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Addressing compensation disparities: An ID perspective from the frontlines

Casi M. Wyatt, DO, FIDSA
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As an infectious diseases physician in Idaho, I’ve seen firsthand the risks posed to patients and public health when there is little access to the expertise that only ID specialists can provide. Just five of my state’s 44 counties have ID doctors: Ada County, where I live in Boise; Kootenai County, which includes the city of Coeur d’Alene; and Bonneville County, which includes Idaho Falls. My state’s not alone — 208 million Americans live in communities with little to no access to an ID physician.

As a member of IDSA’s Payment Policy Work Group, I’ve been working with my fellow ID clinicians to address these stark numbers, in part by focusing on the serious compensation issues we face. This includes inappropriately valued evaluation and management services that have contributed to a large compensation disparity between ID physicians and many other specialties that primarily perform procedures. These disparities limit workforce recruitment and patient access to care, negating efforts to improve pandemic preparedness and health equity.

As one part of IDSA’s multi-pronged compensation strategy, IDSA is advocating for the Centers for Medicare and Medicaid Services to increase the value of inpatient E/M services to maintain relativity with the outpatient E/M services that were revalued last year. In addition to lobbying CMS directly, IDSA is mobilizing members to urge our senators and representatives to press CMS on this issue.

Educating lawmakers about the need for action

Recently, I jumped at the chance to meet with one of my senators, Sen. Mike Crapo (R-ID). Senator Crapo is the ranking member (or most senior Republican) on the Senate Finance Committee, which has jurisdiction over CMS, including federal physician reimbursement policy. I urged him to support IDSA’s efforts on inpatient E/M services as a step toward modernizing compensation to meet the ID threats we face in 21st century that are adversely impacting our communities.

While talking with Sen. Crapo’s staff, I emphasized how important it is for CMS to update reimbursement for inpatient E/M services to improve ID physician compensation. I highlighted that despite the significant value ID physicians provide, only 70% of ID fellowship training programs were able to fill their slots in 2021, with inadequate compensation often cited as a barrier to entering the field of ID. Financial concerns may be particularly challenging for physicians from underrepresented backgrounds, as they may be more likely to carry higher student debt burdens. We must recruit a more diverse ID workforce to promote health equity, and updating inpatient E/M codes to improve compensation is an important step to ensuring a larger, more diverse ID workforce.

What you can do to help

As an ID physician, I was honored to share my frontline experiences to help educate policymakers and ensure we have the ID physician workforce we need to address current workforce gaps and ensure that all communities and patients have access to an expert ID workforce. Our voices are vitally important at the bench, bedside and in congressional and agency spaces where policy affecting our profession is made. The 2023 Medicare Physician Fee Schedule proposed rule is expected to be released by CMS in late June, which will provide another opportunity for advocacy on behalf of ID physicians. I hope you’ll add your voice when called upon. Let’s make the most of opportunities to fortify the ID physician workforce.

Want to get involved in additional efforts to drive change to address ID physician compensation and other key issues? Visit the IDSA/HIVMA Action Center today. 


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