President's Podcast: Bio-Preparedness Workforce Pilot Program

Carlos del Rio: [00:00:00] Welcome to the Let's Talk ID podcast. I'm Dr. Carlos Del Rio, president of IDSA. And joining me today to talk about the Bio Preparedness Workforce Pilot program are two IDSA colleagues, Dr. Paul Pottinger of the University of Washington, and Dr. Emily Spivak of the University of Utah Health. The Workforce Pilot project was included in the Bio Preparedness Workforce Act that was passed by Congress at the end of 2022. Both of you were involved in Issa's advocacy efforts to get this bill passed. Why did you decide to get involved and why do you think it's important for IDSA and HIVMA members to engage in advocacy? Paul, do you want to start?

Paul Pottinger: [00:00:35] Yeah, sure. You know, one of the things I do here at the University of Washington is to serve as director of our ID fellowship program. And so I hear this from our applicants and from our fellows and our graduates. You know, debt relief is an attractive option. It's something that can help draw people into the field if they are on the fence or they're, you know, sincerely, and I think, reasonably understandably, they're worried about the amount of debt that they have acquired during their medical education. And while IDSA works on other ways to improve compensation for people who do the work of ID, this is something that can get things started in the right direction. So I got involved because this is what our fellows have asked for, but I also got involved because it was fun to do something different. I would say, I think ID is all about advocacy in general, right? We advocate for our patients, we advocate for our colleagues. This is a way for me to advocate in some small way on behalf of all of us who do the work of ID and to feel like I was having an impact beyond the walls of my clinic room or the hospital room, or I'm seeing a particular patient.

Carlos del Rio: [00:01:38] That's great. How about you, Emily?

Emily Spivak: [00:01:40] Yeah, similar to Paul, I got involved in a nutshell to broaden the scope of my impact. I serve as medical director of antimicrobial stewardship at University of Utah Health, and I've been in that role about 11 or 12 years, and a lot of my time in that role has been locally advocating for resources, for stewardship, as anyone who does stewardship knows, most places are are underfunded or under-resourced for the amount of patients or beds that you have. It was really great for me to have advocacy opportunities pop up through my role in the Antimicrobial Resistance Committee at the same time that I was really starting to get fairly burned out from kind of banging my head against a wall locally and advocating for resources. And I must say the advocacy with IDSA has really been satisfying for me personally because a lot of it has been quite successful in garnering and getting more resources nationally for stewardship across the country and allowed me at a time when I was feeling very burned out and honestly thinking about sort of shifting gears or finding something else to do, allowing me to feel really successful and impactful, and stewardship and antibiotic resistance work at a time where locally I was feeling a little frustrated with the lack of impact or resources that I could gain locally. So I would encourage everyone to do it because it really will make the scope of your impact broader and make your professional career feel much more satisfying as well.

Carlos del Rio: [00:03:00] I'll follow up on that. Emily, so you decided to get involved. How do you do it?

Emily Spivak: [00:03:05] Well, I think people don't realize they're being asked as many times as they are. Often we get in our emails requests from IDSA to send action alerts by emails or post on Twitter to your local senators or representatives about a particular issue that IDSA is advocating around. So I would encourage people to read their emails from IDSA and respond to those action alerts. And I will tell you, you may not feel immediate sort of feedback from those, but after having talked with IDSA staffers and also with staff of my state senators and representatives, those action alerts that we get really do. If you act on them, it matters. These offices are often counting up the number of phone calls and emails that they get about a particular issue on both sides or various opinions. And so that's an easy way to to really have an impact. Another way is that you may even reach out to IDSA and say, Hey, I live in such and such state, I'm available if you need somebody to advocate for various issues. IDSA reached out to me about a particular issue, specifically the Bio Preparedness Workforce Pilot program, and after a request from IDSA, I met with staff from one of my state's representatives here in their Provo, Utah office, and it was an incredibly important meeting for me, even personally.

Emily Spivak: [00:04:17] It felt quite meaningful to drive to Provo a place that I don't commonly go and to meet somebody that I consider slightly different or have different opinions from myself on their own turf. That led to some meaningful discussions and also led to me working with IDSA to publish a  letter to the editor in our local paper, the Salt Lake Tribune, about the importance of also investing in the ID workforce. So I'd say read your emails. IDSA is going to send you stuff that you can act on very quickly and very easily and also maybe reach out to IDSA and if they reach out to you to advocate, don't be nervous about it, just say yes. And they honestly do all the heavy lifting and all the prep work for you. You really just have to show up whether it's virtually or in-person and talk about your experiences and the things that we do every day and that kind of boots on the ground, personal experience is really what many of our representatives need to hear.

Carlos del Rio: [00:05:07] That's great. How about you, Paul? How did you get involved?

Paul Pottinger: [00:05:10] Yeah, very similar. This is actually going back a period of a few years. And, like Emily, I did respond to one of the emails that came from IDSA. We all get so much email. If it comes from IDSA, itt is not spam. That's my one of my learnings that you're actually talking to a real person. So I was able to engage with the team members at IDSA and they were so easy to talk to, so responsive. They made it very smooth process. I'm lucky to live in the state of Washington, lucky for a bunch of reasons. One of them, Senator Patty Murray. We have a senator here who at that time, chaired the Senate Health Committee. And so for over a period of years, I actually joined IDSA staff for some virtual meetings online and also in-person meetings with her staff several times, most recently just this past October, right before ID week started on Capitol Hill. And it was just an incredible experience. I had a similar feeling to Emily, like, you know, I'm just so busy doing my work and seeing patients that I love ID, but this was a way to to feel like my voice was really going to matter to somebody. And they were so patient and polite and eager to hear from us. When I say us, I mean myself and other doctors from the state.

Paul Pottinger: [00:06:19] I was able to get other ID doctors in Washington State to join in these advocacy efforts to amplify our voices. And that was an enjoyable thing as well. And by the end of last year, Senator Murray, who was in this powerful position, you know, she became one of our most tenacious champions on Capitol Hill to make sure that this pilot project became law. And so that was, again, a very gratifying process. I would also say super fun. And the IDSA staff made this really easy for us to participate. You know, they know the details of how to lobby. They understand how the sausage is made, so to speak. So I learned a lot that way. But really my role was to advocate for my colleagues and for our patients and to be a voice of what it means to be an ID doctor in the United States. And I think the people on Capitol Hill are just so hungry for a touch of reality to know what's really going on in the context of COVID, but in the context of the opioid epidemic, in the context of HIV impacts, whatever it may be, they want to hear these stories. And so that was enjoyable and it had an impact.

Carlos del Rio: [00:07:21] Thank you. Paul. Well, tell us now what the pilot project entails. You talked about this pilot project becoming law. What is this pilot project?

Paul Pottinger: [00:07:28] Yeah, so it's really exciting. The pilot project is designed to provide some student debt relief for people who choose a career in ID. So for example, someone who is an ID fellow, or who has graduated from fellowship within the last ten years, would be eligible to participate in this program. Actually, it's also not limited to doctors. Nurse practitioners, PAs, infection preventionists- people in this field could be eligible to participate. You just have to be working in a health professions shortage area or medically underserved community or working with a federal facility. So what does this all mean? HRSA keeps a list of definitions of what all these things mean, and I would encourage listeners to check it out online. But there are certain parts of the United States that are considered to be short of health care professionals that could be based on geography, for example. There's also communities within any particular geography that are considered to be underserved. These are considered to be medically underserved areas or populations that could be someone who's living unhoused, someone who's a Native American, someone who's a migrant farm worker. There are opportunities that meet these definitions, both rural America and urban America. People who are interested in this would have their choice of different areas where they would choose to practice. If they do, then those health care professionals could be eligible for up to $50,000 per year, up to three years in a row, all of which would go to underwrite and partially defray the amount of debt that they've acquired. Getting to that point in their career, this is not yet available. This bill is passed, so it is law. But now Congress has to fund it. Apparently, these things are not the same. And so here we are, the end of February 2023, and there's still some advocacy to do, and we'll talk a little bit more about that. But we're very, very optimistic that this will become a funded law. And I'm excited to see whether this can help bring people into our profession and the people who've chosen get them some debt relief.

Carlos del Rio: [00:09:32] That's wonderful. Yeah, you're seeing how this was just made, right? You get the law through Congress and then you've got to get the president sign it and now Congress has to fund it. So it's a multi-step process and it's complicated, but but part of it is you're learning about it, in which I think that's important. So, Emily, how does this pilot address the workforce needs? We keep on talking about workforce and Paul talked a little bit about it. How do you see it personally?

Emily Spivak: [00:09:54] Well, personally, I see it that I do a lot of teaching of medical students beginning in the first year of medical school, and literally like half the class is interested in going into infectious diseases by the time they are fourth years. That has whittled down to very few people. But what's interesting, of course, is it's not that they've lost their interest in ID, they still think it's fascinating. They really understand that you can have a dynamic career and stay with an infectious diseases and do many things with different scopes across your career, but they really attribute their decision to go into something else because of their concerns around the amount of debt that they have accrued in medical school and sometimes even an undergraduate before that. And their concerns around compensation compared to other specialties or other fields, is the lack of compensation for ID physicians. So we hope that this pilot program, by alleviating some of the student debt, will sort of take that weight off of some of these medical students and residents' minds and allow them to really pursue what they're passionate about and what they're curious about and hopefully stay and choose a career in ID. The actual sort of scope or the impact of this program, as Paul alluded to, is not yet determined, meaning the number of people who can actually receive this loan repayment, this $50,000 per year, up to three years, depends on how much funding Congress dedicates to this program and to this law.

Emily Spivak: [00:11:17] And so that's going to be where we really need everyone's voice and advocacy because it's not across the finish line yet. And we really will need to get enough funding so that we can provide this opportunity for many people who want to go into ID. We also know that this is not a silver bullet. This is not the one thing that is going to solve the problem of lack of ID workforce and those going into ID, But it's one step, one approach that will, I think, hopefully alleviate some of the problems and help some interested medical students go into ID. But IDSA is also working on a variety of other ways to strengthen the ID workforce and specifically increase ID compensation. So I encourage everyone to stay tuned. Again, like Paul said, read your emails and help advocate for all of these various mechanisms that we think will increase compensation and increase the ID workforce.

Carlos del Rio: [00:12:04] Well, that's great. As president of IDSA, in on behalf of the board, I want to thank both you, Paul and Emily, for what you've done and the advocacy, because I know this is passion, this is free work. This is really you do it because you care about the mission, you care about the topic, You go and you do it, but you're doing it on your own time. And this is really the volunteer work. And we need our volunteers. We need our members to volunteer for this kind of activities in order to get our agenda in order to benefit, as Paul said, our colleagues and our patients. And as you said, now we need everybody involved in advocacy. Right now we need everybody to to call their congressperson, to call their senators, to talk about the importance of funding this bill, to get it passed the finish line and make it available for everybody. So as Emily said, as Paul said, look at your email, open the email from IDSA and get involved because there are more of us getting involved with advocacy at the local level, at the federal level, the better it is for all the important work that IDSA is doing on behalf of our colleagues and on behalf of our patients and to advance the professional infectious diseases. So any closing comments you have, Paul?

Paul Pottinger: [00:13:08] This work, it sounds like a lot of work. It's just so fun because of the way the professional staff at IDSA handle it. And if you are frustrated with the current state of affairs of ID in America, this is your chance to make your voice heard. And I really encourage people to do that. Yeah, you're right, Carlos, email from IDSA is not spam. Check it out. Respond and you will get a nice response. I promise.

Carlos del Rio: [00:13:31] How about you, Emily?

Emily Spivak: [00:13:32] Just echo what you both said and I'm being 100% honest when I say all of the advocacy work that I've been involved with over the last whatever it is, 2 to 4 years now really has been some of the most satisfying work that I have done in that time and has really kept me afloat in a really frustrating time for all of us within exciting but also at times frustrating time within ID. And so it is really just a really important way to have a huge impact, but also to feel very successful in what you do. And so I would encourage everyone again to participate. Respond to the IDSA calls for action, your advocacy messages on social media and respond to IDSA if they ask for you to do in person or virtual meetings in your state because it really will be well received and have a huge impact.

Carlos del Rio: [00:14:19] Well, I want to thank both of you for spending time this morning talking to me about why advocacy is important, about the BIO-Preparedness Workforce Act and about the pilot project. And I want to thank all of you for listening to Let's Talk ID. We'll see you soon.