A Personnel Problem: We Need More Antimicrobial Researchers, Infectious Disease Clinicians
A decreasing number of researchers and open positions for infectious disease clinicians and limited residency matches are underlying issues that need to be addressed to meet the needs around antimicrobial development and clinical care.
The number of researchers working on antimicrobial resistance (AMR) has significantly declined over the past 20 years, according to the AMR Industry Alliance. By one metric, the total number of authors on all AMR publications has declined from a high of 3,599 in 1995 to 1,827 in 2020, alongside an overall decline in publications.1
It's estimated there are approximately 3,000 AMR researchers in the world who are currently active, compared to as many as 46,000 for cancer. This equates to the former group being 15 times smaller than the latter group.1
“Antibiotic drug development isn't a very lucrative field for pharmaceutical companies, and they're the kind of pull incentive that's gets researchers into the field, because there's a promise of a drug down the line that is going to create a return on investment and improve outcomes for patients,” said Amesh Adalja, MD, FIDSA, a senior scholar at the Johns Hopkins Center for Health Security, practicing infectious disease physician, and spokesperson for the Infectious Diseases Society of America (IDSA). "When you think about antibiotics, they're a very small market in terms of pharmaceuticals. And the market that antibiotics play in is very different than any other type of drug.”
In order to try and make inroads to try to get pharmaceutical companies interested in developing antimicrobials, Adalja says one strategy is to develop a pull incentive like the “Netflix pay model," which was previously introduced in Congress as the Pasteur Act, but remains in a holding pattern.
Read more: An Update on the Pasteur Act
“There are some innovative methods, like the Netflix model, where you buy a subscription. A hospital might buy a subscription, or an insurance company might buy a subscription to a portfolio of antibiotics for a certain price, and then they use it as much as they want. Just like when you have Netflix, you can watch a movie as many times as you want,” Adalja said. “So there are initiatives at the legislative level in the United States. This has already happened in the United Kingdom, to try and change that model, to make the financial incentives better…When people invest in antibiotics, then, in turn, this will increase the number of researchers that have positions in antibiotic resistance.”
Infectious Disease Clinicians
On the clinician side, it is a bit more complicated. When looking at the National Resident Matching Program (NRMP), ID matches have been around 50% the last couple of years.2 NRMP is a non-profit organization that manages both the main residency match and the specialties matching service and links medical school graduates with residency and fellowship programs. The match for appointment year 2025, brought 316 new infectious diseases clinicians into the field, according to the IDSA. 2
“The number of physicians entering the field has increased since 2010 and we have also seen a significant increase in the number of training program positions offered. This year, 50.8% of programs were filled in the match, maintaining the same proportion as last year. Overall, when we examine absolute numbers of positions offered, positions filled as well as the number of programs offered and filled since 2010, our trends over time are positive. Specifically, the absolute number of programs filled is relatively stable, but the percentage declined as the number of programs offered increased,” IDSA wrote on its site.2
IDSA says these trends point out the ongoing demand for ID specialists.
In 2023, the Health Resources and Services Administration estimated that in 12 years there would be a demand for 15,130 infectious disease specialists in the US, but there will only be an estimated 14,010 ID physicians.3
Read more: Addressing the Decline in the Number of Infectious Disease Physicians
Whereas cities and suburbs may have access to ID clinicians, rural and smaller communities lack these essential providers. “Physicians who focus on infectious diseases are uniquely qualified to help prepare for the next pandemic, but 80% of US counties lack a single ID doctor,” Carlos del Rio, MD, FIDSA, former president of IDSA, said in a previous statement.3
Furthermore, Adalja points out that although the ID specialty is rewarding, its compensation lags behind other specialties.
“Traditionally infectious disease has been considered one of the more rewarding specialties in terms of intellectual stimulation and cognitive rewards,” Adalja. “But that's not the same thing when it comes to monetary reward. Infectious disease tends to be one of the lower paying specialties of medicine, and that has to do with the formula of how doctors are paid. That comes from the Centers for Medicare and Medicaid Services and how they reimburse certain types of activities that physicians partake in. Infectious diseases is not a procedure-based specialty; it's a cognitive specialty.”
