The discipline of infectious diseases is ever-growing, with a spectrum of practice pathways adopted by ID physicians, including sub-specialized fields of expertise in public health, hospital epidemiology, antimicrobial stewardship, transplant ID, HIV/AIDS, tuberculosis, and global health. During the last decade, considerable interest has developed in combining ID training with an additional year of fellowship in critical care medicine (CCM).

With the emergence of the global outbreaks of novel infectious diseases and the related requirement of an educated work force to manage the burden of care, ID physicians have become the core of attention once again. As the world is dealing with the global spread of novel Coronavirus, or COVID-19, we have discovered that elderly patients with underlying co-morbidities have the highest case fatality rate, most developing respiratory failure resulting in death. We learned from the Ebola virus disease outbreak that hypovolemic and septic shock followed by multisystem organ dysfunction were the most frequent causes of death. In both cases, critical care was has been the cornerstone of effective management to improve clinical outcome, particularly as we wait for effective COVID-19 treatment. Combination of ID fellowship with CCM training is a natural merger to groom young physicians for this evolving challenge.

This combined pathway has been appealing for potential fellowship applicants. Every year, many 2-year ID fellowship spots in the United States remain vacant; but, there has been a reasonable increase in the number of applicants looking for the dual fellowship track, and programs offering such pathways are able to completely fill their fellowship spots. In 2016, Clinical Infectious Diseases published a national survey of ID-CCM physicians trained in the US, revealing that 83% were extremely or highly satisfied with their career path; 76% highlighted that, if given an option, they would pursue dual training again. Interestingly, these physicians preferred combination of ID with CCM due to clinical synergy (70%), increased procedural activity over isolated ID training (50%), and lack of comparable interest in pulmonology (49%).

However, ID-CCM-trained physicians currently constitute only 1% of those who are CCM board certified in the US. Only a dozen academic centers offer this unique combined training pathway, which evokes the grave question of whether we ready to confront the emerging challenge of worldwide infectious disease outbreaks with the current work force? While we strengthen our healthcare facilities with enhanced infection prevention standards to tackle the epidemic spread, efforts are needed to reinforce care teams with dual-trained physicians who have expertise in managing critical illness associated with infectious diseases and resulting complications. In addition to provision of significant funding for cutting-edge research, opportunities should be provided to increasingly more ID fellowship programs to include additional combined CCM training pathways.

References

1. Nitin Bhanot, MD, Zaw Min, MD, Matthew Moffa, DO, Thomas L Walsh, MD, James D Como, MD, 2541. Impact of a Combined Infectious Disease-Critical Care Medicine (ID-CCM) Track on Fellowship Recruitment, Open Forum Infectious Diseases, Volume 6, Issue Supplement_2, October 2019, Page S883.
2. Sameer S. Kadri, Chanu Rhee, Gabriela Magda, Jeffrey R. Strich, Rongman Cai, Junfeng Sun, Brooke K. Decker, Naomi P. O’Grady, Synergy, Salary, and Satisfaction: Benefits of Training in Critical Care Medicine and Infectious Diseases Gleaned From a National Pilot Survey of Dually Trained Physicians, Clinical Infectious Diseases, Volume 63, Issue 7, 1 October 2016, Pages 868–875.
3. Kadri SS, Rhee C, Fortna GS, O’Grady NP. Critical Care Medicine and Infectious Diseases: An Emerging Combined Subspecialty in the United States. Clin Infect Dis. 2015;61(4):609–614.