April 30th, 2008

Young Doctors “Get a Life” — Whither ID/HIV?

A front-page article in yesterday’s Wall Street Journal says that younger physicians (definition:  younger than I am), “intent on balancing work and family,” are choosing specialties that allow them to control their hours.  The content of the article will be familiar, including:

  • The rise of the hospitalist movement
  • A decline in those entering primary care fields
  • The pros and cons of this change (a better-rested, more-balanced doctor vs. the inevitable lack of patient continuity — gone is the “hero model of the lone ranger who is there 24/7, 365”)
  • Ways that specialties with unpredictable call (such as obstetrics) are adapting to this trend

Not discussed in any detail, but obviously also critically important, is that many doctors have hundreds of thousands of dollars of debt from student loans. Why would these doctors choose a field that is both less predictable and less remunerative than one of the “ROAD” specialties (as one med student recently called them) — radiology, ophthalmology, anesthesiology, or dermatology?

Which brings me to Infectious Diseases and/or HIV Medicine as specialties. We certainly can’t compete with the ROADs of the world in terms of predictability of call and per-hour compensation, and the complexity of our cases (and, no doubt, our obsessive tendencies) make us notorious for long hospital hours.  (One of my colleagues was nicknamed “Dr. FILO” — for “first in, last out” — to describe his hospital schedule.)

So where does ID/HIV fit into this new reality? Will we lose the best and brightest young MDs?

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HIV Information: Author Paul Sax, M.D.

Paul E. Sax, MD

Contributing Editor

NEJM Journal Watch
Infectious Diseases

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