HIV and ID Observations

July 1st, 2022

Fellowship Transition and Developing a Sense of Belonging

It’s July 1, which means that today, or sometime very soon, many internal medicine residents will transition to becoming subspecialty fellows. There are many appropriate words to describe this change, including exciting, nerve-wracking, and challenging, but one that doesn’t get quite enough attention is how strangely lonely it feels. The reason this sensation occurs is because […]

---

December 8th, 2019

A Midyear Letter to First-year ID Fellows — With Sympathy, Gratitude, and Hope!

Dear First-Year ID Fellows: Right around now, some of you might be feeling a bit prickly. The workday is long, the supply of daylight dwindles daily, and the cold winds blow in from the north. While friends outside of medicine gear up for holiday time off, your plans might include some hospital coverage. Some of you […]

---

July 7th, 2019

In Praise of Experienced ID Fellows — and a Dozen On-Service ID Learning Units

A few weeks ago, I cautioned ID fellows about underestimating their hospital’s interns and residents. My message — you were like them not so long ago; they didn’t suddenly all lose their brainpower when you graduated. This ungenerous opinion of house staff may be especially held by experienced fellows, as the accumulating workload of the year […]

---

June 23rd, 2019

Advice to Incoming Subspecialty Fellows — Don’t Underestimate or Belittle Your Interns and Residents

Around a million years ago, early during the first year of my ID fellowship, a medical intern consulted me about an elderly patient with a urinary tract infection. Me:  Does she have a catheter? Intern: I don’t know. Me: Has she been admitted before with a UTI? Any cultures? Intern:  I think so — wait, I’m […]

---

July 15th, 2018

On-Service Digest, July 2018 — with Special Section Just for Staph aureus

I’m currently on-service for the inpatient ID consult team, and this is July. At a teaching hospital.  Here’s where some would play scary music. After all, the interns and fellows have just started! YIKES! But no scary music for me — I love working with the July newbies. Because whatever they lack in experience or efficiency, they more than make up […]

---

September 25th, 2016

Is There a Hospitalist “Bounce-Back” to ID?

The New England Journal of Medicine recently published two outstanding pieces on hospitalists, and they had pretty much diametrically opposing perspectives. Both should be required reading for anyone practicing medicine, and indeed anyone who might know — or be — a patient in a U.S. hospital one day. In short, everyone. But since you may not have time, let me […]

---

December 19th, 2015

Part 2, Now The Good News: Why ID Will Survive as a Specialty

Part 1 of this post, which highlighted the primary reason for declining applications to ID fellowship programs, could come across as something of a downer. “Moping about it won’t get us anywhere,” someone said to me, and it’s true nobody likes a whiner. But my point was to acknowledge the issue, and find a way forward. It wasn’t […]

---

December 12th, 2015

The 2015 ID Fellowship Match “Historic Bad”: Part 1, Debating the Cause

This year’s ID fellowship match has just taken place, and the results were, ahem, not pretty. Part 1 will cover why we’re in this situation; in Part 2, I’ll offer some reasons for optimism, and even some solutions. According to data provided by NRMP, 117 of the 335 ID fellowship positions were unfilled. Dan Diekema from U of Iowa, […]

---

August 1st, 2013

Poll: Will There Be A Shortage of HIV Providers?

Over on NEJM Journal Watch — love that new name — I reviewed a paper on the demographics of people living with AIDS in San Francisco. Bottom line — more than half are now older than 50. Implication — that’s so old! First, it really isn’t, unless you compare it to the dismal era 20+ years ago, when […]

---

July 3rd, 2013

First Year ID Fellows — What Do They Learn, and What Do They Hate?

In the weird calendar of academic medical centers, July 1 is the “official” first day of school. In our ID program, however, we shifted it to July 5 a few years ago to avoid the interruption of the July 4 holiday at the beginning of the year. On July 3 — today — our incoming first-year […]

---