Medical pay inequality weakens fight against infectious diseases

Dr Tina Tan works at one of the more prestigious and well-funded medical centres in the US. Yet she struggles to find sufficient high-quality young doctors for trainee residencies with her team that treats infectious diseases.

Tan, a paediatrics professor at Northwestern University’s Feinberg School of Medicine, says just Chicago and Springfield — across her state of Illinois — have infectious disease specialists. Many patients must drive two or three hours to find help, or risk using less specialist assistance. The situation is worse elsewhere: more than 80 per cent of US counties have no infectious disease doctor at all.

“We’re not able to fill our fellowship training programmes,” Tan says. “For some reason, as a field, we definitely are not considered as valuable. And it is getting worse because people are retiring earlier and we don’t have others who are training to take their positions.”

While globally, communicable diseases remain very significant contributors to illness and death, many countries have a deficit in training, recruiting and retaining doctors and healthcare workers. 

In the US, Tan — who is president-elect of the Infectious Diseases Society of America (IDSA) — points to the high cost of medical education and how it relates to the salaries of communicable disease specialists: “Even though a lot of doctors might love infectious diseases, they feel they have to choose a field that will allow them to pay back their debt and live fairly comfortably.”

While medicine remains highly paid, infectious diseases rank as the third lowest speciality, according to the latest survey by Medscape, a healthcare news and data service. Doctors earn the third lowest average annual salary of $261,000 — just ahead of paediatrics and less than half of the average in orthopaedics and plastic surgery. The median medical student debt stands at $200,000, with costs even more of a disincentive for people from low-income families reluctant to take on large loans.

In many other parts of the world, the training and payment of doctors is far worse. In countries such as the UK, the number of government-funded medical places for trainee doctors is capped at levels that health bodies have long argued are too low.

Belgium made efforts to strengthen the European healthcare workforce a priority during its EU presidency in the first half of this year. The topic is on the agenda of Brazil’s presidency of the G20, with a meeting on healthcare scheduled in September.

At the launch of an Africa Health Workforce Investment Charter, during a World Health Organization regional meeting in May, Namibia health minister Kalumbi Shangula noted: “The numbers of Africans who have left the continent in search of greener pastures in other parts of the world are staggering.”

A revised analysis of the global health workforce in 2022 suggested that there was a shortage of 15mn workers below forecast needs in 2020 and the shortage would be 10mn in 2030. Covid-19 resulted in the illness and deaths of tens of thousands of medical staff. Many more have since retired in the face of rising stress.

Jim Campbell, the WHO’s director for the health workforce, stresses that the situation is improving, with little evidence for a widespread and systematic “great resignation” since the pandemic. Nonetheless, significant disparities remain. “Whilst we’ve got more healthcare workers globally, there are nationally defined shortages,” he says. “We’ve still got supply coming through but not sufficient to meet demand.”

Campbell argues for greater flexibility within health systems. Healthcare workers, like counterparts in other sectors, increasingly want to change locations and specialities and take time out for training or career breaks. “If they don’t have decent pay, work, quality of jobs or leadership opportunities, they will vote with their feet,” he warns.

There has been a domestic and an international brain drain, with staff tempted by better conditions in local non-profit groups, in global organisations such as the WHO and in the health systems of richer nations. Ten countries — in Europe, North America, Australia and the Gulf — account for an estimated two-thirds of this workforce shift.

Ben Simms, chief executive of the Tropical Health and Education Trust, a UK-based charity, says one of its top priorities is that governments “make proportionate recompense” to countries that are sending health workers — “recognising the considerable savings we make on the cost of training staff recruited internationally”.