Zombie Doc
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ID is probably the most under the radar speciality in medicine. It took a global pandemic for anyone to know we even existed. I’m writing this thread not because I feel some sort of ego shame that my speciality is considered undesirable or non-competitive. People don’t want to go into ID. That’s fine. I know ID is not paid well relevant to other medical specialities. However, even considering that big factor, it still really baffles me why my speciality is as unpopular as the NRMP match data would have you believe it to be.
I hope my post can help people who maybe are considering pursuing ID as a career however are apprehensive due to the match statistics and the pay. I will list some Pros/Cons of the speciality in general then provide a summary of my current job. But first, a story…
Long ago internal medicine used to be all about finding the right diagnosis. It was diagnostic medicine. Then, for some reason, somewhere in the evolution of our healthcare system, internal medicine became the dumping ground. The land of dispo. Internal medicine became the diet order, laxative, med rec, and discharge summary speciality. “We have the best notes in medicine" we tell ourselves. After all, we need something to feel proud of.
I would argue, however that the true spirit of internal medicine still exists today in 2023. However it simply goes by a different name. If you love everything about internal medicine except everything it’s currently known for, I have the speciality for you. Enter, infectious disease.
PROS
1. Pure medicine. As an ID doc, I get the satisfaction of being both a diagnostician and of helping people fix their problem. When I’m consulted, I always try to figure out the diagnosis even if I don’t think it’s an infection. This is because many non-infectious diseases can resemble infections. But also, because it’s fun. I’ve helped diagnosis HLH, sarcoidosis, cancer, you name it. I’m able to really delve into the diagnostic aspect of medicine because there’s no one distracting me for IDT, dispo planning, med rec, signing forms, etc. You get to really focus your cognitive effort on creating a thorough differential and creating a work-up that will get the patient a diagnosis i.e. the job medicine is supposed to do.
2. Effective Treatments. This really is one of the understated advantages about ID. Because of the effectiveness of antibiotics, if you can figure out what infection someone has, you can almost certainly cure it. Most of our patients get better and we never have to see them again. Even HIV patients can be effectively controlled these days because of how potent ART has become. There’s no lifestyle management, begging people to stop eating 3 Big Macs for breakfast, etc. Diagnosis the infection. Determine the right mix of antibiotics. Cure the infection. Return to clinic as needed.
3. Pure consultant. IM is the primary. Trauma surgery is the primary. ID is never the primary. I look through the chart, go see the patient, write my consult note with recs, then leave. There’s no one calling me for placement, patient angry because you DCed the Dilaudid, family members demanding a certain SNF, nurses paging you so that they can document they paged you, etc. There’s no rapid response, no codes, nothing. I write my notes, make some phone calls, coordinate care, and go home.
4. Lifestyle. See my job section below
CONS
I don’t want this post to come across as biased, so I will include a few cons to ID. No speciality is perfect of course…
1. Of course the first con is the pay. This is the point people usually use to disqualify ID as a career option and fair enough. Yes GI makes triple our salary. Yes you can make more money as a hospitalist without the additional training. But consider, is that extra money really worth it? Is it? Are the endless discharge summaries worth it? Are the 3am diet order pages worth it? Can you make 400k+ as ID? Absolutely. But you will be driving to multiple hospitals per day and seeing 40+ patients. I know IDs who do this. If you want to sacrifice your quality of life because you want more money, you can absolutely do that. But you don’t have to.
2. Reliance on other specialities. As ID we rely heavily on acquisition of specimens i.e. cultures to diagnose an infection and source control i.e. abscess drainage, to treat an infection. Yet we are unable to actually do either of these with our own hands. Thus, we rely heavily on other specialities, i.e. IR, surgery, even neurology for LP. For how under the radar we are, ID is probably one of the most collaborative specialities for this reason. This can be a disadvantage when we don’t see eye to eye with another service. That is, I think an abscess should be drained, but the surgeon doesn’t want to operate. However, I find this disadvantage can be mitigated by developing good relationships with the proceduralists/surgeons at your hospital. Really isn’t much of a con, but I said I would include a few cons so…
And now for some details about what a day in the life of this specialty actually looks like. I graduated in 2021 and these are the stats for my first job:
-Hospital employed
-Work M-F, 45 hours / week
- 7 Weekends / year
- 2 Holidays / year
-8 weeks PTO
-Base salary - 255k
Workload: My mix is about 70% inpatient and 30% outpatient. Some IDs do pure inpatient and others pure outpatient. Most, like myself, do a mix.
Inpatient: 3-4 consults / day. Average census 12-15. Inpatient is where ID shines and the setting most ID’s prefer to practice. See infections that affect every organ system. Endocarditis, orthopedic prosthetic joint infections, brain abscess, tick-borne infections, opportunistic infections in advanced HIV, organ transplant recipients, and other immunocompromised hosts, the occasional case of malaria in a returning traveler. ID has incredible breadth and variety. There’s a reason the longest section of Harrisons is the ID section.
Outpatient: 10-12 PPD. Usually easy hospital follow-ups on OPAT, LTBI, the occasional syphilis couple drama, reassuring people they don’t have Lyme disease, sometimes a delusional parasitosis who slips through our screening.
Average workday:
0700: Wake-up, dress, drive to hospital
0800: Review list, distribute new consults, BS with colleagues
0900-1200: See patients / write notes
1200-1300: Lunch / Meeting
1300-1700: See late consults, coordinate care, finish notes
1700: Go home, gym, dinner, chill
Call: ID call is essentially non-existent. This advantage really cannot be underscored enough. Even when I’m on call I rarely receive any pages. The pages I do receive are addressed with a quick chart check and phone call. There is no driving to the hospital at night to do an emergent cath or scope. I don’t remember the last time I was awoken from sleep while on call.
TLDR; ID is a speciality with good (?great) lifestyle, cerebral work that involves a lot of deep thinking, problem solving, and detective work to make a diagnosis. It has effective therapies that actually gets patients better. There is little to no BS / social / scut work. It’s “pure” medicine. And yes, the rumors are true, the pay is low compared to other specialties.
Again I don’t write this post because I’m trying to convince anyone to go into Infectious Disease. I really could care less if no one wants to do ID (better job market for me) I write it because I really am baffled that more doctors are not going into it. If you enjoy being the doctors doctor, doing differential diagnosis, and actually curing your patients, you would love ID. It’s really not THAT bad.
I hope my post can help people who maybe are considering pursuing ID as a career however are apprehensive due to the match statistics and the pay. I will list some Pros/Cons of the speciality in general then provide a summary of my current job. But first, a story…
Long ago internal medicine used to be all about finding the right diagnosis. It was diagnostic medicine. Then, for some reason, somewhere in the evolution of our healthcare system, internal medicine became the dumping ground. The land of dispo. Internal medicine became the diet order, laxative, med rec, and discharge summary speciality. “We have the best notes in medicine" we tell ourselves. After all, we need something to feel proud of.
I would argue, however that the true spirit of internal medicine still exists today in 2023. However it simply goes by a different name. If you love everything about internal medicine except everything it’s currently known for, I have the speciality for you. Enter, infectious disease.
PROS
1. Pure medicine. As an ID doc, I get the satisfaction of being both a diagnostician and of helping people fix their problem. When I’m consulted, I always try to figure out the diagnosis even if I don’t think it’s an infection. This is because many non-infectious diseases can resemble infections. But also, because it’s fun. I’ve helped diagnosis HLH, sarcoidosis, cancer, you name it. I’m able to really delve into the diagnostic aspect of medicine because there’s no one distracting me for IDT, dispo planning, med rec, signing forms, etc. You get to really focus your cognitive effort on creating a thorough differential and creating a work-up that will get the patient a diagnosis i.e. the job medicine is supposed to do.
2. Effective Treatments. This really is one of the understated advantages about ID. Because of the effectiveness of antibiotics, if you can figure out what infection someone has, you can almost certainly cure it. Most of our patients get better and we never have to see them again. Even HIV patients can be effectively controlled these days because of how potent ART has become. There’s no lifestyle management, begging people to stop eating 3 Big Macs for breakfast, etc. Diagnosis the infection. Determine the right mix of antibiotics. Cure the infection. Return to clinic as needed.
3. Pure consultant. IM is the primary. Trauma surgery is the primary. ID is never the primary. I look through the chart, go see the patient, write my consult note with recs, then leave. There’s no one calling me for placement, patient angry because you DCed the Dilaudid, family members demanding a certain SNF, nurses paging you so that they can document they paged you, etc. There’s no rapid response, no codes, nothing. I write my notes, make some phone calls, coordinate care, and go home.
4. Lifestyle. See my job section below
CONS
I don’t want this post to come across as biased, so I will include a few cons to ID. No speciality is perfect of course…
1. Of course the first con is the pay. This is the point people usually use to disqualify ID as a career option and fair enough. Yes GI makes triple our salary. Yes you can make more money as a hospitalist without the additional training. But consider, is that extra money really worth it? Is it? Are the endless discharge summaries worth it? Are the 3am diet order pages worth it? Can you make 400k+ as ID? Absolutely. But you will be driving to multiple hospitals per day and seeing 40+ patients. I know IDs who do this. If you want to sacrifice your quality of life because you want more money, you can absolutely do that. But you don’t have to.
2. Reliance on other specialities. As ID we rely heavily on acquisition of specimens i.e. cultures to diagnose an infection and source control i.e. abscess drainage, to treat an infection. Yet we are unable to actually do either of these with our own hands. Thus, we rely heavily on other specialities, i.e. IR, surgery, even neurology for LP. For how under the radar we are, ID is probably one of the most collaborative specialities for this reason. This can be a disadvantage when we don’t see eye to eye with another service. That is, I think an abscess should be drained, but the surgeon doesn’t want to operate. However, I find this disadvantage can be mitigated by developing good relationships with the proceduralists/surgeons at your hospital. Really isn’t much of a con, but I said I would include a few cons so…
And now for some details about what a day in the life of this specialty actually looks like. I graduated in 2021 and these are the stats for my first job:
-Hospital employed
-Work M-F, 45 hours / week
- 7 Weekends / year
- 2 Holidays / year
-8 weeks PTO
-Base salary - 255k
Workload: My mix is about 70% inpatient and 30% outpatient. Some IDs do pure inpatient and others pure outpatient. Most, like myself, do a mix.
Inpatient: 3-4 consults / day. Average census 12-15. Inpatient is where ID shines and the setting most ID’s prefer to practice. See infections that affect every organ system. Endocarditis, orthopedic prosthetic joint infections, brain abscess, tick-borne infections, opportunistic infections in advanced HIV, organ transplant recipients, and other immunocompromised hosts, the occasional case of malaria in a returning traveler. ID has incredible breadth and variety. There’s a reason the longest section of Harrisons is the ID section.
Outpatient: 10-12 PPD. Usually easy hospital follow-ups on OPAT, LTBI, the occasional syphilis couple drama, reassuring people they don’t have Lyme disease, sometimes a delusional parasitosis who slips through our screening.
Average workday:
0700: Wake-up, dress, drive to hospital
0800: Review list, distribute new consults, BS with colleagues
0900-1200: See patients / write notes
1200-1300: Lunch / Meeting
1300-1700: See late consults, coordinate care, finish notes
1700: Go home, gym, dinner, chill
Call: ID call is essentially non-existent. This advantage really cannot be underscored enough. Even when I’m on call I rarely receive any pages. The pages I do receive are addressed with a quick chart check and phone call. There is no driving to the hospital at night to do an emergent cath or scope. I don’t remember the last time I was awoken from sleep while on call.
TLDR; ID is a speciality with good (?great) lifestyle, cerebral work that involves a lot of deep thinking, problem solving, and detective work to make a diagnosis. It has effective therapies that actually gets patients better. There is little to no BS / social / scut work. It’s “pure” medicine. And yes, the rumors are true, the pay is low compared to other specialties.
Again I don’t write this post because I’m trying to convince anyone to go into Infectious Disease. I really could care less if no one wants to do ID (better job market for me) I write it because I really am baffled that more doctors are not going into it. If you enjoy being the doctors doctor, doing differential diagnosis, and actually curing your patients, you would love ID. It’s really not THAT bad.
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