Telemedicine in infectious diseases: Opportunities, challenges and the path forward

The diminishing number of infectious diseases physicians is well-documented. Although the number of matched ID fellowship applicants has increased modestly in recent years, the 2025 Match raised significant concerns with only 45% of programs filling available positions, the lowest number since 2014-2015 (1), continuing a trend of declining fill rates.

Meanwhile, many rural and underserved areas have ID physician coverage that has fallen below recommended levels, contributing to delays in diagnosis, inappropriate antimicrobial use and worsening patient outcomes. (2,3) Current estimates suggest that fewer than 10% of U.S. acute care hospitals have on-site ID physician support, with the gap most pronounced in rural areas.

The data are clear: ID expertise is needed. ID consultation has been consistently associated with reduced mortality across multiple types of infections. (4-8) Beyond mortality benefits, ID expertise increases appropriate antimicrobial use, even in hospitals with established stewardship programs. The presence of an ID specialist is associated with both lower total antimicrobial use and lower use of broad-spectrum antimicrobials. (9) This expertise is especially critical as antimicrobial resistance continues to escalate, and inappropriate prescribing remains a significant challenge in hospitals without ID support.

Accordingly, IDSA and the Society for Healthcare Epidemiology of America strongly recommend that antimicrobial stewardship programs be led by ID physicians with additional stewardship training. (10-11) Collectively, these findings highlight the critical need to close the gap in ID care.

The role of telemedicine

Telemedicine offers an effective and efficient, evidence-based solution to bridge the gap between workforce shortage and clinical need. ID telemedicine (Tele-ID) allows ID physicians to care for both inpatients and outpatients remotely through live audio-video visits and e-consults. (12) IDSA supports its use to deliver timely, high-quality infectious diseases care — particularly in resource-limited and underserved settings, where ID is needed the most. Further, IDSA supports Tele-ID use across clinical care, research, education, antimicrobial stewardship, infection prevention and outpatient programs including OPAT. (12)

Tele-ID has proven to deliver the benefits of ID expertise across many clinical settings. (13) It has been shown to have significant impact at rural medical centers that are without local ID support (14), decreasing transfer rates to tertiary centers by up to 60% and reducing hospital stays by an average of 1-2 days. (15) Emerging data show that a robust Tele-ID model leads to same or even improved outcomes compared to in-person traditional coverage models. (16) Expanding its benefits beyond clinical consultation, Tele-ID has also been shown to provide antimicrobial stewardship support in small community hospitals. (17)

On a personal note, Tele-ID isn’t theoretical — it has become my everyday work. I connect with patients through live audio-video visits, and on-site nurses support physical exams using Bluetooth stethoscopes and high-definition portable cameras. I have been able to build strong working relationships with hospitalists in rural areas, supporting clinical decisions and teaching ID principles during real-time case discussions. Bringing ID expertise to these communities is personally fulfilling and helps to provide ID medicine where access to specialists is limited.

Policy and reimbursement challenges

Despite its promise and evidence base, Tele-ID faces major policy and reimbursement threats.

Reimbursement remains inconsistent, particularly for e-consults, which face coverage limitations despite their demonstrated efficiency and impact. Recent changes to Medicare telehealth policy have sharply reduced coverage for nonbehavioral telehealth services, especially for home-based care, limiting how ID physicians can deliver and bill for telemedicine. IDSA has highlighted that the expiration of COVID-era telehealth flexibilities has reduced ID access for many patients and introduced significant uncertainty for clinicians, with ongoing policy shifts requiring continued monitoring and advocacy. (18)

Following the expiration of COVID-era flexibilities, Medicare telehealth policy was extended through March 31, 2025, and subsequently through Dec. 31, 2027, by recent legislation, though uncertainties remain about long-term policy. The temporary nature of these extensions continues to create instability for ID practice planning.

These challenges matter for the future of ID practice. Without sustainable reimbursement and supportive policy, hospital systems may be unable or unwilling to maintain Tele-ID programs, even with data showing that patient outcomes with Tele-ID are comparable to in-person care and with improved access.

Paths forward for telemedicine and ID

Tele-ID is transforming the practice of ID by offering a flexible, remote care model that appeals to many physicians, including myself. It enables ID specialists to reach underserved communities, support hospitals without local expertise and help close critical gaps in care while maintaining a sustainable, high-impact career.

Integrating Tele-ID into fellowship training can ensure the next generation of ID physicians is prepared to meet evolving patient needs and strengthen the specialty’s workforce. Expanding Tele-ID rotations in fellowship programs and increasing Tele-ID’s visibility at national ID meetings can attract more trainees to the specialty and equip them for modern practice. By providing hands-on experience in remote care, these initiatives help trainees develop the skillsets and adaptability needed to deliver ID care in diverse settings.

Telemedicine, whether embraced or resisted, has become an integral component of modern medical practice. ID is uniquely positioned at the forefront of its adoption. To fully realize its potential, we must move beyond describing its benefits and advocate for policies and sustainability in our everyday practice and education. This includes advocating for permanent Medicare telehealth coverage, consistent reimbursement for both live visits and e-consults, and state-level parity laws that ensure private payers reimburse telemedicine services at rates comparable to in-person care.  

Additionally, we must continue to expand training in Tele-ID and prepare trainees for future Tele-ID practice. In doing so, we can strengthen the ID workforce, improve access to care and ensure that our specialty remains at the forefront of medicine. Whether you are a practicing ID physician, program director or trainee, consider how you can contribute: Advocate with your hospital leadership for Tele-ID infrastructure, support policy efforts through IDSA or seek out telehealth training opportunities. The future of ID access depends on our collective action today.

References

1. Infectious Diseases Society of America; Pediatric Infectious Diseases Society. IDSA and PIDS statement on 2025 infectious diseases fellowship Match results. Dec. 3, 2025.
2. Chandrasekar P, Havlichek D, Johnson LB. Infectious Diseases Subspecialty: Declining Demand Challenges and Opportunities. Clin Infect Dis. 2014;59(11):1593-1598.
3. Perez C. Telemedicine offers solutions for the rural disparities in infectious disease (ID) care delivery. Open Forum Infect Dis. 2025;12(2):ofaf052.
4. Tang G, Huang L, Zong Z. Impact of Infectious Disease Consultation on Clinical Management and Outcome of Patients With Bloodstream Infection: A Retrospective Cohort Study. Sci Rep. 2017;7(1):1-9.
5. Lee RA, Vo DT, Zurko JC, et al. Infectious Diseases Consultation Is Associated With Decreased Mortality in Enterococcal Bloodstream Infections. Open Forum Infect Dis. 2020;7(3):ofaa064.
6. Mejia-Chew C, O’Halloran JA, Olsen MA, et al. Effect of infectious disease consultation on mortality and treatment of patients with candida bloodstream infections: a retrospective, cohort study. Lancet Infect Dis. 2019;19(12):1336-1344.
7. Bai AD, Showler A, Burry L, et al. Impact of Infectious Disease Consultation on Quality of Care, Mortality, and Length of Stay in Staphylococcus aureus Bacteremia: Results From a Large Multicenter Cohort Study. Clin Infect Dis. 2015; 60(10):1451-1461.
8. Goto M, Jones MP, Schweizer ML, et al. Association of Infectious Diseases Consultation With Long-term Postdischarge Outcomes Among Patients With Staphylococcus aureus Bacteremia. JAMA Netw Open. 2020;3(2):e1921048.
9. Livorsi DJ, Nair R, Lund B C, et al. Antibiotic Stewardship Implementation and Antibiotic Use at Hospitals With and Without On-site Infectious Disease Specialists. Clin Infect Dis. 2021;72(10):1810-1817.
10. Barlam TF, Cosgrove SE, Abbo LM, et al. Implementing an Antibiotic Stewardship Program: Guidelines by the Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America. Clin Infect Dis. 2016;62(10):e51-e77.
11. Dellit TH, Owens RC, McGowan JE, et al. Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America Guidelines for Developing an Institutional Program to Enhance Antimicrobial Stewardship. Clin Infect Dis. 2007;44(2):159-177.
12. Young JD, Abdel-Massih R, Herchline T, et al. Infectious Diseases Society of America Position Statement on Telehealth and Telemedicine as Applied to the Practice of Infectious Diseases. Clin Infect Dis. 2019;68(9):1437-1443.
13. Li SK, McCreary EK, Khadem T, et al. 101. Impact of an Integrated Tele-Antimicrobial Stewardship Program at a Rural Community Hospital. Open Forum Infect Dis. 2021;8(Suppl 1):S164-S165.
14. Tande AJ, Berbari EF, Ramar P, et al. Association of a Remotely Offered Infectious Diseases eConsult Service With Improved Clinical Outcomes. Open Forum Infect Dis. 2020;7(1):ofaa003.
15. Monkowski D, Rhodes LV, Templer S, et al. A Retrospective Cohort Study to Assess the Impact of an Inpatient Infectious Disease Telemedicine Consultation Service on Hospital and Patient Outcomes. Clin Infect Dis. 2020;70(5):763-770.
16. Gupta N, Bariola JR, Mellors JW, et al. In-Person Versus Tele-Infectious Disease (Tele-ID) Care: Is One Better? Open Forum Infect Dis. 2022;9(8):ofac410.
17. Vento TJ, Veillette J, Gelman SS, et al. Implementation of an Infectious Diseases Telehealth Consultation and Antibiotic Stewardship Program for 16 Small Community Hospitals. Open Forum Infect Dis. 2021;8(6):ofab168.
18. Infectious Diseases Society of America. Medicare Telehealth Restrictions and Extension Updates Beginning October 2025: Impacts and Implications for Infectious Diseases Physicians and Their Patients. 2025.