Steve Schmitt: [00:00:09] Welcome to Let's Talk ID, the podcast that's all ID, all the time. This is the President's Podcast. And I'm Steve Schmitt from Cleveland Clinic. I'm president of IDSA. Today, we're talking about the ID workforce and the ID program Match. And I am pleased to welcome today two experts in this area. First, I'll introduce Dr. Vera Luther, who's professor of medicine and director of the fellowship training program at Wake Forest, and the chair of the Training Program Directors’ Community of Practice for IDSA. Welcome, Vera.
Vera Luther: [00:00:43] Thank you.
Steve Schmitt: [00:00:44] I'm also pleased to have with me today, Dr. Emily Blumberg, who is professor of medicine, director of transplant ID and program director of the ID fellowship at the hospital of the University of Pennsylvania, and the chair of the Professional Development Committee at IDSA. Welcome, Emily.
Emily Blumberg: [00:01:03] Thanks very much. Happy to be here.
Steve Schmitt: [00:01:05] Well I'll get right to it. So recently, my last presidential podcast, I spoke with Wendy Armstrong and Erin Bonura about the past ID training program Match data. And since then, we have the 2023 Match data. I'll ask Vera, what are the overall trends for us to pay attention to?
Vera Luther: [00:01:30] Well, I think one key point as we're looking at trends is to look at the absolute numbers. So look at the numbers of applicants, positions offered, the positions that were filled, the number of programs that offered spots, and the number of programs that filled. Because percentages don't tell us the whole story. But looking at trends over the past 15 years or so, the number of physicians entering the field has increased overall and overall, the trend is positive. When we look at the past few years, we saw a peak in physicians entering the field early in the pandemic for 2020 and the 2021 Matches. So that's people who are starting their fellowships in 2021 and 2022, respectively. And then we saw that spike dissipate closer to baseline rates in the following two Matches. And when we look at the absolute number of programs filled, we see those numbers are relatively stable. But the percentages of positions that were filled and the percentages of programs that filled has decreased because there's been a significant and steady increase in the number of programs and positions offered. I think that reflects the high demand for ID specialists nationwide. So there is a bit of a supply demand mismatch. Importantly, when speaking with program directors around the country, the consensus is that the caliber of the ID fellowship applicants remains incredibly high. So there's a lot of enthusiasm for this next generation of ID physicians.
Steve Schmitt: [00:03:14] Do you have anything to add to that, Emily?
Emily Blumberg: [00:03:15] This current year's applicant pool was amazing. The commitment of the individuals, the things they had achieved prior to joining the Match was just extraordinary. And so while the absolute number was lower, the caliber of people remains just exceptional. And so excited to see what this next generation of ID practitioners is going to contribute to the field.
Steve Schmitt: [00:03:40] Yeah, I'll echo that. You know, we just have had exceptional folks interviewing and now entering the program. So we're really excited to train those folks. You know, one of the trends that seemed interesting from the Match data was regarding US grads versus international medical grads. I wonder, Vera, could you comment on that?
Vera Luther: [00:04:03] When we saw the spike in fellowship applicants early in the pandemic, we specifically saw a dramatic rise in applicants who were international medical graduates, including US born applicants who went to an international medical school. Interestingly, the number of US born allopathic trained applicants stayed pretty steady over that time and has stayed pretty steady over the past decade. And then in the past two Matches, we saw the number of applicants who were international medical grads or US born international medical grads, we saw that number decrease. The number of osteopathic applicants who applied to ID around this time also spiked during the time of the pandemic, so we really need to do more investigating into why we're seeing differences in application among different types of candidates, all of whom are incredibly important to our workforce. But we need to do more investigating around issues involving visas, immigration, obtaining visa waiver positions, and implications for the ID workforce. We don't have a full understanding of the impact Covid had on the decision to pursue a career in ID, and this cohorts training was certainly impacted by Covid, so most of the people who applied to ID this past Match were in their third year of medical school during the early stages of the pandemic, and then experienced the effects of the pandemic throughout much of their training. So that's going to be a really interesting thing to take a deep dive into.
Steve Schmitt: [00:05:54] That's a fascinating part of this. You know, I'm not sure that we really have any idea on that. And I think it seems pretty clear that these nuances around Covid and the international medical graduates, etc. are really going to keep the med ID community of practice busy doing the analysis. So shifting gears a little bit here, you know, one of IDSA's key strategic efforts has been focused on ID workforce. And the Match is certainly, you know, part of that. And we all are wanting to make sure that ID is healthy and vibrant going forward as it is now. But I know, Emily, you've been very much involved in that from the Professional Development Committee point of view. Are there some key elements that have affected our workforce that you all have ferreted out, and how is IDSA addressing these?
Emily Blumberg: [00:06:50] There are two main themes that we're tackling first. The first is burnout. There's no question that the Covid 19 pandemic had a tremendous impact on our field. Initially, to just make us feel that we really could make a huge difference in what was happening to patients and really impacting care and truly being involved in saving lives. But when the reality sank in, we realized there was just a lot more work than there were people to do the work. And I think all of us found ourselves working longer and harder than we had anticipated, and for a longer period of time. The impact of the pandemic really stretched well beyond the first few months and stretched into several years. And I think everybody is still recovering from that level of burnout, both from the actual hours at work, but also dealing with sort of societal reaction to the pandemic and what that meant for us.
Emily Blumberg: [00:07:54] IDSA has really recognized that our workforce needs to be recognized, and we need to put some safeguards in place to actually help people do their jobs better, more efficiently and more effectively, and also to be recognized for the work that's being done. And this is taking many forms, but certainly there's been a lot of interest in creating more individualized education and the educational platforms that have been available through the society during the pandemic but have extended beyond, have actually really helped us all do our jobs more effectively.
Emily Blumberg: [00:08:33] But we also recognize that there's a need for sort of for mentorship and the ability to create opportunities to grow in leadership, to help us better do our jobs, and also to be better recognized in health care systems for the work we do, so we can get more resources and impact our ability to work. And so this has been very valuable to have specific leadership training. We're also interacting with ABIM to think about really what it means to stay continually certified in the field. And what we can do to work with ABIM to work on those issues as well. We've also reached out to advanced practice providers and pharmacists to incorporate them into our field, and make sure we can all work together as a team and work smarter and more effectively and efficiently from that. And so this whole notion of interprofessional team based care, I think, will help our field moving forward as we go through this. And then the final thing I think for workforce is, we're now training some really exceptional international medical grads, who are dealing with the issues of their visas, their visa requirements, their ability to work within their scope of practice that they've now just trained in immediately, as opposed to go into practices that are unrelated. And I think IDSA is working hard to try to figure out how better to help these international medical grads find more of a home for the practice that they have trained for. And that's a very important part as well.
Emily Blumberg: [00:10:16] The other piece of this that I think we have to acknowledge is that our compensation does not reflect the level of our work. We are, unfortunately, on the lower realm of compensation, which probably makes a difference when people come to choose the field that they're going to go into. Because medical students now graduate with enormous amounts of debt, and they may not be able to afford a career that they might otherwise choose. And it's unfortunate, but hospitalists do get paid more than ID specialists in many areas of the country. And so I was excited to see that IDSA is actively working on this. I had the opportunity to go lobby Congress recently, and this was one of the topics that we discussed, is just recognizing that the compensation models that currently are the basis for all of our salaries and for things like Medicare reimbursements, really don't reflect the level of commitment and and effort that's going on. And so having a voice in the federal government to try to recognize this and really try to work with payers as well to better compensate people for the work they're actually doing, will help us be able to promise higher compensation to people who have so much debt and require more support to be able to choose the field that they might otherwise want to do.
Steve Schmitt: [00:11:43] Yeah, that's really an excellent point. And, you know, as you may know, I chair the comp task force and, uh, we've really been working hard on the advocacy piece, but also we've provided some resources for folks to use in negotiation and some a really interesting piece of having one on one sessions with some of our consultants for folks to look at their comp and as they enter their negotiations. And so I think that's a that's, uh, go to the website to the comp page, if you want to find some of those resources and, and you haven't yet. Emily, you're talking about going to Capitol Hill. And so I think that was on the front end of our recent leadership summit. Yes?
Emily Blumberg: [00:12:30] Yes, it was. It was great to go and talk to, you know, really diverse lawmakers offices about this.
Steve Schmitt: [00:12:37] Right, which was fantastic. So we had some great advocacy, uh, going into the leadership summit. And that carried that energy, carried into the summit where we actually had the board and then all the chairs and vice chairs of the various committees and communities of practice in one place, which was fantastic interaction and energy. And I'll throw it out to either one of you. Can you talk about some of the ideas that emerged from some of those sessions for us to carry forward and work on?
Emily Blumberg: [00:13:07] One of the things that we are really interested in doing is engaging people, sort of from the ground up. So really trying to, you know, identify interested people as early as college and medical school and going into the community. And we have some phenomenal educators, and we want them to really connect things like the GERM award program, which gives scholarships for people to do research or, you know, significant clinical experiences are ways that will hopefully attract this. And I think we're really looking to engage the medical education community of practice for innovative strategies. So that's one thing that really came up, is really trying to go in at the very beginning of medical careers to entice people with the incredible opportunities in our field.
Vera Luther: [00:14:04] Yeah, we had several similar conversations of how to best share the meaningful work we do, share all of the variety that encompasses is the field of ID, and just the point that a lot of times learners don't get a chance to see that. They see just a small piece of what we do in ID. So ways to share all of the interesting things that you can do with a career in ID, that meaningful work to reach patients both one on one, but then at, you know, a broader level, public health work, what it means to be involved in stewardship or infection prevention, and why trainees might want to go into that. And then also talking a little bit about some of the educational resources that IDSA currently provides to help educators do their job the best they can and what we can do to expand on those. So, you know, current offerings, things like the Chalk Talk series and the antibiotic stewardship curricula. And so those can be, you know, helpful resources for educators to go to and, and use. And then we also had a lot of great conversations around the importance of diversity in our specialty, and how it's so important to ensure that diversity continues to have that prominent role in everything we do in all of our initiatives.
Emily Blumberg: [00:15:39] Yeah, I think it's really important for the workforce to reflect the communities we care for. And I think that's something that to a person in the ID community that we feel very in touch with the communities we care for, and we want to have a diverse workforce that allows us to really better understand and work with all kinds of communities throughout, throughout the world. Really, one of the things we all felt was really important was for the people in the c-suites to understand exactly what we do, and so there was a lot of enthusiasm for that in our group to really make sure that we had the tools that you described going on the compensation pages for people to be able to reflect on the activities they do that aren't the sort of direct patient fee structure payments, but the things like stewardship and infection control. But even beyond that, work that ID providers do to improve the practices in the hospital, make them more efficient, more cost effective, get people out of the hospital sooner with better plans for maintaining or achieving health, and that this really is something that we're trying to work to develop the tools so people can go to those people who are running hospitals and health care plans and let them know these are the things we're doing, this is saving you money. This is improving the care of your patients. These should be recognized as well.
Steve Schmitt: [00:17:14] Yeah, and not just as add-ons. You know, I think that's the other part of this, right? You'll see this on the, on the comp pages, but too often these things just get tacked on without necessarily there being an FTE recognition of that part. And so people end up with a documented 1.0 FTE and working about a 1.3 or 4 FTE, if not more. And so finding ways of making sure that either a. You're getting paid 1.3 or b. or you're cutting back on the clinical commitment to reflect the other things you're doing is so important. Any final words that you all would like to leave the members with as we're working toward securing the future of the workforce here?
Vera Luther: [00:18:08] Role models matter. I think, you know, those of us who entered the field of ID can remember 1 or 2, maybe a few more, if we're lucky, but people who really inspired us. And so you can absolutely be that person. I think taking the time to talk to medical students and residents about why you went into ID, what you find meaningful and exciting in what you do, you know, taking the time to share interesting cases. And then, as Emily mentioned, even thinking about people who are earlier on in their careers, and maybe who haven't even entered medicine yet, but people in college. So if you, you know, have the opportunity to speak at a local university or college, take advantage of that and share your enthusiasm for the field of ID, share a little bit about what it is exactly that we do and how meaningful that is. And even, you know, there's data to support even earlier outreach. So even high schools and, and younger students, and those early exposures can be really impactful.
Emily Blumberg: [00:19:20] One thing that I think we should really reflect on is we should be really proud of the work we did in Covid. We don't have to look very far to recognize that the ID community not only rose to the challenge, but really saved lives, impacted communities, and continued to make a difference, to make our world a safer place to live in. And that's an incredible accomplishment for us all to be proud of. As we reflect on how tired we were doing this. Now we can look back and think, but look what we how far we've come.
Steve Schmitt: [00:20:02] Well, that is a great jumping off point here. Thank you so much to the both of you for coming on today and for everything you all do for the future of ID. This has been the Let's Talk ID President's Podcast. I've had a wonderful conversation with Dr. Emily Blumberg and Dr. Vera Luther. Please stay tuned to this channel for more strategic conversations in ID. Thank you for listening today.