Transplant patients have added risk and require additional attention when it comes to infectious diseases. Minimizing infections is a major element of ensuring that someone who has undergone a transplant will be able to experience life with their new organ. While many advancements have been made when it comes to organ transplant, the risk of infection is always a serious factor and challenge. This delicate process is managed by an Infectious Disease Specialist for Transplant Patients.
What is an Infectious Disease Specialist for Transplant Patients?
In some cases, the procedures that are used to help a body accept a new organ can be the same ones that cause infection. Infectious disease specialists work alongside patients and transplant teams to decrease the chance of infection, identify possible infections, and help patients who have received a transplant experience the increased quality of life they hope for after surgery and rehabilitation.
Infectious disease physicians have a variety of roles. They are described by the University of Washington Transplant Services as follows:
Infectious diseases that affect transplant patients can include healthcare-acquired infections, donor-derived infection, community-acquired pathogens, reactivation of previous infections, specific epidemiologic exposures, infections specific to a donor organ, specific travel-associated pathogens as well as the infectious that are associated with the patient health prior to transplant. With all of these risk factors, specialized physicians are needed to maintain a close watch on patients before, during and after a transplant.
These specialists are trained to identify possible causes of infections and indicators of infections so that the patient can be treated and hope to heal from the transplant while accepting their new organ.
The USMLE is administered in three parts, the first two of which are taken during medical school and are used to show that the student is prepared to move on to the next step in their doctor training journey. After step three of the test, taken post-residency, students will officially be considered a physician in the United States.
After four years of medical school and the first two steps of the USMLE, students are ready for residency. Residency matches are based on the type of medicine one wishes to practice and their further sub-specialization needs. For infectious disease physicians, the residency is in internal medicine and can last between one and three years depending on the program and location selected. During residency, physicians will practice under the supervision of experienced doctors which will continue training, teaching and honing the skills of the resident physician.
The third and final part of the USMLE is taken after successful completion of residency.
Doctors who wish to establish themselves as infectious disease specialists will then need to complete a fellowship in infectious disease. This fellowship is the opportunity for the physician to gain a clearer understanding and experience in the sub-specialty as well as begin to encounter the types of patients they hope to help in their future practice. Fellowships in infectious disease are generally three years long with time split between patient care and research.
From there, students can complete an additional fellowship focusing on transplant patients. For example, the Infectious Disease Transplant Fellowship offered by Mayo Clinic is one year and is specifically “designed to prepare physicians with prior training in infectious disease for a career in academic medicine, subspecialty practice and/or hospital epidemiology with a special focus on transplantation.” The infectious disease transplant fellowships are post-subspecialty fellowships and are in addition to the years of training already completed by the doctor.
Whether the physician chooses to study at Mayo Clinic or one of the other fellowship opportunities throughout the country the description of education will likely be similar to the following;
“In this post-subspecialty fellowship, you acquire comprehensive knowledge and competence in managing infectious disease-related issues in bone marrow/peripheral blood stem cell transplantation and solid-organ transplantation, including liver, kidney, heart, lung and pancreas transplantation.”
Understanding the Career Path
A large percentage of infectious disease specialists spend less than 30 hours per week with patients. Across the medical specialties, this number varies with some specialties reporting over 40 hours per week with patients. The breakdown for infectious disease puts 26% spending fewer than 30 hours a week with patients, another 24% between 30 and 40 and 28% between 41 and 50 hours a week. Only 5% of infectious disease physicians don’t see patients at all. These numbers represent the specialty as a whole, and are not particular to those physicians working with transplant patients.
The majority of infectious disease physicians see between 25 and 49 patients per week – 27%. Another 20% see between 50 and 75. The patient load is extra high for another 17% who see over 100 patients per week. This statistic changes based on the type of setting that the doctor is working in. For example, physicians working in the hospital may see more patients than those working in a clinic while those focusing in Intensive Care Units may have fewer patients, but may spend more time with them throughout their stay in the unit. These numbers will shift based on the setting of the doctor within the transplant specialty.
Infectious disease physicians need more time with patients than many other types of doctors. In a recent survey, no infectious disease doctor reported seeing patients for anything less than 13 minutes. The vast majority fell in the 13 to 16 minute range for each patient encounter. Another 21% saw their patients for 17 to 20 minutes and 21% say they spend 25 minutes or more, on average, with each patient.
Because of the nature of the work of infectious disease doctors for transplant patients, it is very likely that the majority of the time spent with the patient will be in the hospital shortly after transplant to ensure that everything is moving ahead smoothly. There are a lot of risks involved with infectious diseases when it comes to transplants and proper care and monitoring within the hospital is paramount to being able to live a long time with a new organ. This aspect of the specialty is a shift from other infectious disease physicians who many spend the majority of their time seeing patients in a different setting.
Lastly, infectious disease physicians can expect to spend more time on administrative tasks and paperwork than many other specialties. When working with patients fighting infectious diseases post transplant, it is important to document and record everything as well as spend a great deal of time on tests and reading data that would reveal any problems with the transplant or any infections.
The following is salary information for infectious disease physicians. Those who specialize in treating transplant patients will find that their salary is comparable, though potentially slightly higher for their specialized work.
38% of infectious disease physicians make between $150,000 and $199,999 a year. With this median there are only 16% of physicians that make under $100,000 and 17% that make over $300,000.
Infectious disease doctor compensation varies greatly throughout the United States, my more than some specialties. The Northwest, including Alaska, Washington, Oregon, Idaho, Montana and Wyoming has the highest compensation at $300,000 while the South Central United States, which includes Texas, Oklahoma and Arkansas, has the lowest at $137,000 on average. Interestingly, the current reported amounts are the opposite of what was reported in 2011. At that time South Central was highest and Northwest was lowest on average.[i] As of a report done in 2013, only 54% of infectious disease physicians felt fairly compensated for their work.
Two other factors that affect salary are the work setting and work situation of the infectious disease physician. Here is a list of averages based on these factors:
Multi-specialty group practice: $223,000
Single-specialty group practice: $188,000
Healthcare Organization: $134,000
Outpatient clinic: $132,000
Owner (solo practice): $259,000
Independent contractor: $175,000
Advancements to Consider
Technology continues to improve the ability to find cures for diseases. And this technology also affects the practice of medicine, regardless of subspecialty. Recent technological innovations in 3D bio-printing are making it possible for the creation of “biocompatible materials, cells and supporting components” to be created using additive manufacturing – or 3D printing.
Simply stated, 3D printing is making it possible to create functional living tissues. Because of this advancement, the field of transplant medicine is working alongside engineers, biomaterial scientists, cell biologists, physicists and other physicians to explore the opportunities to create needed organs and tissues. The possibilities are endless for anyone wanting to delve into the intersection of this technology with the field of medicine.