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THE DUMMIES GUIDE TO GETTING OBSERVERSHIP

Sandeep Kochar ('93)1 and Mini Kamboj-Gill ('93)2

(1) Clinical Assistant Professor, SUNY Downstate Medical Center, Brooklyn, New York, USA

(2)Attending Physician, Infectious Disease Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA

(Posted 03/09)

An Infectious Diseases (ID) specialist, as the name suggests, is a physician who is an expert in the diagnosis and management of diseases caused by microorganisms (bacteria, fungi, viruses, parasites and prions). Biased, as we may be, we consider ID to be one of the most challenging and exciting subspecialties of medicine. ID physicians are at the forefront of some of the most exciting, cutting-edge and challenging happenings in medicine such as emerging infections (avian influenza, SARS, West Nile virus), battling multidrug-resistant infections, bioterrorism, dealing with disease outbreaks, and trying to battle with one of the landmark event or our times - the AIDS epidemic. Astonishingly, in India we don’t have ID as distinct discipline. It is time to for us to shed this complacent attitude. So, here are the nuts and bolts of the life cycle of an ID physician (in the USA)!

How do you become an ID specialist?

To be trained in ID, one usually first completes a 3-year medicine residency (pediatric ID is a separate discipline, requiring a training in a pediatric residency program). With an annual number of 300-odd spots and ever-increasing era of specialization, ID, like all other fellowships is gradually becoming harder to get.

The Fellowship

A clinical ID fellowship is usually 2 years: the first year is predominantly clinical, and the second has a few clinical months plus several months available for research. A publication or research project is expected. A research fellowship can be anywhere between 3-5 years (usually 3-years). The first year is clinical, and the next 2-3 years are devoted to a research project (clinical or basic-science) under a mentor. Some programs may allow you to do a master’s in public health (MPH) or clinical science (MSCS) in lieu of a research project.

Many hats to wear

The field of ID offers a physician several different and exciting options in addition to the traditional role of a consultant treating difficult and complex infections: HIV is field within itself and you can make an entire career out of it. Or you could make a niche for yourself treating infections in the immunocompromised host (cancer and transplant patients) or specializing in tropical and travel medicine. Hospital Epidemiology and Infection Control and advanced degrees in public health are other areas to consider.

I am done with the fellowship. I am ready to step into the real world now. What next?

Congratulations!  You can now look for jobs in either private practice or academia. Private practice-based jobs usually involve a group of physicians who have consulting privileges at a few surrounding hospitals; at other times you will see patients in your office. Research and teaching responsibilities are less of a priority, but you make more money than you would make in an academic setting. Working in a university-based setting, on the other hand, allows you to have a satisfying mix of clinical, research, teaching and administrative tasks. The life-style is better and more flexible; even though you get paid less than a job in private practice (often the difference is significant). Remember that larger centers/ universities might support your salary for a year or two, but eventually you will be required to get your own extramural funding or research grant and if this is your focus, we highly recommend that you start working or thinking about research during residency. Identify a mentor early on if you can, either during residency or fellowship.

Several of us choose to move away from clinical medicine. ID physicians are highly sought after in public health departments for obvious reasons. Others turn to the pharmaceutical industry that, in addition to an opportunity to participate with novel drugs, provide lucrative perks and good working hours. Working with governmental and non-governmental organizations (such as the Centers for Disease Control (CDC), the WHO, Gates foundation, just to name a few) is another option. International Health is an up and coming field, and ID is often a critical part of the curriculum.

Thanks for all the jazz. Now give me the bottom-line. How much will I make?

In the beginning you will probably make anywhere from $120,000-150,000 annually (more in the private setting). The mean income once you are settled in can be around $250,000. A lot of factors determine the amount of money you make - the geographic area is a big one among these. Places with shortage of ID physicians (and there are many) will pay more. If you get really creative and provide services like outpatient antibiotic infusions, infection control, wound care etc, you will probably make a lot more.

To summarize, ID is a very dynamic, cerebral and ever evolving field with several career-tracks to choose from, provides for a flexible and good life-style, and offers decent salaries. All of this ensures you will have a satisfying and rewarding career. So go ahead, get bitten by the bug!

 

Get to Know a Bug Doctor!

To provide aspiring colleagues a snapshot and contrast of sorts, we have briefly profiled two of our current alumni who have further specialized in ID.

Mini Kamboj-Gill (’93) is an Attending Physician with the Infectious Disease Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA:

“I work as a faculty member at Memorial Sloan Kettering Cancer Center. In this position, I spend 75% of my time doing research with my current focus being molecular diagnostics in ID. Other responsibilities are inpatient consult service (6-8 weeks per year), weekly clinic, and teaching medical students and residents. In my current role, I also help run the hospital infection control program as the associate physician director. Overall, it is somewhat demanding and challenging (considering am a new mom as well) but also this is what I always wanted to do!”

Sandeep Kochar (’93) is presently a Clinical Assistant Professor in Hospital Medicine at the SUNY Downstate Medical Center, Brooklyn, New York, USA:

“After finishing a fellowship in ID a little more than a year ago, I paused to think. I loved ID, but felt slightly restricted as a consultant in my ability to provide comprehensive care to my patients. And I also love internal medicine. So I decided to mix and match. I have been working as a Hospitalist for about a year (for folks back home, Hospitalists are internists who work wholly in the hospital-setting without outpatient responsibilities). I also continue to do a weekly HIV clinic, following my panel of patients. As an academic hospitalist, I love the fact that I get a chance to work with medical students and residents, and I have always enjoyed teaching and administrative work. Also, I work about 8 months a year; during my away time, I am free to do what I wish. For me, that means a chance to pursue research activities, work in international - health (my aim is to work with AIDS-related issues in India), and fulfill my passion for travel.”

 

 
 
 
 

 

 

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