TABLE 5

Invisible Value and the Amount of PID Specialists

ThemeIllustrative Quotation
“Invisible” value“Much of the work that ID does is not quantified. It is not captured anywhere. I get that. But in this world of how we get paid and how we’re measured, it’s really counting and making widgets, right? So if it isn’t documented it isn’t done. So you can tell me that you did 10 curbsides and it added value to managing patient care but what am I supposed to do with that? So you need to figure out a systematic way to capture that work.” (Administrator, site B)
“I think it is hard to measure the outcomes to establish the value of ID because, well, if somebody lives or dies, that’s easy. But if somebody develops c. diff, or loss of appetite, or insomnia, or whatever as a result of treatment, that’s a negative impact on outcome, but it’s hard to measure. So I think that there are lots of things that ID positively contribute to but are hard to measure. So, like, having a specific plan to minimize blood monitoring of drugs with which we’re not familiar, dosing antibiotics appropriately, treating for an optimal amount of time and determining when things aren’t going as expected and intervening early, helping to stop an outbreak of norovirus in the unit, those things all positively contributes to outcome, but are harder to see from an administrative standpoint.” (Pediatric intensivist, site A)
Questioning how many PID specialists are needed“Well, I place the value of ID as very high, and I see it most of all as being a safety net. I don’t think we actually need an up-front infectious disease doctor most of the time, because most children’s infections have straightforward clinical symptoms, well-established treatment regimens, and a predictable response to therapy. And so I see the need as being the safety net to intervene for the outliers, the patients who either have an atypical presentation or an atypical organism or aren’t amenable to conventional therapy, and so that’s got to be probably <10% of all the infectious patients, 90% of them you don’t need an ID doctor for. But for that 10%, the contribution is significant and is very likely to reduce both morbidity and mortality.” (Oncologist, site C)
“I do think they add value. I think their volume may be low, so it might not be a bad thing to share them with other facilities, but we definitely access to them. So, maybe, having them as a regional resource. In other words, making use of telephone and video and other appointment types. So you don’t necessarily need them in person, but you need access to someone.” (Administrator, site A)
“I think ID phone support only is stupid. I mean, if you’re talking Nome, Alaska, then maybe. But not here [medium-sized city]. Yes, there are some questions that can be handled on the phone. But there are plenty of times people will tell me “oh it’s this, that and the other,” and I have an idea in my mind of what it is and I walk in the room, look in the patient and go “this has nothing to do with what you just described to me.” Especially for ID with the rashes and everything, they need to see the patients.” (Intensivist, site A)
  • ID, infectious disease.