Infectious Disease Doctor

What the pay looks like

The national median is $256,560 a year and the bottom tenth sit near $73,570. Two honest warnings. First, this is the published figure for General Internal Medicine Physicians, the larger group this specialty sits inside, not for infectious disease alone. Second, the federal survey counts physicians who are employed and paid a wage, so doctors who are partners in their own practice are left out, and the low end mostly reflects part-time and very early career work.

One of medicine's worst pay puzzles

This is the field's open secret and the reason its training programs struggle to fill. You spend two extra years in fellowship and usually come out earning around, or below, what you would have made finishing at general internal medicine. The work is thinking and advising, and American medicine pays for procedures.

While you are training

You are paid from your first day out of medical school, but that is five years of residency and fellowship on long hours and night calls before an attending physician's salary starts.

What it costs to get there

Bachelor's degree, four years at an in-state public university

Roughly $10,000 to $16,000 a year in tuition and fees

Medical school, four years

Roughly $30,000 to $45,000 a year in-state public, considerably more at private schools

Admission test and applications

$1,000 to $3,000 for the MCAT (Medical College Admission Test), the application service and secondary applications

Licensing exams

Several hundred dollars for each of the three steps of the United States Medical Licensing Examination, plus board certification fees later

Roughly, all in

$167,000 to $310,000

Tuition, fees, exams and kit. Not rent, food or travel

The low end is four years at an in state public university at about $10,000 a year, then a public in state medical school at around $30,000 a year, plus the admission test, applications and the three licensing exam steps. The high end is the higher in state undergraduate rate followed by a private medical school at around $60,000 a year with a fuller application season. Residency and the infectious disease fellowship that follow are paid jobs, not tuition, so they add years but not cost. The Association of American Medical Colleges runs a fee assistance program that cuts admission test and application costs for students who qualify, and most graduates who borrow leave owing six figures, so interest matters here even though it is not in these numbers.

Most graduates leave medical school owing six figures. The Association of American Medical Colleges runs a fee assistance program that cuts admission test and application costs for students who qualify, and it is worth applying for before you spend a dollar.

Where the money comes back

• Public Service Loan Forgiveness

  Ten years of payments while working full time for a nonprofit hospital, a public health department or a government agency wipes the remaining federal loan balance. Most teaching hospitals qualify, and this specialty lives in them.

• National Health Service Corps and state repayment programs

  Pay down loans in exchange for working in an area short of doctors.

• Hospital salary plus stipend

  Many infectious disease doctors are paid a base salary plus money for running the hospital's antibiotic stewardship or infection control program.

• Research grants and academic appointments

  A large share of this field sits in universities, where part of the salary comes from grant funding.

• Consulting and industry work

  Vaccine and antibiotic companies, and public health agencies, hire specialists as advisers.

The path

Thirteen years after high school, minimum, and every step is competitive.

1. 1

   Bachelor's degree

   4 years

   Any major, as long as you finish the required biology, chemistry, physics and math courses. Grades and the admission test do the deciding.

2. 2

   Medical school

   4 years

   Four years for a Doctor of Medicine or Doctor of Osteopathic Medicine degree. Two years of classroom science, two years rotating through hospital departments.

3. 3

   Internal medicine residency

   3 years

   Three years of paid hospital training in adult medicine, matched through the national residency match. This is the base you specialize from.

4. 4

   Infectious disease fellowship

   2 years

   Usually two more years, accredited by the Accreditation Council for Graduate Medical Education, focused on infections, antibiotics, immunocompromised patients and travel and tropical medicine.

5. 5

   State license and board certification

   Months, ongoing renewal

   A medical license from the state you work in, plus board certification in internal medicine and then in infectious disease.

High school courses that help

• Biology and chemistry

  Take both to the highest level offered. They are the spine of everything that follows.

• Physics

  Required for medical school admission, so you will meet it either way.

• Statistics

  Infectious disease runs on population data, outbreak curves and study design more than most specialties.

• English and a language

  Half of this job is explaining a complicated infection to a worried family, often not in English.

Time and money, at a glance

Years after high school

13 to 14

Admission

Very competitive; high grades plus the MCAT (Medical College Admission Test)

Total tuition

Often $160,000 to $250,000 across college and medical school, in-state public

Paid while training?

Yes, from the start of residency, at roughly $65,000 to $95,000 a year

Licensing is state by state

There is one national exam sequence, the United States Medical Licensing Examination, taken in three steps across medical school and residency. There is no national license. Each state medical board issues its own, and moving states means a new application, new fees and a wait. Board certification is separate again: it is granted by a national board, is not legally required to practice, and is required by essentially every hospital that would employ you.

Where people train

• Any accredited medical school

  Where you go to medical school matters much less than people think. Where you do residency matters more.

• Large teaching hospitals

  Infectious disease fellowships sit in academic medical centers, because that is where transplant, cancer and intensive care patients are.

• The fellowship directory

  The Infectious Diseases Society of America publishes a directory of accredited fellowship programs and runs the match that places applicants into them.

Sub-paths inside the specialty

• Transplant and cancer infections

  Caring for patients whose immune systems have been deliberately switched off. Highly specialized and in demand at big centers.

• Antibiotic stewardship

  Running the hospital program that decides which antibiotics get used and when. Often comes with a leadership title and extra pay.

• Infection prevention and hospital epidemiology

  Stopping infections spreading inside the building. Every hospital needs someone doing this.

• Public health

  Outbreak investigation and policy at a city, state or federal health agency. A different pay scale and a different kind of day.

• Travel and tropical medicine

  Malaria, dengue, parasites, and clinics for people going to or coming from other countries.

Nice-to-haves

• A master's in public health

  Common in this field and often done during fellowship. It opens the outbreak and policy side.

• Research experience

  Start in college. A published paper is close to expected for competitive fellowship spots.

• A second language

  Spanish above all, and it matters more here than in most specialties.

• Time abroad

  Global health placements are common, and tropical infection work needs people who have seen it.

You can stop one step earlier

If thirteen years is too many, the three-year internal medicine residency alone makes you a general internist or a hospitalist, and the pay is usually the same or better than an infectious disease specialist's. Some people do the fellowship anyway because they want the work, which is an honest reason and the main reason the field survives. Nobody enters infectious disease for the money.

A typical day

Mornings are consults: other doctors have patients with fevers nobody can explain, infections that are not responding, or cultures growing something odd. You read the chart, examine the patient, ask the questions everyone else skipped, and then look at the laboratory results yourself. Afternoons bring clinic patients on long-term antibiotics, a stewardship meeting about an antibiotic the hospital is using too freely, and the microbiology lab, where you look at plates and slides with the technologists. You spend more time reading and thinking than almost any other doctor in the building.

The honest trade-offs

Work life

Typical hours

50 a week, plus weeks on call

Remote work

Some, through telemedicine consults to smaller hospitals

Physical demand

Low, but long days on your feet

Unionized

Rarely, though resident physicians at some hospitals have unionized

Similar paths

• Internal Medicine DoctorThe adult body, all of it, and the complicated patients nobody else can sort out. Eleven years of training.
• EpidemiologistWork out why people are getting sick, and what would stop it. Mostly data, occasionally an outbreak.
• MicrobiologistGrow, identify and outsmart the organisms too small to see, in medicine, food, water and drug manufacturing.

The fellowship is one of the few that does not fill

Most American medical training programs get more applicants than spots. Infectious disease is an exception: a large share of its fellowship positions go unfilled every year, because the two extra years of training usually do not buy a raise. Professional groups have been lobbying to change how the work is paid for exactly this reason.

You are the antibiotic police

Hospitals run antibiotic stewardship programs because overusing antibiotics breeds resistant bacteria, and federal rules now require those programs. The infectious disease doctor is usually the one who has to tell a surgeon that the drug they ordered is the wrong one.

The job changed in public in 2020

Before the pandemic most Americans had never met an infectious disease specialist. Applications to the field rose afterwards, though not enough to fill the training programs, and many specialists spent those years doing hospital planning and public briefings instead of seeing patients.

Antibiotics are running out faster than they are invented

Drug-resistant infections kill tens of thousands of Americans a year, and very few new classes of antibiotic have reached the market in decades, because developing a drug people are told to use sparingly is a bad business. Slowing resistance is a large part of what this specialty now does.