Over the last 40 years, Infectious Diseases has fallen steadily behind other medical specialties in the US with respect to brand recognition, value, and career attractiveness. This value depreciation manifests as difficulty filling Fellowship spots, being one of only two subspecialties remunerated below that of a general internist, and declining influence in expert bodies (e.g., the National Academy of Medicine). Unfortunately, the COVID-19 pandemic has only underscored this decline in value and influence.
Although the decline of the ID brand has been widely recognized, little effective change has been implemented to reverse it. We appreciate that the Infectious Diseases Society of America (IDSA) acknowledges the dilemma. The Society’s approach thus far has been meritorious, focused largely around increased fee-for-service billing reimbursement. However, the society has not promulgated other specific solutions. And the lobbying for increasing fee-for-service reimbursement has thus far not borne fruit despite years of very competent and skilled activism by the IDSA representatives. Many other solutions have been proposed but not acknowledged by the IDSA. It is time for a change.
We, the undersigned, therefore urge the IDSA to immediately undertake several additional solutions:
1. Establish a Committee to propose and serve as subject matter experts on reforming medical practice to align Infectious Diseases with prevailing healthcare market forces.
2. Lobby government for changes to regulations and/or law such that only those who have undergone specialized ID training or certification are allowed to interpret diagnostic/susceptibility results or prescribe newly approved antimicrobial agents. Such actions would greatly improve public health by reducing wasteful and harmful testing and procedures, and the spread of antibiotic resistance.
3. Lobby government for changes to regulations and/or law such that reporting of antimicrobial prescription use is a mandatory public reported measure, and link that reporting with payment bonuses and penalties. Similarly, such a change would dramatically help reduce over-prescription of antibiotics, reducing the selective pressure that drives antibiotic resistance.
4. Lobby government for changes to regulations and/or law such that the US healthcare system moves fundamentally away from a fee-for-service model and towards a population health model. Such a model is not only more fiscally responsible for the taxpayer, international experiences demonstrate fundamentally better health outcomes with such systems. Such systems will also help in efforts to combat health inequities that we, the members of IDSA, witness on a daily basis.
We are poised and ready to mobilize for change once and for all. We ask that the IDSA listen to its membership, who are speaking collectively through this petition on these important issues.