New IDSA President: ‘The COVID-19 pandemic Is not going anywhere fast’

HealthLeaders: What are the primary elements of your agenda as the new president of the IDSA?

Daniel McQuillen: It is obvious that the COVID-19 pandemic is not going anywhere fast. That is going to be something that our society must pay a lot of attention to. My role is to help us get through the pandemic work successfully, both for the members of the society and for our role in trying to move the country along during the pandemic.

Our board developed a five-year strategic plan in 2019, and we were all set to move forward with initiatives such as speeding up our guideline development. We also felt that we needed to spend time communicating what is valuable about having infectious disease specialists, trying to grow our workforce, making sure that we are appropriately compensated, and driving national progress on antimicrobial resistance. Those were the areas that we wanted to focus on; and when we started to dig in and get to work, COVID hit.

We had to pivot what we were doing. Since the onset of COVID, our staff, who were all heavily involved in our board’s priorities, have been heavily involved in our response to the COVID pandemic. Probably 85% of their time is spent on work related to the pandemic. In addition to addressing the pandemic, we will be focusing on the workforce and compensation issues for the next 15 months.

HL: Why is the infectious disease specialist workforce a priority issue for the IDSA?

McQuillen: Over the past decade, one of the things we have had trouble with is attracting trainees. When we talked with people who had considered going into the infectious disease specialty, the number one reason they moved in a different direction was that the pay for infectious disease physicians is among the lowest of all the medical subspecialties and considerably lower than specialties where physicians do procedures. When you come out of medical school with an average debt of at least $200,000, compensation is a major consideration when selecting a specialty.

HL: How has the coronavirus pandemic illustrated the importance of infectious disease specialists?

McQuillen: Every day, you turn on the news and you see at least two infectious disease specialists—Anthony Fauci and Rochelle Walensky—talking about issues that inform how the country is dealing with the pandemic.

Personally, when we had our initial COVID patient surge here in Boston, our group of five infectious disease doctors at Lahey Hospital & Medical Center saw nearly every patient in our hospital, from March through the end of May 2020, who either had COVID or was suspected of having COVID. Like many physicians during that time, none of us had any days off.

We played a role in both diagnosing cases and figuring out treatment plans. We also developed protocols for keeping our providers safe in terms of what kinds of protective equipment they needed to wear. We are still doing that protocol work.

The IDSA and the National Institutes of Health are the two main sources of both infection prevention and treatment guidelines for COVID. We managed to get our guidelines out before the NIH did. We have been updating our guidelines whenever there is new peer-reviewed information that would impact care.

One of the big things IDSA has done in terms of messaging is that the Centers for Disease Control and Prevention came to us early in the pandemic and asked us to go into a cooperative agreement with them. That cooperative agreement involves more than a dozen other societies, and we have developed the COVID-19 Real-Time Learning Network, which is an online resource for any healthcare worker that includes links to the NIH guidelines and addresses any particular issue that COVID patients have. The learning network site is updated daily. We have IDSA members who volunteer to do that work.

In addition, the IDSA has been doing twice monthly webinars for frontline healthcare professionals—not just infectious disease doctors. These webinars typically get 800 to 1,000 viewers.

In the community, many of my colleagues have served as infectious disease consultants for organizations such as churches, school boards, and universities to help them figure out how they can get back to normal activities and keep people safe at the same time.

The infectious disease profession is central to getting our country through and out of the pandemic. Our profession is also central to looking back and seeing what things were not successful in trying to prevent the pandemic. We will be trying to figure out how we can get an infrastructure in place so that when the next pandemic comes along, we will be ready for it. That is vitally important.

HL: As the pandemic drags on, what other roles should infectious disease specialists be playing?

McQuillen: There is also another pandemic going on—misinformation about COVID on all levels. There is misinformation about the vaccines, medications, and the virus and illness itself. We feel that the IDSA is an authoritative voice to counteract the misinformation. We want to get the data out, so people can understand it.

In addition to being a reliable source of information, infectious disease specialists need to be thinking ahead to what the next pandemic is going to be. It is not necessarily going to be a virus. It could be a bacterial infection. Antimicrobial resistance is already a pandemic. Even before the coronavirus pandemic, we started to see a lot of bacteria for which we might have one or two antibiotics that are effective.

HL: Why is reimbursement reform a top issue at the IDSA?

McQuillen: The problem is that infectious diseases is a cognitive specialty. I am not doing a procedure on the patient. I am thinking about the symptoms the patient has, I am figuring out what infection the patient has, then I am helping to treat the patient by either giving an intervention such as an antibiotic, or advising the patient that they need a procedure such as getting an abscess drained. I am not draining the abscess—those procedures often get paid more than what I get paid spending an hour with the patient figuring out a diagnosis and treatment plan. The system does not reward infectious disease specialists for their work.

At the same time, we do services for our health systems and hospitals such as the response to COVID-19 that do not involve direct patient care. Those services that are non-direct patient care do not get paid well despite the positive impact that we have on hospitals and other healthcare organizations. For example, we have an impact on readmissions to the hospital within 30 days and length of stay, and the penalties on hospitals go down.

We are working on creative ideas to try to compensate us for the extra effort we are doing. It is a long battle.

HL: What advice would you offer to new physicians considering a career as an infectious disease specialist?

McQuillen: As an infectious disease physician, I get to see every kind of patient in the hospital and clinic system. I am not restricted to doing just diabetes, lung disorders, and other conditions. I see everybody.

It is an incredibly challenging field, but it is also incredibly intellectually stimulating. It is fascinating to see patients, figure things out, and make a difference in people’s lives.