A few years ago, here in the UK, Infectious Diseases training and Microbiology training “merged” to form a joint pathway. Consequently, I am one of the ‘new breed’ of trainees that will span both specialties. There are positives and negatives to this and each specialty currently sees themselves as separate from the other. One key question for ID physicians regards the loss of general medicine and I get a few questions on this. As a result, I thought I’d give you my thoughts so far.
Historically, ID is very general and one of its key attractions for doctors is that it is one of the few specialties in which the physician gives a truly general medical opinion (as opposed to ‘specialised’). This is because infection can affect any organ in the human body and we encounter all specialties, including surgical, when we’re getting referrals. Being an ID physician therefore requires you to remain up to date with many advances in medicine and surgery to some degree, as well as have a broad knowledge of acronyms! XXXsmileyXXX ID often gets called to ‘the weird and wonderful’ cases. How does this differ from Medical Microbiology?
Traditionally, microbiologists have been far more laboratory focussed. They have a much better understanding of microbiological tests and therefore a better ‘relationship’ with laboratory scientists. Sometimes, for example, the laboratory will need to know how to process a particular sample and will call partly on clinical microbiological knowledge in order to perform the right test. It also means that traditionally microbiologists had little physical patient contact but would be a key source of antibiotic advice. More practically, they get calls from other doctors in the hospital about choice of antibiotics. They also may get called about ‘the weird and wonderful’ but usually in the context of cases that are more obviously infective in nature, and particularly when there are no ID physicians within that hospital- it tends to be questions more in line with appropriate antibiotic therapy.
Now, there’s us. The new hybrid doctor that hopefully in the future will be a good source of microbiological support for the lab as well as a general medical opinion for the ward. Now this is not easy to achieve and I have encountered scepticism as to how this works practically. However, I’ve witnessed the gap in lab-based knowledge within ID and the gap in general medical knowledge in Micro. Microbiology doctors are also increasingly expected to be visible to ward staff but don’t necessarily consider themselves clinicians, because traditionally, they weren’t. They don’t examine patients. ID is so medical that sometimes they don’t understand the key micro points or lab questions, because they’re not traditionally lab based.
At the moment, there is a bit of a choice for doctors choosing their ID specialty: ID/gen med or ID/micro. From my own point of view, I will miss the general medical training that came with ID jobs. However, I strongly suspect that ID/gen med trainees (there are still a few around the country) will end up doing heavily acute-medical jobs in the future; ID/micro trainees may get a better balance. I’m also aiming to keep up some of my general medical knowledge through teaching, occasional shifts and conferences.
At the moment, I think the divide is largely cultural. There is so much cross-over between ID and micro that I hope in the future, we hybrids will be of great use to hospitals. There will be those who ‘pick a side’ and obviously their training will be more ‘concentrated’ if they choose micro rather than micro/ID. I’m enjoying my current micro post but I miss physically seeing the patients; I do enjoy the challenge of phone diagnosis, though.
But honestly, I’m excited for the future of this specialty and for many of us, I think the separation will eventually die out- we will be known simply as Infection Specialists or something similar.
So for those asking, ID/micro is the way forward. We get to be both clinical and laboratory focussed and simply put, we are the future of Infection medicine.