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Making Sense of the ID Fellowship Match

Roni K. Devlin, MD, MBS

Disclosures

February 23, 2022

Some years ago, I was called to the emergency department (ED) to perform an infectious diseases (ID) consult on a young man with fever and an impressive full body rash. The list of potential diagnoses proposed by the ED staff was impressive but included both infectious and noninfectious etiologies that were unlikely to be seen in a healthy, immunocompetent patient in the Midwest. I ultimately diagnosed a strep infection and recommended a short course of penicillin.

As I left the ED, a third-year medical student followed me into the hallway, asking if I'd be willing to discuss the case further. As we talked, I could sense in him a nearly palpable level of intrigue — clearly, he'd just discovered the magic of ID. Isn't it amazing to witness a young trainee at the exact moment they've found their calling? I continued to mentor this student as he graduated from medical school, began his internal medicine residency, rotated on the ID service (more than once!), completed an important infection control project, and submitted his preferences for the ID Fellowship Match this year.

In the 2021 Match, there was a hint of hope that more residents were interested in infectious diseases as a specialty than had been seen in past years. According to the Infectious Diseases Society of America (IDSA), last year's match consisted of the "highest proportion of filled positions and programs in over a decade." In 2016, only 42% of the ID fellowship programs filled their positions.

Why doesn't ID hold more appeal for students and residents in the US? Maybe because it's a challenging specialty that requires its practitioners to handle many different responsibilities. Maybe because it's one of the lowest-paid specialties in America. Maybe because they haven't had the chance to work with an ID provider that can serve as a mentor. Maybe because they've witnessed ID providers who are overworked, exhausted, or burned out. Previously published studies have confirmed that all of these concerns, among others, have affected ID fellowship program fill rates — take a peek at this publication by Bonura and colleagues for more details.

Fortunately, the resident I've mentored just heard he matched at his first choice for ID fellowship and is overjoyed. Other stats on the 2022 ID Fellowship Match, per IDSA:

  • The total number of certified ID fellowship programs for 2022 was 172 (seven more than the year before, but 42 more than a decade ago).

  • Seventy percent of the 172 programs filled (a decrease from 75% last year).

  • A total of 436 ID fellowship positions were available, and 82% of them filled (down from 88% in 2021).

  • Of the applicants who matched, 46% are US MD graduates, 26% are foreign medical graduates, 14% are US foreign graduates, and 14% are US DO graduates.

I'd like to think that the benefit, importance, and worth of ID providers would be even more understood (and, frankly, celebrated) as we enter our third year of the COVID pandemic. But there is already a shortage of ID providers, and we need to do more to ensure that we fill all available ID fellowship positions in future years.

Without a doubt, ID providers warrant improved compensation and options for student loan forgiveness. More case-based, interactive ID didactic sessions for students and residents should be offered to better pique interest. Trainees must have access to ID rotations in medical school and/or within the first 6 months of residency (it has been shown that early exposure increases interest in ID as a career choice). We ought to have protected, dedicated teaching time for ID docs at community-based teaching hospitals. And we need to keep our current ID providers happy and healthy so that we don't lose a generation of amazing mentors to burnout and early retirement.

The Association of American Medical Colleges has noted that the number of students applying to medical school is up 18% from last year. This phenomenon has become known as the "Fauci effect" and is thought to be a result of Dr Anthony Fauci's impact during the COVID pandemic. I can only hope that it translates into an increased interest in infectious diseases, as well.

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About Dr Roni Devlin
Roni K. Devlin, MD, MBS, is an infectious diseases physician currently residing in the Midwest. She is the author of several scholarly papers and two books on influenza. With a longstanding interest in reading and writing beyond the world of medicine, she has also owned an independent bookstore, founded a literary nonprofit, and published articles and book reviews for various online and print publications. You can reach her via LinkedIn.

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