The Infectious Disease Workforce Is Collapsing
In December physicians matched into adult infectious disease fellowships That was a drop from the year before and fewer than half of ID fellowship programs filled at all Six years earlier more than three-quarters of programs filled The table below...
Post 1 of 4 The Infectious Disease Shortage
- The Infectious Disease Workforce Is Collapsing
- Hospitals Can't Wait for the ID Workforce to Recover
- An Open Invitation to Independent Infectious Disease Practices
- Shared Rails, Not Another Point Solution
In December 2025, 272 physicians matched into adult infectious disease fellowships. That was a 14% drop from the year before, and fewer than half of ID fellowship programs filled at all. Six years earlier, more than three-quarters of programs filled.
The table below, drawn from NRMP match data via the Pediatric Infectious Disease Journal, shows the trend:
| Match year | Programs filled |
|---|---|
| 2019 | ~77% |
| 2021 | ~70% |
| 2022 | ~63% |
| 2023 | ~55% |
| 2024 | 51% |
| 2025 | <50% |
This is not a cyclical dip. It is a steady, year-over-year collapse in the pipeline that produces America's infectious disease physicians.
Why trainees are walking away
The economics explain most of it. Infectious disease is the third-lowest-paid specialty in American medicine, at an average of $282,000 a year (Medscape, via Becker's, April 2026), less than half what orthopedic surgeons earn. Only 34% of ID physicians say they feel fairly compensated, the lowest rate of any specialty surveyed. Among internal medicine residents, low pay is the single most cited reason for avoiding ID, named by nearly two-thirds.
And the economics just got worse. The 2026 Medicare Physician Fee Schedule cut ID reimbursement by 6% overall, 9% for facility-based physicians, who provide the bulk of hospital ID care. IDSA calls infectious disease the hardest-hit specialty in the schedule. The AMA reports that 81% of ID physicians face cuts of 5% or more.
Demand is moving the other way
Federal HRSA projections put ID physician supply at roughly 14,010 against demand for 15,130 by 2035, a gap estimated before the fellowship collapse accelerated. Four out of five U.S. counties already have no infectious disease physician at all.
Fellowship fill rates below 50% compound over time: fewer trainees today means fewer practicing physicians for decades. The pipeline will not recover on its own.
The question for hospitals is therefore not how to recruit from a shrinking pool. It is how to deliver infectious disease expertise without depending on recruitment at all.
Next in this series: why hospitals can't wait, the stewardship mandate.
References
- Healio, "Compensation, current events impact ID recruitment," January 16, 2026. healio.com
- Arias & Pirofski via Pediatric Infectious Disease Journal, adult ID fellowship match fill rates, 2019–2025. ppidjournal.com
- Becker's, "10 highest, lowest-paying physician specialties," April 10, 2026 (citing Medscape). beckersasc.com
- IDSA advocacy on Medicare practice expense cuts (2026 Physician Fee Schedule analysis). idsociety.org
- AMA, "What to expect from the 2026 Medicare Physician Fee Schedule." ama-assn.org
- Medical Xpress / IDSA, December 2022, HRSA 2035 projections; 4 of 5 counties without an ID physician. medicalxpress.com