Hospitals Can't Wait for the ID Workforce to Recover

The supply of infectious disease physicians is collapsing. But hospitals do not have the option of waiting for it to recover, because their obligation does not shrink with the supply.

The mandate

Since 2019, the Centers for Medicare & Medicaid Services has required every hospital and critical access hospital to maintain an antibiotic stewardship program as a Condition of Participation. The Joint Commission requires one for accreditation. These are not recommendations. They are conditions of getting paid and staying accredited.

Stewardship programs exist because the clinical and financial stakes are enormous. Sepsis is the most expensive cause of hospitalization in the United States, one 2026 analysis puts the annual cost above $52 billion, more than 14% of all hospital spending, and as many as half of U.S. hospital deaths involve sepsis. Infectious disease consultation is one of the few interventions consistently tied to lower mortality, shorter stays, and lower antibiotic costs.

The gap

Here is the collision: every hospital must run stewardship, but most small and community hospitals cannot recruit the physicians to do it. Four out of five U.S. counties have no ID physician. Fellowship programs are filling fewer than half their slots. The recruiting pool is not just tight. For many hospitals, it does not exist.

This is what makes the hospital a compliance-driven buyer. Unlike most purchasing decisions, this one does not require convincing anyone of the ROI. The regulation already did that. What these hospitals need is not a pitch. They need a vendor.

The endorsed answer

The field itself has named the model: telestewardship and tele-ID. For resource-limited hospitals, remote infectious disease support, delivered by physicians the hospital could never recruit locally, is the explicitly recommended path. Infectious disease is also unusually well suited to it: the specialty is cognitive work built on chart review, culture review, and lab review, which travels well over a structured telemedicine workflow.

The hospitals that solve this first will not be the ones that recruit best. They will be the ones that stop trying to recruit for a role the workforce can no longer fill, and buy the capability instead.

Next in this series: the model, shared rails, not another point solution.

References

• CMS Hospital Improvement final rule (Conditions of Participation), finalized September 2019, antibiotic stewardship programs required for all hospitals and CAHs. cidrap.umn.edu
• ClaimDOC, "Sepsis: A Common, Costly Challenge for Health Plans," September 2026, sepsis costs above $52B annually, 14%+ of hospital costs. claim-doc.com
• Newswise / Kaiser Permanente Division of Research, sepsis involved in up to half of U.S. hospital deaths; AHRQ: most expensive cause of hospitalization. newswise.com
• PSQH / Accreditation & Quality Compliance Center, Q&A on the CMS antimicrobial stewardship rule; Joint Commission requirements. accreditationqualitycenter.com