"ID-ing" the value: how are orthopaedic infectious disease physicians compensated for their time? A national survey

Background: Optimal outcomes in periprosthetic joint infection (PJI) and other complex orthopaedic infections depend on longitudinal, multidisciplinary input from infectious disease (ID) specialists. Much of this work is not directly billable, and the financial structures that support it have not been systematically described in any healthcare system. Methods: We distributed an anonymous online cross-sectional survey to ID physician members of the Musculoskeletal Infection Society (MSIS) and the Infectious Diseases Society of America Bone and Joint Interest (IDSA-BOJO) group between 12 December 2025 and 30 January 2026. The survey captured practice setting, clinical and non-clinical orthopaedic ID responsibilities, and sources of compensation and protected time. Data were analysed descriptively; no inferential statistical testing was performed. Results: Fifty-two ID physicians responded, 94 % from US academic medical centres. Median ID clinical effort was 70 % (IQR 60 %-81 %); of this, a median of 55 % (IQR 40 %-90 %) was devoted to orthopaedic infections. Compensation was most commonly a base salary plus productivity incentives (53 %) or base salary alone (40 %) and was funded by medicine/ID in 88 % of cases. Care coordination (90 %), curbside consultation (85 %), trainee education (77 %), and guideline development (71 %) were performed; 83 % of respondents received no protected time or dedicated funding for any of these non-billable activities. Conclusions: In this descriptive, hypothesis-generating national survey of highly subspecialized US ID physicians, compensation structures were dominated by clinical productivity and rarely included protected time for the non-billable coordination work that underpins modern multidisciplinary PJI care. These findings should be interpreted in the context of a small, academic-predominant sample and of substantial international variation in healthcare financing, and they support the need for larger international studies of how orthopaedic ID expertise is funded and protected.