Life as an Infectious Disease Consultant

It’s been almost two years since I pondered over my career path.  The job search was just something else. Juggling different priorities to see which opportunity would meet all the needs and most of the desires was not easy.  2009 was just so miserable. Truly.  *Shudder* When I signed that three-year contract to work “in the middle of everywhere” I knew my non-existent social life was taking a huge step backwards and not the much-needed step forward but I figured I would still be young (not yet mid-30s) after I had served my sentence. Oh boy! It has been so painful on the social front being here, made even worse by countless friends and family asking me when I’m going to get married.  Married to whom? Moose-man? Sigh!  I really hope that in a decade from now I can look back and know that I made the right sacrifices.

Underlying this move to “the middle of everywhere” was the need to handle my financial business. Since I was an international student in the US, I funded my education with expensive private loans. Loans that had to be co-signed by a generous US citizen, an act that makes me wince each time I hear Suze Orman tell people on her show NEVER COSIGN A LOAN, WHETHER IT’S FOR YOUR CHILD, YOUR PARENT, etc, and NEVER ASK A LOVED ONE TO COSIGN YOUR LOAN.

I don’t really talk to my cosigner and I wonder what this mortgage (just about a quarter million US dollars – how do you like the sound of that?) of a student loan I have is doing to their credit. I wince again when I recall people trying to steer me away from internal medicine and specifically from infectious disease because of their low salaries in comparison to other medical specialties. But I didn’t listen, not because I was being stubborn, but because I wanted to do what I wanted to do.  So now I must lay in the bed that I laid. I expect it will take a several years to make a sizable dent in this overburdening debt.

But make no mistake, I LOVE INFECTIOUS DISEASE! I wouldn’t be in any other medical specialty.  I am currently a hospital employed infectious disease consultant at a mid-sized tertiary hospital. Through no plan of my own, I ended up starting as a solo consultant for a several months and as such was thrown into a leadership role. That was scary fresh out of fellowship. But I passed that swim or sink test and am now medical director/division chair/what have you, choose your pick.

I’m hospital based for the most part seeing patients at the request of other physicians – hospitalists, internists, orthopaedics, neurologists, cardiovascular surgeons etc. I’ve had a vast array of infectious disease dilemmas that have kept me on my toes and for that I am grateful. Honestly, leaving the academic world I thought my life was going to be full of urinary tract infections and diabetic foot cellulitis and though there is plenty of that, I have had interesting cases such as a patient with Q Fever and a patient with progressive multifocal leukoencephalopathy who did not have HIV/AIDS.

My schedule itself is not bad. Since I do not live to work and I am my own boss I basically set my hours from 8 am to 5 pm and defer consults to the following day if I have to.  As far as I’m concerned, infectious disease is not an emergency field…if the patient is septic, get them to the intensive care unit. If their arm is falling off because of a flesh-eating bacteria get them a surgeon. Certainly start antibiotics, but antibiotics are the least of considerations if there is no blood pressure to pump them to wherever they are needed or if surrounding tissue is dead.  Of course there are days I don’t make it home till late and there are days I do have to return to the hospital after I have left.

I would say my census usually hovers around 12-15 patients and a usual day consists of 3-6 consults. That is not bad at all.  However, there was that day I received a record 18 new consult requests.  I thought I was going to faint. The patients all became one big blur.  I guess that’s how it is in the world of private infectious disease where doctors run from one hospital to another. That’s another thing. I work at a single center by choice and my employer is looking to expand my services into rehabilitation hospitals and I’m so not interested. Not only would I have gone elsewhere if I wanted to drive back and forth through town every day but rehabilitation hospitals and long-term acute care hospitals? Gag me! So not my scene. And let’s not even talk about nursing homes.  I guess there’s money to be made in going to these places where there’s a need but we are talking about MY SANITY and HAPPINESS here.

I have an office session once a week that is mostly filled with hospital follow-ups. We are working at increasing outpatient referrals into the office. Truthfully, I can do without office hours as my mind is programmed to work at the inpatient speed and level of acuity.  Patients in the office tend to want to tell me about their pet dog’s new coat (and not because I asked) when I’m trying to get them out the door.  Besides, there aren’t many people who know they have HIV in this area and services for those with the infection are poor. I can’t really be an effective HIV specialist if the patient has no way of affording their medications can I? So I have a very small cohort of HIV infected patients which is actually unfortunate because I wanted to continue to be up to date in this field and now I can’t even remember what the generic components of Trizivir are!

And then I have my administrative duties which I didn’t really plan to have, but I guess you take what life throws at you. I’m on several committees – pharmacy & therapeutics and infection control to name a few and I am writing memos and scripting changes to hospital policy almost weekly. That does give one a sense of importance.  I’ve also begun an anti-microbial stewardship service to improve the use of antibiotics in the hospital and am implementing ways to improve physicians compliance with hand hygiene.  These have actually been quite fun projects and have opened up opportunities for publications so maybe all is not lost on the academic front for me. It’s been so rewarding. Can I just say our physician hand hygiene compliance rate has sustained a respectable range for several months now through our efforts. Woot! Woot!

So career-wise I am not at all disappointed.  Well, at times I get frustrated when I’m asked to see a child. Recently it was a 3 day old (THREE DAYS OLD! and premature to boot) in the NICU and I had to be firm. I am not a pediatrician. I am an intern – a doctor of adult patients.  I may be a specialist in infectious disease but kids are a whole other species. I remember clearly on my first day of pediatrics rotation as a medical student being told “children are not little adults”.  Uh-huh, I’m NOT seeing children. Sorry, not sorry!