In the pandemic year of 2020, applications to medical schools in the United States surged by an average of 18%, according to the Association of American Medical Colleges. At a few med schools, applications were up by 20%, 30% and more.
Observers were quick to anoint this trend as the pandemic effect or, more precisely, the Fauci effect, in honor of Anthony Fauci, an infectious disease specialist and director of the National Institute of Allergy and Infectious Diseases and the nation’s most recognizable face and voice of the COVID-19 era.
At the University of California, Davis School of Medicine, where applications are up a whopping 38%, Dean Allison Brashear says that young people “are rightfully looking up to leaders in medicine, science and research and setting their career goals based on the admirable work being done to relieve the world of this deadly pandemic.”
Specifically, many are eyeing a specialty in infectious diseases (ID). But will the Fauci effect cause a seismic shift toward careers in infectious diseases and public health? How it might eventually register on the Richter scale of medicine is unknown, but the trend will be welcomed with open arms by the leaders of the infectious disease specialty.
Daniel McQuillen, a senior physician in the Division of Infectious Diseases at Beth Israel Lahey Health, Lahey Hospital & Medical Center and president-elect of the Infectious Diseases Society of America (IDSA), explains that “virtually every young doctor I spoke to last year about fellowship opportunities in infectious diseases mentioned the pandemic as a compelling reason for their interest. They talked about its impact on their current training, how fascinating it is and why they want to be a part of getting rid of this disease.”
As far as McQuillen and IDSA are concerned, the help can’t come soon enough. Last October, he and colleagues published a brief research report in Annals of Internal Medicine titled “Where is the ID in COVID-19?” One of the study co-authors, Rochelle Walensky, chief of the Division of Infectious Diseases at Massachusetts General Hospital, has been tapped by the incoming Biden administration to head up the Centers for Disease Control and Prevention (CDC).
The report included maps of the U.S. showing how the distribution of ID specialists is skewed, such that 80% of the counties with the greatest number of cases per 100,000 population — many of them rural — have below-average density of physicians specializing in infectious diseases. Some counties had no such specialty doctors at all. “The deficits in our ID physician workforce today have left us poorly prepared for the unprecedented demand ahead,” the report stated. “Faced with a surge of patients with COVID-19, these rural counties will be left wanting for the public health and clinical care activities ID physicians provide.”
ID shortage is not new
Concerns about the infectious disease workforce are not new but have persisted for more than a decade, explains McQuillen. Over the years, dozens of available ID fellowship positions have gone unfilled. In 2014 alone, for example, 99 positions in 70 ID programs went unclaimed. The IDSA has convened a task force for recruitment in an effort “to be more vocal about selling all the positive aspects of our specialty.”
Young doctors coming out of medical school and residency with $200,000 to $300,000 in debt, McQuillen says, are often not attracted to ID and other specialties because, frankly, the finances are daunting: ID and other specialties that rely primarily on cognitive skills are not as well compensated as specialties that focus on performance of procedures, such as colonoscopies, cataract surgery, removal and biopsy of skin lesions, or cardiac catheterization.
McQuillen and colleagues have been looking for ways to increase interest in ID among the best and brightest graduating students and residents — as well as doctors who are looking to switch specialties or subspecialize. The pandemic has highlighted the value of careers in infectious disease with an opportunity to develop infection control policies, lead multidisciplinary COVID-19 care teams and fortify an infrastructure that is largely invisible to the public but vitally needed in both normal and pandemic times.
Post-pandemic, the need will only grow. As McQuillen commented in a follow-up to his article in Annals, “a diverse cognitive care workforce will be required to care for COVID-19 survivors who will have chronic respiratory and other complications long after their viral infection is gone.”
Beyond unraveling the mysteries of the virus and coping with its real-world consequences, ID specialists are also needed to help care for a large population of patients living with HIV, manage antibiotic stewardship programs to counter the challenges of drug resistance, deal with the threat of bioterrorism and address an urgent need to correct long-standing inequities in the healthcare system. McQuillen, who was just finishing his own training when the AIDS epidemic erupted, says that the pace of learning about a new disease was fast then and is even faster now. “I liken AIDS to a 33 rpm record,” McQuillen says. “COVID-19 is 78 rpm. It’s astounding to think that within a year we’ve gone from knowing essentially nothing about this disease to having vaccines that are 95% effective.”
A brighter outlook
If 2020 is any indication, things are looking up for the ID specialty, which currently includes 8,000 physicians in the U.S. The typical pathway is four years of medical school, followed by three years of internal medicine residency, followed by two years of an ID fellowship. The 2020 fellowship match results are “extremely encouraging” to IDSA: 88% of positions were filled, up from 79% in 2019 (and a low of 65% in 2016), and 124 of 165 programs (75%) filled all their slots (up from a low of 42% in 2016) — in both cases, the best results in more than a decade. Over that same time frame, the number of ID fellowship programs in the U.S. increased from 128 to 165, and the number of positions offered grew by 100 to 416.
Beyond the star power of Fauci — he and front-line health workers were named Time Magazine’s Guardians of the Year, and a bobblehead doll with his likeness is a national best-seller — the basic science of COVID-19 and the rapid unraveling of its mysteries hold great appeal for future physicians. In addition, another inspiring role model will arrive on the scene as Walensky takes command of the CDC and becomes an influential voice. “There will definitely be a Walensky effect,” McQuillen says. “She is charismatic, with a unique gift for explaining medicine in understandable terms.”
Of course, all the Fauci and Walensky wannabes and anyone else who applies to medical school travel a highly competitive road. Boston University, for example, has 11,000 applicants for 125 spots; Tulane has 16,000 applicants competing for 190 spaces.
For those who get in, successfully navigate the academic and clinical gauntlet, and make it through medical school, residency training, and possibly a fellowship, job opportunities should not be scarce. The AAMC projects a nationwide shortage of 21,400 to 55,200 primary-care physicians and 33,700 to 86,700 specialty physicians by 2033. Because of the pandemic, the AAMC predicts that “interest in some specialties, like infectious disease, may increase while interest in others, like emergency medicine, may decrease.” IDSA believes that primary care and infectious diseases will become more attractive if the financial challenges can be tempered, through student loan forgiveness programs and reimbursement reform to better compensate cognitive patient care skills.
For now, the pandemic has ID doctors and the many colleagues on their clinical teams working collaboratively nonstop. IDSA notes that “this dynamic and evolving discipline offers exciting opportunities for physicians who enjoy helping others through problem-solving and medical detective work.” To those now in training who would join them on the front lines of care, McQuillen and IDSA say: Come on down.