Procedures done by ID Docs

[sylvester500]

(First year MD student) — Not sure if this belongs on a different forum, but thought I'd start here. From a medical perspective, and the perspective of my career (i.e. opportunities for research, broader impact on medical system), infectious disease seems like a really great option for me. However, ever since I have been interested in medicine, a core desire of mine has been to address patient's problems with my hands. Over the years, I have learned that this might not necessarily be surgery (i.e. I think putting in central lines and tubing patients as a EM doc would be enough, certainly interventional cards or GI would scratch this itch).

However, ID docs seem to have next to 0 opportunity to do procedures that will help heal their patients. Am I right about this? Could I circumnavigate by doing a CCM fellowship in tandem with ID? Part of me wants to do EM/IM combined residency => ID fellowship to get some procedures in.

Thanks for the consult.

---

Members don't see this ad.

 

[TelemarketingEnigma]

ID is probably about as far as you will get from a procedural specialty - it tends to be very cerebral and minimally hands on in terms of procedures. Though I will note if you're big on doing complete physical exams, ID folks I've worked with do tend to be a bit more thorough on that front because you never know what weird findings you might identify, to go with your detailed history.

You do get opportunities to learn procedures during an IM residency (don't need to do EM just for procedures), which you could theoretically continue to do as an ID physician, but it would be unlikely. Most relevant things would be LPs, placing/removing lines, maybe some rare biopsies... but most ID consultants will be busy enough seeing all their consults, and will leave the procedures to the primary team caring for the patient (hospitalists, surgery, ICU, etc) or other specific consultants (IR, etc). If you like outpatient style procedures, HIV primary care could be an option that scratches both itches (doesn't necessarily require ID fellowship though).

I have actually met/heard of several people who did both ID and crit care fellowships (and there are even a rare few combined programs I believe) but the procedural opportunities will come from the crit care side and not the ID side. To get what you want, I imagine you'd basically end up being an intensivist who happens to have more ID knowledge than other people in the room.

 

[Redpancreas]

(First year MD student) — Not sure if this belongs on a different forum, but thought I'd start here. From a medical perspective, and the perspective of my career (i.e. opportunities for research, broader impact on medical system), infectious disease seems like a really great option for me. However, ever since I have been interested in medicine, a core desire of mine has been to address patient's problems with my hands. Over the years, I have learned that this might not necessarily be surgery (i.e. I think putting in central lines and tubing patients as a EM doc would be enough, certainly interventional cards or GI would scratch this itch).

However, ID docs seem to have next to 0 opportunity to do procedures that will help heal their patients. Am I right about this? Could I circumnavigate by doing a CCM fellowship in tandem with ID? Part of me wants to do EM/IM combined residency => ID fellowship to get some procedures in.

Thanks for the consult.

ID physicians traditionally do not engage in procedures. Some may have dabbled in wound care on the side, but ultimately procedures are not the core competency of ID physicians. One could make the hypothetical argument that it could be of value to have ID physicians who know how to do this...but the argument falls flat in practice. Take an LP for example. We have enough Neurologists who have the clinical volume of LPs. If you did a few LPs in residency and do one in practice and there's a clinical complication, it's very difficult to say the standard of practice was followed when there was a neurologist for consult. While in residency/academics, you're sometimes encouraged to own your patients and stretch your abilities to the fullest, but in the real world when you're practicing on your own license, you can get in trouble by getting into the domains of others.

As an infectious disease physician, you obtain pristine but focused histories/physicals, gather extensive knowledge and more importantly experience to diagnose, treat, and clinically follow patients with infections, many of which are uncommon. It's quite cool, but if this is not what you enjoy, don't do ID.

I suspect you may find satisfaction in Pulmonary/Critical Care fellowship and ultimately become an ICU attending or Intensivist where there's a lot of medicine/problem solving going around with a good amount of procedural aspects. I do not recommend ID/CCM or Nephrology/CCM. I also don't recommend EM/IM combined residency unless you want a certain academic niche. Absolutely do not do EM/IM -> ID fellowship. You will end up practicing the core competency of only one of those domains long term.

Hope that helps!

 

[sylvester500]

ID physicians traditionally do not engage in procedures. Some may have dabbled in wound care on the side, but ultimately procedures are not the core competency of ID physicians. One could make the hypothetical argument that it could be of value to have ID physicians who know how to do this...but the argument falls flat in practice. Take an LP for example. We have enough Neurologists who have the clinical volume of LPs. If you did a few LPs in residency and do one in practice and there's a clinical complication, it's very difficult to say the standard of practice was followed. While in residency/academics, you're sometimes encouraged to own your patients and stretch your abilities to the fullest, in the real world, you can get in trouble by getting into the domains of others.

As an infectious disease physician, you obtain pristine but focused histories/physicals, do a focused and through experience/extensive knowledge, diagnose, treat, and clinically follow infections, many of which are uncommon. It's quite cool, but if this is not what you enjoy, don't do ID.

I suspect you may find satisfaction in Pulmonary/Critical Care fellowship and ultimately become an ICU attending or Intensivist where there's a lot of medicine/problem solving going around with a good amount of procedural aspects. I do not recommend ID/CCM or Nephrology/CCM. I also don't recommend EM/IM combined residency unless you want a certain academic niche. Absolutely do not do EM/IM -> ID fellowship. You will end up practicing the core competency of only one of those domains long term.

Hope that helps!

This is really helpful.

I took a class in college that went through mechanisms of action of antibiotics, mechanisms of resistance of bacteria, and biosynthetic pathways of antibiotics. Almost made me switch to chemistry PhD.

I think critical care of illnesses from drug resistant infections (sepsis, MDR TB, etc.) is really interesting. Maybe I'd get enough exposure to infectious diseases in the ICU, and could explore the science on the side if I like.

Sounds like you would recommend against EM/IM => cardiology or pulm/ccm as well then? I'm unfortunately wishy-washy and struggle letting go of the ER. It's what I worked in throughout college and feels real comfortable (+ cool career opportunities in the military). But, I also really want to have my own niche procedures that really only I can do as a specialist that either diagnose or treat patients (definitely more surgery's realm, so haven't rule out that pathway either).

 

[sylvester500]

ID physicians traditionally do not engage in procedures. Some may have dabbled in wound care on the side, but ultimately procedures are not the core competency of ID physicians. One could make the hypothetical argument that it could be of value to have ID physicians who know how to do this...but the argument falls flat in practice. Take an LP for example. We have enough Neurologists who have the clinical volume of LPs. If you did a few LPs in residency and do one in practice and there's a clinical complication, it's very difficult to say the standard of practice was followed. While in residency/academics, you're sometimes encouraged to own your patients and stretch your abilities to the fullest, in the real world, you can get in trouble by getting into the domains of others.

As an infectious disease physician, you obtain pristine but focused histories/physicals, gather extensive knowledge and more importantly experience to diagnose, treat, and clinically follow infections, many of which are uncommon. It's quite cool, but if this is not what you enjoy, don't do ID.

I suspect you may find satisfaction in Pulmonary/Critical Care fellowship and ultimately become an ICU attending or Intensivist where there's a lot of medicine/problem solving going around with a good amount of procedural aspects. I do not recommend ID/CCM or Nephrology/CCM. I also don't recommend EM/IM combined residency unless you want a certain academic niche. Absolutely do not do EM/IM -> ID fellowship. You will end up practicing the core competency of only one of those domains long term.

Hope that helps!

Oh yes. Very helpful. Thank you.

 

[Redpancreas]

This is really helpful.

I took a class in college that went through mechanisms of action of antibiotics, mechanisms of resistance of bacteria, and biosynthetic pathways of antibiotics. Almost made me switch to chemistry PhD.

I think critical care of illnesses from drug resistant infections (sepsis, MDR TB, etc.) is really interesting. Maybe I'd get enough exposure to infectious diseases in the ICU, and could explore the science on the side if I like.

Sounds like you would recommend against EM/IM => cardiology or pulm/ccm as well then? I'm unfortunately wishy-washy and struggle letting go of the ER. It's what I worked in throughout college and feels real comfortable (+ cool career opportunities in the military). But, I also really want to have my own niche procedures that really only I can do as a specialist that either diagnose or treat patients (definitely more surgery's realm, so haven't rule out that pathway either).

I would recommend against EM/IM-> Cardiology for several reasons because the procedural aspects of EM do not translate to Cardiology. Even if they did, why learn them twice? I think there are a few places that offer IM/EM/CCM bundled together in ?6 years (as opposed to 3+3+1-?2). Hennepin, Henry Ford, and UMD come to mind. I don't know if these programs are still around, but I still think IM + 1 year CCM -> Intensivist job is a better route to go through. I think the IM/EM/CCM program directors would beg to differ, but I think if you go that route, you're going to have to work to find a niche that allows you to practice all the roles.

 

[sylvester500]

Good points. Also a point about EM alone that is a big downside for me is that, no matter what, I will only ever be employed by a hospital. Maybe wouldn't be such a big deal if I were to move to a smaller region with less grandiose healthcare systems, but IM also gives me to join or start a practice, technically (although I acknowledge this option is shrinking).

 

[Redpancreas]

Good points. Also a point about EM alone that is a big downside for me is that, no matter what, I will only ever be employed by a hospital. Maybe wouldn't be such a big deal if I were to move to a smaller region with less grandiose healthcare systems, but IM also gives me to join or start a practice, technically (although I acknowledge this option is shrinking).

I see what you're saying. I suspect that it's better to just do one and get good at it. There's no significant demand for those who can do both EM and IM. Pick one. I don't think hospital employability is as much of a hang up as some people say because private/group practices are getting less frequent and at this stage, you lack the foresight to know what business model you'll be practicing in. If the hospital employability is a hang up, just do IM or FM. The good thing about IM is there's significant flexibility where you can do GIM clinic, Hospital Medicine, a hybrid, become an intensivist, or do Fellowship. Family Medicine also provides you with General Clinic and Hospitalist route (and an even more age/gender-diverse patient group). FM also offers better training in basic clinical procedures than General IM where findings mentors willing to teach you basic procedures like joint aspirations/pap smears can be a struggle since about half in IM are more fellowship minded.

 

[sylvester500]

I see what you're saying. I suspect that it's better to just do one and get good at it. There's no significant demand for those who can do both EM and IM. Pick one. I don't think hospital employability is as much of a hang up as some people say because private/group practices are getting less frequent and at this stage, you lack the foresight to know what business model you'll be practicing in. If the hospital employability is a hang up, just do IM or FM. The good thing about IM is there's significant flexibility where you can do GIM clinic, Hospital Medicine, a hybrid, become an intensivist, or do Fellowship. Family Medicine also provides you with General Clinic and Hospitalist route (and an even more age/gender-diverse patient group). FM also offers better training in basic clinical procedures than General IM where findings mentors willing to teach you basic procedures like joint aspirations/pap smears can be a struggle since about half in IM are more fellowship minded.

I appreciate all of your advice. IM definitely seems to be winning over EM for me. Specialization opportunities, self-emplyability / job security (not as good as surgery). I'll keep searching, but you have helped me a lot!

 

[Redpancreas]

I appreciate all of your advice. IM definitely seems to be winning over EM for me. Specialization opportunities, self-emplyability / job security (not as good as surgery). I'll keep searching, but you have helped me a lot!

Thanks for saying that. I will say I am biased towards IM so seek other's input.

 

[Ganon]

ID doc I know does 1 day a week of wound care just so they can use their hands a little with minor stuff. Seems neat

 

[TelemarketingEnigma]

This is really helpful.

I took a class in college that went through mechanisms of action of antibiotics, mechanisms of resistance of bacteria, and biosynthetic pathways of antibiotics. Almost made me switch to chemistry PhD.

I think critical care of illnesses from drug resistant infections (sepsis, MDR TB, etc.) is really interesting. Maybe I'd get enough exposure to infectious diseases in the ICU, and could explore the science on the side if I like.

Sounds like you would recommend against EM/IM => cardiology or pulm/ccm as well then? I'm unfortunately wishy-washy and struggle letting go of the ER. It's what I worked in throughout college and feels real comfortable (+ cool career opportunities in the military). But, I also really want to have my own niche procedures that really only I can do as a specialist that either diagnose or treat patients (definitely more surgery's realm, so haven't rule out that pathway either).

i think you could easily meet your interests in crit care alone. In the MICU, you’ll be first line for making decisions on septic patients, it will be a part of your bread and butter. many places don’t even bring ID in unless it’s something weird or resistant. And if it’s the research side of ID you’re interested in, plenty of room for intensivists to be involved in research relating to infections in the ICU.

That said, you have a ton of time to figure out what you want, and gain exposure to environments outside the ED. I am personally someone who loves ID but also loved my MICU rotation - an IM residency will keep both doors open for you.

 

[Ho0v-man]

Dude just chill. You’re interested in everything from neurosurgery to IM subs. Get some exposure to these fields first.

 

[sylvester500]

Dude just chill. You’re interested in everything from neurosurgery to IM subs. Get some exposure to these fields first.

Honestly probably the best advice.

 

[ACSurgeon]

(First year MD student) — Not sure if this belongs on a different forum, but thought I'd start here. From a medical perspective, and the perspective of my career (i.e. opportunities for research, broader impact on medical system), infectious disease seems like a really great option for me. However, ever since I have been interested in medicine, a core desire of mine has been to address patient's problems with my hands. Over the years, I have learned that this might not necessarily be surgery (i.e. I think putting in central lines and tubing patients as a EM doc would be enough, certainly interventional cards or GI would scratch this itch).

However, ID docs seem to have next to 0 opportunity to do procedures that will help heal their patients. Am I right about this? Could I circumnavigate by doing a CCM fellowship in tandem with ID? Part of me wants to do EM/IM combined residency => ID fellowship to get some procedures in.

Thanks for the consult.

The only procedure I’ve seen ID docs do with their hands is writing notes

 

[ACSurgeon]

But in a more serious response you have to decide what you want. Is it to be an expert on rare infectious problems and minutiae related to Abx? If so do ID.

Do you want to do procedures? Do something that is procedure heavy.

Instead of trying to combine two specialties or forcing a specialty to be something that it’s not, do something that you like and realize that there is cross-talk among the specialties. Every hospitalist, intensivist, surgeon, primary care doc, urgent care doc etc will deal with infections and Abx. Some more than others. You won’t be the most expert person, but you can get pretty close to never needing to consult ID as an IM or ICU doc.

Finally, we have an ICU doc who did a combined fellowship. He covers ID docs sporadically and otherwise just does critical care. He thinks it’s painful to keep up with ID while doing it so infrequently. If you have such a strong interest in ID that you just want to learn that knowledge, go for it. Otherwise there’s no reason to do ID unless you want to be a full time ID doc.

 

[Redpancreas]

But in a more serious response you have to decide what you want. Is it to be an expert on rare infectious problems and minutiae related to Abx? If so do ID.

Do you want to do procedures? Do something that is procedure heavy.

Instead of trying to combine two specialties or forcing a specialty to be something that it’s not, do something that you like and realize that there is cross-talk among the specialties. Every hospitalist, intensivist, surgeon, primary care doc, urgent care doc etc will deal with infections and Abx. Some more than others. You won’t be the most expert person, but you can get pretty close to never needing to consult ID as an IM or ICU doc.

Finally, we have an ICU doc who did a combined fellowship. He covers ID docs sporadically and otherwise just does critical care. He thinks it’s painful to keep up with ID while doing it so infrequently. If you have such a strong interest in ID that you just want to learn that knowledge, go for it. Otherwise there’s no reason to do ID unless you want to be a full time ID doc.

Exactly, OP's got to commit to what core competency he wants to develop (i.e. choose a field). To add to this, I know two ID/CCM physicians. They just ended up doing CCM and they end up having to consult ID for ID issues despite being board certified which you can imagine would be frustrating. As I was explained, it was not that the cases were too complex, it's that there needs to be infrastructure in place for follow-up which with ID is sometimes half the battle especially with outpatient parenteral antibiotic therapies (OPAT). I suppose the ID/CCM could try some clinic/ICU hybrid like Pulm/CCM but these guys didn't pursue it so there must be a reason. Also Pulm/Crit goes hand in hand while ID and Crit are pretty distinct. Lastly, there's no real incentive for anyone to hire you as a merged ID/CCM specialist. They'd rather just have you dedicated to CCM and consult ID when needed. I'd assume if you wanted to do the merged ID/CCM specialist route and have ID clinic, you'd have to set up the system all on your own.

 

[greatnt249]

Though by no means is it a glamorous way to think about your future in terms of what specialty you want to choose, I would highly encourage you to pay very close attention on your rotations to what are the most common/mundane issues each specialty deals with and ask yourself if this is what you're willing to put up with for the next 30+ years of your life. I say this because I was initially interested in ID as a resident, but on my rotations it became apparent that the specialty was less about seeing cool infections and more about diabetic foot wounds and approving antibiotic use. I'm not saying this to discourage you from the specialty, just as a reminder to not look at specialty choice based on the "cool stuff" alone.

 

[ortnakas]

Though by no means is it a glamorous way to think about your future in terms of what specialty you want to choose, I would highly encourage you to pay very close attention on your rotations to what are the most common/mundane issues each specialty deals with and ask yourself if this is what you're willing to put up with for the next 30+ years of your life. I say this because I was initially interested in ID as a resident, but on my rotations it became apparent that the specialty was less about seeing cool infections and more about diabetic foot wounds and approving antibiotic use. I'm not saying this to discourage you from the specialty, just as a reminder to not look at specialty choice based on the "cool stuff" alone.

This, a thousand times this.

Pretty sure the advice I give most often here is to pick the specialty you most like the bread & butter, not the one you most like the zebras.

 

[Ho0v-man]

Though by no means is it a glamorous way to think about your future in terms of what specialty you want to choose, I would highly encourage you to pay very close attention on your rotations to what are the most common/mundane issues each specialty deals with and ask yourself if this is what you're willing to put up with for the next 30+ years of your life. I say this because I was initially interested in ID as a resident, but on my rotations it became apparent that the specialty was less about seeing cool infections and more about diabetic foot wounds and approving antibiotic use. I'm not saying this to discourage you from the specialty, just as a reminder to not look at specialty choice based on the "cool stuff" alone.

Yeah it seems really cool until you see all that. Furthermore, ID seems to end up with a bunch of administrative infection control BS that is for some reason their problem. Imagine being 10 years into your career and having to waste time listening to nurse admin repeat the same garbage strategies to encourage hand-washing and reduce CAUTIs. No thanks.

 

[ACSurgeon]

Yeah it seems really cool until you see all that. Furthermore, ID seems to end up with a bunch of administrative infection control BS that is for some reason their problem. Imagine being 10 years into your career and having to waste time listening to nurse admin repeat the same garbage strategies to encourage hand-washing and reduce CAUTIs. No thanks.

Why aren’t you more of a team player? Let me guess, you don’t like being called a provider either do you?! Flag for HR to keep an eye on you

 

[Radetzky]

for what it’s worth it doesn’t take long before CVLs, LPs etc become a pain in the backside rather than some glamorous procedure. And always at 3am..

 

[sylvester500]

Thanks for the advice, everybody!

 

[Rector]

So I just stumbled on this thread. There seem to be a lot of opinions presented to this young (I assume) student and not a ton of data.

I'm an ID/CCM physician, academic faculty, hold various positions of some note in CHEST and SCCM, serve on a couple of IDSA committees. My practice structure is relatively analogous to what a pulmonary intensivist does - about 0.5 FTE in critical care (meaning a week per month, on average, in the ICU) and 0.5 FTE in ID, where I do mostly transplant ID. I have joint appointments in ID and CCM at my institution and practice both specialties.

A few passing thoughts on the earlier parts of this thread:

1. Yeah, not a lot of ID doctors do many procedures. People who still do some inpatient IM might do the occasional bedside procedure, but I can barely find any full-time hospitalists who still do many bedside procedures. Folks who do a lot of HIV and STI work are more likely to do LPs, but the earlier descriptions of ID as a cognitive and not very procedural specialty are absolutely right. The hands-on nature of bedside evaluation by ID is very tactile, to be fair, but it's not the same thing exactly.

2. I always find it amusing when other people tell students about what my job is like. There was a nice survey published in Clinical Infectious Diseases by Sameer Kadri to which the great majority of ID/CCM physicians responded (there are maybe 250 or so of us in the US). The short version is about half of us practice just CCM and about 40% of us practice both. (The rest are a mixture of "pure" ID physicians and those with non-clinical jobs, like in government or industry.) I am lucky to practice ID and CCM both, and I wouldn't have it any other way. Was it a little more work to find a job doing both ID and CCM than compared to, say, being a pulmonologist or whatever? Sure, it took a little more work. Big deal.

You do have to set some priorities. I recently stopped doing much outpatient HIV, for example, in part because I changed jobs, but also because it had become clear to me over the years that having an easily-distracted intensivist was maybe not the best plan for my HIV-positive patients who really just needed a good internist. I can still manage HIV and STIs, but I am no longer that good at managing outpatient diabetes, for example, and if you work in a practice model where the HIV specialist is also your primary care doctor, I might not be the guy for that. But consultative ID in combination with the ICU is not that hard and can be a nice cognitive break. Most of my partners in my critical care section do something else besides the ICU: OR anesthesia, emergency medicine, pulmonary or other IM subspecialties, whatever. It is a good thing and, I think, makes you a better intensivist, both intellectually and emotionally.

Also: ID involvement in infection control is based on the job and your personal interest. Whoever said we always get involved in "bunch of administrative infection control BS" is a little off base. Lots of ID doctors get involved in infection control, but some of us enjoy it. (I did my time as IC chair once, it was fine, but I don't do it anymore. I am involved in our stewardship program, but I find that a lot more interesting and is genuinely very important to me, since too many of our non-ID colleagues still have no idea how to use antibiotics well.)

3. For the original poster: others have commented that it's pretty early in your life cycle to start making firm specialty plans. This is true and wise. (I was planning on doing general surgery when I was a first-year student.) But you may notice that there are a lot of people telling you what you can and can't do or what you should or shouldn't do. You should ignore most of these people. One of the great things about medicine is how you can shape your own career and your own practice to fit your interests and aptitudes. There are a lot of overly-linear thinkers who will try and explain how deviation from the One Set Path is doomed to failure. I'm not saying you shouldn't consider the specific ramifications of a decision you're making and be prepared to deal with the consequences. When I was on my most recent job hunt, I found it pretty easy to get an all-ID job and pretty easy to get an all-CCM job. So I had to look a little harder. Like I said, big deal. A good thing is worth the effort.

Happy to discuss more if you're interested.

 

[Redpancreas]

So I just stumbled on this thread. There seem to be a lot of opinions presented to this young (I assume) student and not a ton of data.

I'm an ID/CCM physician, academic faculty, hold various positions of some note in CHEST and SCCM, serve on a couple of IDSA committees. My practice structure is relatively analogous to what a pulmonary intensivist does - about 0.5 FTE in critical care (meaning a week per month, on average, in the ICU) and 0.5 FTE in ID, where I do mostly transplant ID. I have joint appointments in ID and CCM at my institution and practice both specialties.

A few passing thoughts on the earlier parts of this thread:

1. Yeah, not a lot of ID doctors do many procedures. People who still do some inpatient IM might do the occasional bedside procedure, but I can barely find any full-time hospitalists who still do many bedside procedures. Folks who do a lot of HIV and STI work are more likely to do LPs, but the earlier descriptions of ID as a cognitive and not very procedural specialty are absolutely right. The hands-on nature of bedside evaluation by ID is very tactile, to be fair, but it's not the same thing exactly.

2. I always find it amusing when other people tell students about what my job is like. There was a nice survey published in Clinical Infectious Diseases by Sameer Kadri to which the great majority of ID/CCM physicians responded (there are maybe 250 or so of us in the US). The short version is about half of us practice just CCM and about 40% of us practice both. (The rest are a mixture of "pure" ID physicians and those with non-clinical jobs, like in government or industry.) I am lucky to practice ID and CCM both, and I wouldn't have it any other way. Was it a little more work to find a job doing both ID and CCM than compared to, say, being a pulmonologist or whatever? Sure, it took a little more work. Big deal.

You do have to set some priorities. I recently stopped doing much outpatient HIV, for example, in part because I changed jobs, but also because it had become clear to me over the years that having an easily-distracted intensivist was maybe not the best plan for my HIV-positive patients who really just needed a good internist. I can still manage HIV and STIs, but I am no longer that good at managing outpatient diabetes, for example, and if you work in a practice model where the HIV specialist is also your primary care doctor, I might not be the guy for that. But consultative ID in combination with the ICU is not that hard and can be a nice cognitive break. Most of my partners in my critical care section do something else besides the ICU: OR anesthesia, emergency medicine, pulmonary or other IM subspecialties, whatever. It is a good thing and, I think, makes you a better intensivist, both intellectually and emotionally.

Also: ID involvement in infection control is based on the job and your personal interest. Whoever said we always get involved in "bunch of administrative infection control BS" is a little off base. Lots of ID doctors get involved in infection control, but some of us enjoy it. (I did my time as IC chair once, it was fine, but I don't do it anymore. I am involved in our stewardship program, but I find that a lot more interesting and is genuinely very important to me, since too many of our non-ID colleagues still have no idea how to use antibiotics well.)

3. For the original poster: others have commented that it's pretty early in your life cycle to start making firm specialty plans. This is true and wise. (I was planning on doing general surgery when I was a first-year student.) But you may notice that there are a lot of people telling you what you can and can't do or what you should or shouldn't do. You should ignore most of these people. One of the great things about medicine is how you can shape your own career and your own practice to fit your interests and aptitudes. There are a lot of overly-linear thinkers who will try and explain how deviation from the One Set Path is doomed to failure. I'm not saying you shouldn't consider the specific ramifications of a decision you're making and be prepared to deal with the consequences. When I was on my most recent job hunt, I found it pretty easy to get an all-ID job and pretty easy to get an all-CCM job. So I had to look a little harder. Like I said, big deal. A good thing is worth the effort.

Happy to discuss more if you're interested.

Great to see you've made an appearance and concede your knowledge/experience is far more accurate than my second hand account and extrapolation. That said, if there are truly approximately 250 ID/CCM boarded physicians and only 40% practice both (relative to 8500 ID physicians total per google search), I think it is truly a niche role likely tied to academics and while I shouldn't be telling OP what he can't or shouldn't do, I think it's completely reasonable to tell OP that ID/CCM is likely not what he's looking for if he is very interested in a procedural specialty and is trying to reconcile that with an interest in ID by doing ID/CCM. There are more common things OP will probably consider first before considering this. I also imagine the job structure is mainly academic and tied heavily to a hospital, meanwhile OP's mentioned a major factor for him is not being tied to a hospital system.

 

[Rector]

Great to see you've made an appearance and concede your knowledge/experience is far more accurate than my second hand account and extrapolation. That said, if there are truly approximately 250 ID/CCM boarded physicians and only 40% practice both (relative to 8500 ID physicians total per google search), I think it is truly a niche role likely tied to academics and while I shouldn't be telling OP what he can't or shouldn't do, I think it's completely reasonable to tell OP that ID/CCM is likely not what he's looking for if he is very interested in a procedural specialty and is trying to reconcile that with an interest in ID by doing ID/CCM. There are more common things OP will probably consider first before considering this. I also imagine the job structure is mainly academic and tied heavily to a hospital, meanwhile OP's mentioned a major factor for him is not being tied to a hospital system.

100% agree that it is a niche role. The Venn diagram of people who are well-suited to both ID (long, thoughtful evaluations; poor hand-eye coordination mitigated by not doing procedures) and CCM (thinking fast on your feet; poor hand-eye coordination mitigated by brute force) is a thin sliver of overlap.

You are also right that if you are specifically interested in doing procedures, then ID/CCM is a bit of a roundabout way to get there. It does tend to skew a bit academic, although I do know some folks who work in non-academic settings. But yeah, it is definitely tied to hospital systems. Of course, most critical care jobs are.

But if you dig ID a lot and still want to do procedures and primary inpatient management, in addition to some consultation, and also be the #1 biggest baddest MF in the hospital, then it is a heck of a way to go.

 

[MedicineZ0Z]

ID physicians traditionally do not engage in procedures. Some may have dabbled in wound care on the side, but ultimately procedures are not the core competency of ID physicians. One could make the hypothetical argument that it could be of value to have ID physicians who know how to do this...but the argument falls flat in practice. Take an LP for example. We have enough Neurologists who have the clinical volume of LPs. If you did a few LPs in residency and do one in practice and there's a clinical complication, it's very difficult to say the standard of practice was followed when there was a neurologist for consult. While in residency/academics, you're sometimes encouraged to own your patients and stretch your abilities to the fullest, but in the real world when you're practicing on your own license, you can get in trouble by getting into the domains of others.

As an infectious disease physician, you obtain pristine but focused histories/physicals, gather extensive knowledge and more importantly experience to diagnose, treat, and clinically follow patients with infections, many of which are uncommon. It's quite cool, but if this is not what you enjoy, don't do ID.

I suspect you may find satisfaction in Pulmonary/Critical Care fellowship and ultimately become an ICU attending or Intensivist where there's a lot of medicine/problem solving going around with a good amount of procedural aspects. I do not recommend ID/CCM or Nephrology/CCM. I also don't recommend EM/IM combined residency unless you want a certain academic niche. Absolutely do not do EM/IM -> ID fellowship. You will end up practicing the core competency of only one of those domains long term.

Hope that helps!

If you've done a bunch of LPs, you should know how to do it safely. Your success rate won't be perfect at the start, but you should 100% know how to do it safely. And what complication(s) are you even talking about?

I know I'm dissecting your argument, but I'm strongly opposed to the idea of limiting all our procedures to specialists. It's one of the big problems we have in medicine right now. Intense fear of doing anything as a doctor, but then we let the midlevels do everything. Not to mention many institutions don't even have specialties who are willing to do all your procedures. What if your next job expects you do to everything? These jobs are not uncommon at all.

And the litigation fear with procedures is fabricated. Complication risks are accepted to a degree and do not result in litigation nor any board action, unless you did something not within standard of care. I'll go even further and say that procedure related litigation is very rare. I've never come across a case. I'm sure you could find one if you dig but it's incredibly rare compared to cognitive error based litigation cases.