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Infectious Disease Specialist Shortage: a Looming Crisis

We must hurry. Superbugs are coming for us. We need experts who know how to treat them – Matt McCarthy, MD, in an open-ed for the New York Times.

Experienced medical transcription companies know just how important it is to ensure accurate and timely narratives of physician dictation that feed into electronic health records (EHRs). Error-free provider information and clinical records promote continuity of care. However, some medical specialties face more specific challenges. A recent New York Times report highlights the urgent need to tackle the shortage of infectious disease specialists in the US. According to the author, Matt McCarthy, an infectious-disease physician at Weill Cornell, with the rise in drug-resistant infections, the growing shortage of infectious disease specialists “could not be happening at a worse time”.

Infectious Disease Specialist Shortage: a Looming Crisis

Infectious diseases are a major global health threat. In the US, endemic diseases such as chronic hepatitis, HIV, and other sexually transmitted infections affect millions of people. Foodborne infections pose an additional threat. According to the US Centers for Disease Control and Prevention (CDC) two million Americans develop antibiotic resistance infections each year, which cause up to 23,000 deaths. Although there has been considerable progress in the reduction of vaccine-preventable diseases, drug-resistant superbugs are spreading. The CDC lists C. difficile or C. diff, Carbapenem-resistant Enterobacteriaceae (CRE) and N. gonorrhoeae as three “urgent” antimicrobial resistant threats. The CDC recently reported that Candida auris, an emerging fungus infection, is on the rise worldwide, and that the number of confirmed cases and in the U.S is 587. The shortage of infectious disease specialists makes these threats even more frightening.

Dr. McCarthy points out that, like nephrology, infectious diseases too do not fill all of its training spots every year in the National Resident Matching Program. The number of programs filling all of their adult-infectious-disease training positions fell by more than 40 percent between 2009 and 2017.

Why is there a deficit of infectious disease doctors? According to Dr. McCarthy, the reason is lack of proper compensation. While infectious disease specialists handle some of the most complex patient cases in healthcare, they are among the lowest paid due to Medicare’s reimbursement process. Medicare and Medicaid use relative value units (RVUs) as the basis for reimbursement to physicians. Many private health insurance carriers also use RVUs as their reimbursement basis. Each RVU is assigned based on the complexity of the services as by a defined CPT code, and each has 3 components:

  • Physician work RVUs are related to the time spent in providing a service or performing a procedure, the overall difficulty involved, and the cognitive and technical skills needed
  • Practice expense RVUs represent non-physician clinical staff time, medical supplies, and equipment used to maintain and operate the medical facility where the patient encounter occurs
  • Professional liability RVUs account for the cost of malpractice insurance

Of the three RVU components, physician work RVUs have proved to be the most contentious and difficult to accurately quantify. While the RVU formula prioritizes invasive procedures over intellectual expertise, the problem is that infectious-disease specialists provide expert consultation rather than procedures, and they don’t get reimbursed much for that, says Dr. McCarthy.

He explains how diagnosing a case of fungal pneumonia took hours with reviews of X-rays and imaging studies, discussions with the radiologist and primary care physician, and microbiological study. Most of this work was unpaid. Today, new threats require sophisticated diagnostic techniques that need a lot of expertise. While the Food and Drug Administration has approved new powerful antibiotics to confront the rising threat of superbugs, infectious-disease specialists are often the only health care providers who know how to use them, says Dr. McCarthy. Unless the insurance system has a better way to measure the value of diagnoses and treatments, physicians in cognitive specialties will not get the compensation they deserve.

A recent article in Contagion Live highlighted the problem of burnout among infectious disease specialists. According to the report, the causes of burnout among infectious disease physicians include focus on documentation, billing, RUVs, administrative tasks, and lack of support staff, concerns which also affect other physicians in other fields. However, infectious disease specialists face many unique challenges, according to Kwan Kew Lai, MD, DMD (www.contagionlive.com).

“Infectious disease is also the only field where illnesses are emerging [that] did not exist before, such as extensively drug-resistant organisms or new influenza viruses due to genetic re-assortment. Infectious diseases are also re-emerging due to political factors, civil wars, lack of access to vaccines, anti-vax movements, climate change, globalization, etc.”, she noted.

Dr. Lai also says that new treatments for various diseases may affect patients’ immune system, predisposing them to various infectious diseases. Further, as life span increases thanks to bone marrow or solid organ transplants, infectious disease specialists need to work to prevent and treat patients’ infectious complications.

Outsourcing medical transcription is a viable strategy to overcome the challenges associated with EHR documentation. The industry needs to work towards addressing the other concerns faced by infectious disease specialists so that the nation has experts who can treat deadly superbug infections.

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