Infectious disease doctors are involved in diagnosing, investigating and treating patients with infections. They deal with infectious microorganisms such as bacteria, viruses, protozoa and fungi.
This speciality combines both clinical and laboratory practice. There is a mix between acutely unwell and chronically ill patients. Most of the patients that infectious disease doctors deal with are inpatients in large/specialist hospitals (1).
Commonly, an infectious disease doctor’s job is to deal with conditions such as pneumonia, viral hepatitis, HIV and bone infections. They may also deal with conditions associated with travel such as cholera, dengue, Ebola and malaria. Long-term patient continuity is possible for some lifelong diagnoses such as HIV.
Dr. Cesar Guinto
Due to the scope of diseases encountered in infectious diseases, common procedures include insertion of a central line, lumbar puncture and sigmoidoscopy.
As with any medical speciality, multi-disciplinary team working is to be expected. Infectious disease doctors are expected to work with nurses, laboratory staff and other medical specialists.
According to the 2014-2015 census dashboard, in 2014, there were 180 infectious disease consultants, 126 of them were male (2). Time management, communication skills and an aptitude for keeping up with epidemiology, virology and bacteriology are needed.
Dr Abhijeet Sharan
An interest in public health and research are also important. It must be noted that this speciality offers opportunities for overseas working for those interested.
This is a growing speciality due to recent increasing antibiotic resistance, hospital acquired infections and blood-borne virus infections. International travels’ growing popularity has expanded travel-related diseases and the need for expert knowledge in that area. Due to the increasing population age and associated frailty of patients, the severity of infections has also increased. All the above factors have increased the demand and role of infectious disease doctors.
A standard contract for a full time NHS consultant is 10 PAs (programmed activities) per week. This is typically divided into 7.5 PAs for direct patient care and 2.5 SPAs (supporting activities) which are tailored to each doctors’ interest.
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Infectious disease doctors encounter patients from different backgrounds. They often work with immunocompromised patients, provide consults to other specialities managing patients with nosocomial infections and manage patients in the ITU setting. As well as that, they may be involved in providing advice on policies influencing antibiotic choice and guidance on preventing travel related infections.
A new curriculum for infectious diseases is being implemented in August 2021 (4). The following information is from the JRCPTB curriculum draft and therefore is subject to change.
Entry to infectious diseases is possible following the completion of two foundation years training and core training. Core training can be completed via Internal Medicine Stage 1 training. It will not be possible for candidates to train in Infectious Diseases (ID) alone. Candidates must choose from ID with Internal Medicine, ID with Medical Microbiology or ID with Medical Virology.
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Internal Medicine Stage 1 training is two years in ID with Medical Virology or ID with Medical Microbiology and three years in ID with Internal Medicine. Despite these differences, all the training pathways take seven years of training for Certificate of completion of Training (CCT) accreditation.
After the completion of core training, candidates must pass the Membership of the Royal College of Physicians UK Exam (MRCP UK) for entry to speciality training. During speciality training, trainees must pass the Fellowship of the Royal College of Pathologists exam (FRCPath) before CCT.
Flexibility in the curriculum allows those who have completed four years in Acute Care Common Stem- Internal Medicine (ACCS-IM) plus MRCP(UK) entry into ID with Internal Medicine. Those interested in ID with Medical Microbiology/Medical Virology can alternatively come from a three-year background of ACCS-IM plus MRCP(UK) (5).
Infectious Disease Clinic
Essential requirements include Eportfolio completion and Annual Review of Competence Progression (ARCP) at the end of each training year (6). The Diploma of Tropical Medicine and Hygiene (DTMH) and the Diploma of HIV are preferable to have.
For those interested in research, PHDs, MDs and MScs are possible to obtain but are not built into training time. Interested candidates can apply for an Out of Programme experience (OOP) to facilitate this (6).
According to the 2018 competition ratios, there were 125 ST3 combined infection training applications for 69 posts making the competition ratio 1.81 (7).
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At the medical student level, interest can be demonstrated by undertaking electives or Student Selected Components (SSCs) in infectious diseases. At the junior doctor level, interest can be shown by doing a post in infectious diseases or focussing on the infectious presentations in other speciality posts.
Taster weeks are also a great way of demonstrating interest and gaining a deeper understanding of what a career in infectious diseases entails.
The Centre of Excellence in Infectious Diseases Research (CEIDR) are currently focussing on tackling and reducing the effect of antimicrobial resistance in the UK and globally. The London School of Hygiene and Tropical Medicine is one of the highest-rated research institutions in the UK. It is well known for its postgraduate studies and research.
Clinical Infectious Diseases
NHS consultant salaries are the same for all specialties but vary between Scotland (highest), England, Northern Ireland, and Wales (lowest) and increase with service (up to 19 years). In 2020 the salary bands range from £77, 779 to £109, 849. Salaries can be further enhanced with NHS excellence awards.
As with any speciality, there is the potential to enhance NHS earnings via private practice. JRSM reported in 2008 that the total income for infectious disease consultants was £97, 808 with NHS income making up £79, 300 and private income making up £18, 507 making the ratio 0.23.
This ratio is higher than haematology (0.20) and intensive care medicine (0.16) but lower than obstetrics and gynaecology (0.49) and anaesthetics (0.34) (8).
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The Journal of Infection publishes original papers that cover the microbiology, epidemiology and clinical nature of infections. Reviews in areas of specialist interest can also be found here.
The Journal of Infectious Diseases is a well-established journal that provides a platform for original infectious disease research. It is the official publication of the Infectious Diseases Society of America.
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