that still have a degree of competitiveness

I thought sports can generate some bucks from quick procedures like steroid injection?

 

[Drrrrrr. Celty]

Yeah, i remember being surprised when I saw the average Step scores for USMDs applying ID were similar to those applying for cards and GI.

I hope ID continues to get more respect/compensation as time goes on and more and more studies show the significant benefits from early ID consultation. But I also hope that holds off for a few more years until I apply to ID fellowship haha.

I think the problem is that it's just not a glamorous specialty and it's not a procedural specialty. And every specialty especially if you practice it well and interact nicely with others is respected in the hospital.

 

[InternistDO]

I think the problem is that it's just not a glamorous specialty and it's not a procedural specialty. And every specialty especially if you practice it well and interact nicely with others is respected in the hospital.

Respected might be the wrong word, ID docs tend to be pretty respected by other doctors. I more meant that the benefit that ID adds to patient care in terms of mortality benefit and stewardship dont really translate to anything financial for hospitals in the FFS environment so there’s not much incentive to hire lots of ID docs or encourage ID referrals. In contrast, having lots of cardiologists means more imagining and procedures meaning more money.

I think if ID paid at rhuem level it would be reasonably competitive—it doesn’t have procedures but it deals with a lot of cool and interesting cases while avoiding the headaches of general medicine and not having a terrible schedule. I think it’s pretty competitive in the UK where compensation is pretty stable between specialties.

 

[Drrrrrr. Celty]

Respected might be the wrong word, ID docs tend to be pretty respected by other doctors. I more meant that the benefit that ID adds to patient care in terms of mortality benefit and stewardship dont really translate to anything financial for hospitals in the FFS environment so there’s not much incentive to hire lots of ID docs or encourage ID referrals. In contrast, having lots of cardiologists means more imagining and procedures meaning more money.

I think if ID paid at rhuem level it would be reasonably competitive—it doesn’t have procedures but it deals with a lot of cool and interesting cases while avoiding the headaches of general medicine and not having a terrible schedule. I think it’s pretty competitive in the UK where compensation is pretty stable between specialties.

Rheumatology is entirely private practice and can do some procedures and make money running infusion programs. So they make more money because they can maximize their schedules.

I don't really know much about the literature on ID. I enjoy having them on. But I'm not really sure there is a lot of natural hiring pressure for ID. I mean Cardio and Gi hire quickly because they see more volume of patients and directly provide a skill set that most internist may not entirely be comfortable in. Ex cardioversion, starting rhythm control, preparing patients for advanced heart failure, etc.

 

[InternistDO]

Rheumatology is entirely private practice and can do some procedures and make money running infusion programs. So they make more money because they can maximize their schedules.

I don't really know much about the literature on ID. I enjoy having them on. But I'm not really sure there is a lot of natural hiring pressure for ID. I mean Cardio and Gi hire quickly because they see more volume of patients and directly provide a skill set that most internist may not entirely be comfortable in. Ex cardioversion, starting rhythm control, preparing patients for advanced heart failure, etc.

I think we're in agreement. ID provides an excellent service but it is not one easily tracked and monetized. Any doofus can spray someone with broad spectrum antibiotics and tell themselves they know what they're doing, and unlike cardiology ID isn't exactly generating revenue in the outpatient setting seeing viral hepatitis and HIV patients. My hospital could certainly use another ID attending or two and in doing so more patients would get ID consults (who could probably benefit from it), but the hospital isn't going to make any money doing that.


My point was more that the thing that makes ID uncompetitive is the salary as opposed to the work itself. If the salary was similar to rheum (for whatever reason), I think it would be a pretty popular specialty.

 

[Drrrrrr. Celty]

I think we're in agreement. ID provides an excellent service but it is not one easily tracked and monetized. Any doofus can spray someone with broad spectrum antibiotics and tell themselves they know what they're doing, and unlike cardiology ID isn't exactly generating revenue in the outpatient setting seeing viral hepatitis and HIV patients. My hospital could certainly use another ID attending or two and in doing so more patients would get ID consults (who could probably benefit from it), but the hospital isn't going to make any money doing that.


My point was more that the thing that makes ID uncompetitive is the salary as opposed to the work itself. If the salary was similar to rheum (for whatever reason), I think it would be a pretty popular specialty.

I mean I think Rheum is still only 30-40k higher on average than ID. Rheum is competitive because it's outpatient and it has a few diseases that are cool. None of these specialties make you anymore money than just being a PCP and practicing market PCPology.

 

[Kaustikos]

I think the problem is that it's just not a glamorous specialty and it's not a procedural specialty. And every specialty especially if you practice it well and interact nicely with others is respected in the hospital.

Meh,
I'll be placing PICC lines in all my ID patients. What's the RVU on that?

 

[I-dont-do-source-control]

Meh,
I'll be placing PICC lines in all my ID patients. What's the RVU on that?

Yes and just do your own punch biopsies of weird things instead of sending to Derm initially, I&D things yourself takes 5-10 min , almost zero risk, fun and $$$. Im sure an agressive biller in ID could make a good chunk of change, esp with the 2021 E&M code changes where you can bill office visits for time spent on record review , OSH record review, and documentation. Alot of EL-5/NL-5 possible there. Negotiate yourself good money for your infection control comitte appointment and stewardship appointments, the hospitals NEED you to do that for CMS, you dont NEED to do it for them.

 

[blue.jay]

Competitive specialities are either 1. Procedural and pay well - Cards, GI, Pulm
2. Pay well due to lift style, high demand like Hem/Once
3. Pays as much as IM but with better lifestyle - Rheum, Allergy

Endocrine is somewhat more competitive than ID and Nephro due to the above.

Nephro stands the last due to complex subject matter, sick patients with multiple comorbidites, lower salary, and bad schedule - running between dialysis, clinics and inpatient consults.

 

[AlbinoHawk DO]

Competitive specialities are either 1. Procedural and pay well - Cards, GI, Pulm
2. Pay well due to lift style, high demand like Hem/Once
3. Pays as much as IM but with better lifestyle - Rheum, Allergy

Endocrine is somewhat more competitive than ID and Nephro due to the above.

Nephro stands the last due to complex subject matter, sick patients with multiple comorbidites, lower salary, and bad schedule - running between dialysis, clinics and inpatient consults.

So where's ID in your opinion? Pays like IM but better life?

 

[blue.jay]

So where's ID in your opinion? Pays like IM but better life?

Like others mentioned above, it depends if you love the speciality.
For eg, hospital employed ID (new grad) in the place where I work gets a salary of 190k (no rvu or bonus) with totally 4 weeks of vacation, no holidays, 1/4 weekend coverage, no limit on new consults/cap.
Hospitalists (new grad) get 220k for 12-13 shifts a month (mix of days and nights) with a rounding cap of 12-14 and night admissions about 6-8.

So where I work ID sees more patients, works more hours a day, more days in a year, for a less pay. Similarly like others mentioned above, ID docs are also well respected compared to hospitalist by other specialist and hospital staff. Private practice ID might make more but they are also lot busier. I am also unsure how long hospitalists will get paid well especially with glut of midlevels entering the market these days.

 

[blue.jay]

If hospitalists pick up extra shifts to match the work hours of that ID physician they will probably make 270-300k but when I talk to that ID doc he is just content with his pay though he knows he gets less than even the laziest hospitalist. He loves spending time to thoroughly review charts, write very long notes with images and x-rays while hospitalists are packing their bags.

 

[I-dont-do-source-control]

Like others mentioned above, it depends if you love the speciality.
For eg, hospital employed ID (new grad) in the place where I work gets a salary of 190k (no rvu or bonus) with totally 4 weeks of vacation, no holidays, 1/4 weekend coverage, no limit on new consults/cap.
Hospitalists (new grad) get 220k for 12-13 shifts a month (mix of days and nights) with a rounding cap of 12-14 and night admissions about 6-8.

So where I work ID sees more patients, works more hours a day, more days in a year, for a less pay. Similarly like others mentioned above, ID docs are also well respected compared to hospitalist by other specialist and hospital staff. Private practice ID might make more but they are also lot busier. I am also unsure how long hospitalists will get paid well especially with glut of midlevels entering the market these days.

I would add its the type of work.. no case manager meetings, no dispo, no angry families, no nights, no codes, no STAT evals. Interesting patients (for me anyways), either circling the drain already in the MICU or fixable/easy from a consultant standpoint (osteo, IE, complex UTI cellulitis), or rare and interesting.
IVDU is a lot more fun when you dont prescribe the pain meds or control the AMA process and just figure out what bug they got this time.

Overnight If (big if) you get called its either something super interesting, or "start empirical antibitoics per guidelines and we will see in AM". No HD/CRRT, Scope, Cath, Vent to do anything about.

Endo/Rheum may be better pay but the daily clinic grind aint for me. I wanted a big mix of inpatient and outpatient

Where I do my residency (privademic center) the ID staff are doing 20 +/- weeks on service, when not on service they do 2-4 half day clinics a week. Remainder is admin time for Med-ed, Research, Stewardship, Infection control etc. Service days are 9-6 for them, other days with just half day clinic or 8-4 clinic, or nothing but a few meetings.

Ill come in at 8 and sip my coffee while I chart my patients round on the old ones and see new consults till whenever. Home by 5 if I'm a staff on service. If its a clinic day or admin time then ill be doing research and out early. 1/4 weekends means rounding and charting, not getting slammed with admissions or cross covering for 12 hours, dinner +/- lunch with my family.

So yes, pay is bit less but much better lifestyle and for me the most gratifying and interesting patients.

 

[Chemist0157]

I would add its the type of work.. no case manager meetings, no dispo, no angry families, no nights, no codes, no STAT evals. Interesting patients (for me anyways), either circling the drain already in the MICU or fixable/easy from a consultant standpoint (osteo, IE, complex UTI cellulitis), or rare and interesting.
IVDU is a lot more fun when you dont prescribe the pain meds or control the AMA process and just figure out what bug they got this time.

Overnight If (big if) you get called its either something super interesting, or "start empirical antibitoics per guidelines and we will see in AM". No HD/CRRT, Scope, Cath, Vent to do anything about.

Endo/Rheum may be better pay but the daily clinic grind aint for me. I wanted a big mix of inpatient and outpatient

Where I do my residency (privademic center) the ID staff are doing 20 +/- weeks on service, when not on service they do 2-4 half day clinics a week. Remainder is admin time for Med-ed, Research, Stewardship, Infection control etc. Service days are 9-6 for them, other days with just half day clinic or 8-4 clinic, or nothing but a few meetings.

Ill come in at 8 and sip my coffee while I chart my patients round on the old ones and see new consults till whenever. Home by 5 if I'm a staff on service. If its a clinic day or admin time then ill be doing research and out early. 1/4 weekends means rounding and charting, not getting slammed with admissions or cross covering for 12 hours, dinner +/- lunch with my family.

So yes, pay is bit less but much better lifestyle and for me the most gratifying and interesting patients.

I think ID is great. It was on my short list but just didn't quite win out.

 

[AlbinoHawk DO]

Like others mentioned above, it depends if you love the speciality.
For eg, hospital employed ID (new grad) in the place where I work gets a salary of 190k (no rvu or bonus) with totally 4 weeks of vacation, no holidays, 1/4 weekend coverage, no limit on new consults/cap.
Hospitalists (new grad) get 220k for 12-13 shifts a month (mix of days and nights) with a rounding cap of 12-14 and night admissions about 6-8.

So where I work ID sees more patients, works more hours a day, more days in a year, for a less pay. Similarly like others mentioned above, ID docs are also well respected compared to hospitalist by other specialist and hospital staff. Private practice ID might make more but they are also lot busier. I am also unsure how long hospitalists will get paid well especially with glut of midlevels entering the market these days.

Wow, your hospitalist are treated soft. Here it's about 20 patients census, fifteen 12-hr shifts, as many admits as they come in (roughly 4 a day)

 

[NITRAS]

Wow, your hospitalist are treated soft. Here it's about 20 patients census, fifteen 12-hr shifts, as many admits as they come in (roughly 4 a day)

They also aren’t paid well.

 

[blue.jay]

Wow, your hospitalist are treated soft. Here it's about 20 patients census, fifteen 12-hr shifts, as many admits as they come in (roughly 4 a day)

This is at a community site of a huge academic center where they care about patient satisfaction and quality, so rarely the census goes above 14 or 16. Private ID guys have a list of 30-40 and that guy works every day except for 1-2 weeks off a year but I think he makes lot of money. Employed ID gets to do few weeks in the mother ship and he still sees about 16-20 pts a day (new consults and followup).

 

[I-dont-do-source-control]

This is at a community site of a huge academic center where they care about patient satisfaction and quality, so rarely the census goes above 14 or 16. Private ID guys have a list of 30-40 and that guy works every day except for 1-2 weeks off a year but I think he makes lot of money. Employed ID gets to do few weeks in the mother ship and he still sees about 16-20 pts a day (new consults and followup).

Also remember rounding on 20-30 consults where you are not managing the patient (and filling out FMLA forms and arranging SNF placement and calling the family for an update and titrating the Nifedipine and telling the patient they cant have more Norco) is very different than seeing 20 people and copying the note that says continue antibiotics control sugars manage hemodynamics + new consults where you solve the puzzle or recommend tests and bounce. Volume =/= work

 

[blue.jay]

Also remember rounding on 20-30 consults where you are not managing the patient (and filling out FMLA forms and arranging SNF placement and calling the family for an update and titrating the Nifedipine and telling the patient they cant have more Norco) is very different than seeing 20 people and copying the note that says continue antibiotics control sugars manage hemodynamics + new consults where you solve the puzzle or recommend tests and bounce. Volume =/= work

Hospitalists don't fill FMLA. Case managers work on placement, and you do the discharge once there is an accepting facility. Titrating BP meds and discussing opioids are part of the job. ID is good for people who love the speciality. Hospitalists job is not very fancy or glamorous but it pays your bills and your schedule is flexible. I know colleagues who had kids were able to get 3 months off due to flexible scheduling. Certainly someone who is nerdy, smart and inquisitive won't like hospital medicine.

 

[AlbinoHawk DO]

Hospitalists don't fill FMLA. Case managers work on placement, and you do the discharge once there is an accepting facility. Titrating BP meds and discussing opioids are part of the job. ID is good for people who love the speciality. Hospitalists job is not very fancy or glamorous but it pays your bills and your schedule is flexible. I know colleagues who had kids were able to get 3 months off due to flexible scheduling. Certainly someone who is nerdy, smart and inquisitive won't like hospital medicine.

Yeah, that's part of the thing for me. I don't think hospitalist work is terrible. In fact, many times I do like it. Sure, I prefer not telling families the bad news, carrying a rock until there's a bed for placement, or having to explain how to follow the DKA protocol for the 100th time to the ICU nurses who still mess it up. On the other hand both ID and Nephro are things that I enjoy doing and like the idea of having in depth knowledge over one subject and treating that one thing without worrying to manage 7 other things

 

[Renal_Prometheus]

Yeah, that's part of the thing for me. I don't think hospitalist work is terrible. In fact, many times I do like it. Sure, I prefer not telling families the bad news, carrying a rock until there's a bed for placement, or having to explain how to follow the DKA protocol for the 100th time to the ICU nurses who still mess it up. On the other hand both ID and Nephro are things that I enjoy doing and like the idea of having in depth knowledge over one subject and treating that one thing without worrying to manage 7 other things

My only caveat is that easy to match into specialties are easy to get into for a reason. Once you have a family and kids, financial goals are really what people care about. Those specialities you mentioned don't help you get there and you may regret wasting time doing it.

 

[Suture15]

I am currently a Hospitalist, and was also debating Infectious Disease in my PGY3 as my background.

I ultimately decided to do hospitalist due to pay and "lifestyle" - Let me expand on the second part.

The pay on average/median whatever is higher as a hospitalist vs. ID. No questions. At individual places, due to individual, unique scenarios can ID be higher? Absolutely. No questions asked.

The issue with ID is that to generate money, like others have suggested, you either need volume (ID consultants at my hospital will have 20-30 patients on their list), or have your own infusion center, which at least in my state is rare, OR have your fingers in different pies - the attending I did my elective with did inpatient consults, had clinic, and also worked with wound care clinics to provide ID input and he on average made more than a hospitalist.

But we do not choose careers based on exclusions, right? I picked hospitalist medicine because I did not want to just see ID in every case but I still see a healthy amount of ID (Isn't most of IM really ID?), and the money is better. To comment on what I said about lifestyle, 7 on 7 off is very decent.

Now, it does not sound like liking ID is a problem for you, you have that down, much like I did. If the pay issue bothers you a lot, I would think heavily before doing it because on average you WILL take a pay hit, but ultimately may enjoy what you do on a daily basis more.

Another option (which I am also remotely considering) is to pay a significant amount of my loans, then do ID so that the financial issue does not bother me as much.

Hope this helps.