Why new doctors aren't specializing in infectious diseases
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New doctors are increasingly moving away from specializing in infectious diseases as the prevalence of vaccine-preventable illnesses like measles and whooping cough ticks up.
Why it matters: The Trump administration's cuts to public health funding and its overhaul of federal vaccine policy may be putting even more of a damper on a field that took the brunt of the COVID-19 pandemic.
- It doesn't help that the field has historically paid less than other specialties.
Interest from medical residents "was markedly worse" this year, said Wendy Armstrong, president-elect of the Infectious Diseases Society of America.
- "I think that reflects the environment that we are in right now where our specialty has frankly been under attack."
By the numbers: 319 physicians applied for infectious disease fellowships that will begin later this year, compared with 404 at the specialty's recent post-pandemic peak in 2021, according to data from the National Residency Matching Program.
- Doctors filled only about 61% infectious disease fellowship positions offered this year, compared with 88% of positions five years ago.
Physicians often enroll in additional optional training in a specialty following their medical residencies. Fellowships were offered in 81 subspecialties this year.
Zoom out: Infectious disease specialists have been the target of backlash from the COVID-19 pandemic, with skeptics undermining or dismissing the field as irrelevant, Boghuma Titanji, an assistant professor of medicine at Emory University, recently wrote in MedPage Today.
- That's worsened in the past year as Trump administration political appointees slashed funding for research grants and questioned the expertise of public health professionals.
- "The hostility directed at the field has been unlike anything we've seen in decades. That takes a psychological toll, and trainees see that," Titanji wrote.
The other side: The Trump health department blames the situation on its predecessors.
- "The erosion of public trust and politicization of infectious disease medicine is a legacy of the Biden administration," HHS spokesperson Emily Hilliard said in an email to Axios.
Zoom out: Low compensation also is discouraging infectious disease training, IDSA's Armstrong said.
- Infectious disease has one of the lowest average salaries among physician specialties — $277,000 in 2025 — ranking even lower than internal medicine, according to Medscape's most recent compensation report.
- High-paying specialties like cardiology and gastroenterology are among the fastest-growing fellowship choices for doctors.
Infectious disease physicians secured a new Medicare add-on code last year that allows them to get extra payment for complex hospital evaluation and management services.
- But additional changes to doctors' Medicare compensation are expected to cut infectious disease providers' payment an average of 6% this year.
- "We urgently need to re-look at compensation," Armstrong said.
What we're watching: Declining interest in infectious disease medicine is coinciding with increases in viruses ranging from flu to measles to HIV.
- Infectious disease specialists also help protect the growing share of patients taking immunosuppressive medications, and work to manage antimicrobial resistance, Armstrong said.
- "We are all at at risk of infectious diseases, and I think people forget that there's a range here," she said. "I am really worried that we aren't going to have enough people to treat those kinds of patients."
