What Harmed the Value of Infectious Disease Specialists?

Infectious disease clinicians may be front and center of coronavirus 2019 (COVID-19) response—the greatest issue in this generation of public health development—but the subspecialty has been burdened with limited resources for some time in the US.

In a continued interview with Contagion, Brad Spellberg, MD, chief medical officer of the Los Angeles County and University of Southern California Medical Center, and author of the book Broken, Bankrupt and Dying, discussed how infectious disease has become financially neglected and an infrequently sought-after subspecialty among young physicians.

As he noted, its status as a cognitive field harms the funding its clinicians receive in health system allocation.

“If you want to survive in the healthcare system in the United States, you need to rack up item bills,” Spellberg said. “You need procedures, you need to do invasive things.”

And though infectious disease specialists have a reputation for refined skill in HIV, antimicrobial prescribing and virology, they lack true ownership of any of these necessary offerings—unlike other specialists.

As such, they often have to compromise pay and resource allocation, or risk being replaced by physician assistants, family medicine physicians, or critical care/emergency medicine specialists.

“We have let our specialty go without owning anything,” Spellberg, an infectious disease specialist himself, explained. “In contrast: you’ve got a cancer patient, you better have an oncologist, or you can’t prescribe chemotherapy.”

Spellberg also discussed when he believes this shift in lost ownership first began: the introduction of antibiotics, the first infectious disease therapy to really peak cross-specialty interest.