An ongoing dialogue on HIV/AIDS, infectious diseases,
September 27th, 2013
Yes! An Economic Justification for ID Specialists
ID Doctor #1: He seems like a great candidate — wants to study hospital and community epidemiology of highly drug-resistant bacterial infections, and has already made major contributions to his hospital’s quality assurance program.
ID Doctor #2: Listen to this applicant: She’s been working in [insert resource-limited country here] since junior year in college, even continuing to go there part-time during her residency. She apparently started an HIV screening program in rural healthcare settings that has reduced perinatal HIV infections by 50%!
ID Doctor #1: My next interviewee has his PhD in yeast genetics. I can’t understand his work, but he has three first-author papers in [insert three highly prestigious basic science publications here], and he won the “Top Clinical Resident” at his program last year, proving he’s not just a science drone.
ID Doctor #2: He sounds terrific. But should we ask these young doctors the really tough question about ID fellowship: Will they be willing to work hard in a medical specialty that pays so poorly?
Look, I get it. We just don’t — and can’t — do the obvious things that bring revenues to U.S. medical providers. First, we do essentially no procedures. Second, the very nature of our patient population makes it impossible to churn through high volumes of clinical visits, either in the inpatient or outpatient setting. And third, for those ID doctors who focus on HIV, the demographics of the patients will almost invariably skew toward the indigent.
Now all of this makes us ID doctors, sniff, feel relatively underappreciated, at least from a financial perspective. You should see the red carpet (salaries, office space, advertising, yachts — OK, not yachts) rolled out for our interventional radiologists who treat varicose veins. Meanwhile, we struggle to find funding for the food at our weekly educational conferences.
Is that fair? Of course not.
But what we ID doctors do must have some value, right? Otherwise why does the demand for ID consults seem infinite, increasing all the time? Does our expertise in management of highly complex medical and surgical patients improve patient outcomes and — gasp — even reduce costs?
“Yes!” says this in-press paper in Clinical Infectious Diseases.
The final corrected proof is not yet available, but set aside your “let’s wait for the final published paper” tendencies, and contemplate these incredible findings about those who get ID consults versus those who don’t:
- They had a significantly lower mortality. Is there a more important clinical endpoint? Impossible, kind of like trying to beat 5 Aces in poker.
- They had a significantly lower length of stay in the ICU. We all know that the more days in the ICU, the greater likelihood of badness (a medical condition to avoid) and the higher the cost.
- They had a significantly lower rate of readmissions. Quality assurance gurus love readmissions data.
What’s more, “Patients receiving ID intervention within 2 days of admission had significantly lower 30 day mortality, 30 day readmission, hospital and ICU length of stay, and Medicare charges and payments compared to patients receiving later ID interventions”. I quoted it in its entirety, because how can you improve on that? Better quality and lower costs? Sounds like just what the doctor ordered for our troubled healthcare system.
There’s some potential bias here, since many of the authors are of course ID doctors themselves; plus, we ID docs love Clinical Infectious Diseases; it’s a journal that speaks right to us. But these concerns notwithstanding, I’m hoping this important study will catch the attention of non-ID providers, hospital administrators, and healthcare economists, and that they will subsequently realize that not everything can be measured in RVUs/hour. Maybe they’ll even send some of that varicose vein-procedural revenue our way so we can have sandwiches at our case conference.
Meanwhile, time to continue interviewing these promising young pre-ID doctors for the best specialty in the world.