Reimbursement for health care. Training, cost containment, and practice: effect on infectious diseases

In 1978 the statement was made that if any more infectious disease specialists were trained they would be culturing one another. The increase in infectious disease consultants continues unabated. The number of training programs in infectious disease is rising in proportion to the number of fellows being trained; one-third of these training programs are in New York, California, and Texas, and a number of them are not associated directly with medical schools. It is often argued that there is no reason to restrict the number of infectious disease consultants because there is plenty for them to do. There are an equal number of arguments against unbridled growth, including the fact that the existence of specialists in most community hospitals with lead to fewer referrals to the teaching centers and the resulting lack of patients will lead training programs to atrophy. Infectious disease is destined to function best as an academic specialty whose trainees should pursue careers primarily as investigators. The number of clinicians leaving training should be reduced and not further glut the marketplace; they should be based in academic divisions and devote their clinical time and effort to the care of complex referral and to indigent patients.