Infectious diseases fellowship training: another viewpoint.

According to some observers, an oversupply of physicians in general, and of infectious disease (ID) specialists in particular, already exists; if not, oversupply may be imminent. More stringent licensing requirements, mandatory accreditation for specialty programs, and legislation restricting Medicare expenditure on direct education may help to keep the numbers of specialists down. However, once saturation is reached, it will persist longer in ID than in other, older subspecialties. In the future, many ID specialists may spend much of their time evaluating conditions that have no obvious relation to an infectious disease. Rather than an unfortunate waste, however, ID training will be advantageous in these circumstances because of the excellent background acquired in evaluating histories and performing thorough physical examinations and the emphasis placed on cost-effective use of antimicrobial agents. Physicians well trained in ID are likely to be cost conscious in the use of the laboratory as well as parsimonious in the use of drugs. A further lowering of costs probably results from contributions of these physicians to hospital formulary committees and infection control programs. Thus, residents in internal medicine who wish ID training should be given the opportunity; they will be better internists for the experience.