Daniel McQuillen, MD: [00:00:14] Thanks for joining us for the latest episode of the Let's Talk podcast. Today I'll be talking with three of our members about three important initiatives that will be the focus of the society's work over the next year and beyond. As I've shared previously, last fall, the IDSA Board of Directors took a fresh look at our strategic plan, understanding that now is the time to seize the moment as the important contributions of the workforce are front and center. We have approved directing major investments into three projects that will have a broad impact across the society's priorities and have potential for making significant progress. These initiatives are. One advocating for the value of ID and quantifying the impact of the ID workforce during the COVID pandemic. Number two, an ID Physician compensation Learning campaign to raise member awareness and create behavioral change. And three, expanding the advocacy and lobbying influence to ensure a seat at the table with policy makers to advance our overall antimicrobial resistance, workforce compensation and pandemic preparedness goals. Joining me today to talk about these initiatives are Dr Jeanne Marrazzo, Treasurer of the Board of Directors and Director of the Division of Infectious Diseases at the University of Alabama at Birmingham. Dr Steve Schmitt, Vice President of the Board of Directors and Vice Chair of the Department of Infectious Diseases at the Cleveland Clinic. And Dr Emily Spivak, Chair of IDSA's Antimicrobial Resistance Committee and Associate Professor of Medicine in the Division of Infectious Diseases at the University of Utah. Dr Spivak also serves as the co-director of the Antimicrobial Stewardship Programs at both University of Utah Health and the Salt Lake City Veterans Affairs Health Care System. Thank you all for being here today.
[00:02:08] Jeannie, let's start first with you. Covid has dominated our lives and our livelihood for the past two years, as we all know. We've talked a lot at the board level about the leadership role in the of the field of ID and the importance of finding a way to quantify and document the contributions are of our profession. So how is our board going about doing that?
Jeanne Marrazzo, MD: [00:02:29] Dan, it's a really critical question and I think it's become even more critical as we realize how eager people are to just be done with the pandemic and to essentially forget a lot of the pain that we've all suffered. What we are doing is coming up with a whole suite of things to be able to communicate what we have done as a group and as a field during the pandemic. The centerpiece of this effort is going to involve IDSA partnering, partnering with the Johns Hopkins Center for Health Security. And what we will be doing with them is to develop and publish a white paper. The white paper is going to explicitly talk about the significant contributions that the workforce in ID has made to the COVID pandemic and will also make recommendations to strengthen and secure our workforce as part of future broader pandemic preparedness efforts. And the idea to have this paper is not just so it goes on the shelf, but so that it becomes a really useful tool to talk to decision makers who can impact policy change, who can really advance what we need to keep ourselves healthy as a field. So federal policymakers in Congress, the administration, and then of course, C-suite executives who we answer to all the time at hospitals and health care systems. And as I mentioned, the paper is really just the first part of this initiative. In partnership with that, IDSA will also be undertaking a significant advocacy and communication strategy to drive attention to the paper and really give people the opportunity to advance meaningful policy changes.
McQuillen: [00:04:16] So how are we going to operationalize this going forward?
Marrazzo: [00:04:20] The question is how do you gather in particular content for this paper so that it does really reflect actual effort? What we are doing is with the Hopkins Center surveying ID division chiefs and hospital epidemiologists and conducting interviews with a cross-section of the ID workforce. And it's going to be very important to have that interview reflect our fields geographic, racial, ethnic diversity as well, and also practice setting, right? So we really want people in academics as well as people in private practice, people in public health. So what we want to do with this approach, which the Hopkins Group is really very adept at, is to uncover and quantify the many ways that the field has contributed to the response and really the essential roles that ID people have filled in our institutions and our communities. The other thing we want to get to, which we are all very sensitive to, is how do we quantify the significant additional workload and how much of it was uncompensated in the pandemic, because certainly that was a major, major feature. Two other quick things. The paper is going to include a major focus on ID physicians because they are the bulk of IDSA's membership. But we have to recognize that it took a huge village, right, to implement the ID led efforts. And so the multidisciplinary ID team, including advanced practice providers, pharmacists, clinical microbiologists, scientists and more, will be part of this effort too, because everybody has been central. And then the last thing is just to remind people that the success of all of this is going to depend on the responses we receive. So if you are asked to participate, despite it being the 50th thing, you probably have to do that minute. We do really hope you will have time to respond because this is our moment, right? It's our once in a lifetime chance to make the argument that if it weren't for us leading the effort during the pandemic, things were bad. But they certainly could have been a lot worse. So please consider participating if you can.
McQuillen: [00:06:32] Yeah, I'd love to echo those requests. And I do think that this ties in quite well with one of our major advocacy efforts that Dr Spivak and I will talk about later in this podcast, particularly the team nature of this and the fact that it's not just physicians and that IDSA recognizes that. And it's an important advocacy point that we are already making on Capitol Hill.
[00:07:36] Now let's turn to ID physician compensation. Steve, you and I have been tackling this issue of demonstrating the value of the profession brings to medicine for a long time. What about this initiative is different from what we've been doing and how will it make a difference for our members and for all those in the field?
Steven Schmitt, MD: [00:07:54] The difference this time is about granularity and then also about action. So this really affects all practice types. It shows how IDSA is investing in its members in the wake of COVID and the things that we found out back up what we kind of already knew, that physicians work longer hours of greater administrative work are paid less than the majority of their physician counterparts. And it's not just a gap really between cognitives, like ID, and proceduralists. You know, we set up that that artificial boundary, but in fact, you know, IDs have been relatively flat over variety of compensation metrics compared to even other cognitive specialties which have had some growth over the last five years. Why is it important? Because it affects recruitment to the specialty. Is it easy to imagine, Dan, you've really shown elegantly how a large percentage of counties in the US have no infectious disease doctors in order to get people to attract people to ID and to make it a viable specialty, we have to show them that they're going to be recognized and paid appropriately. And as we face COVID and HIV and the emerging crises that are surely to come, we need to grow the specialty. And the pandemic has been mentioned, has shown how ID brings value to the bedside, to healthcare settings, to public health policy and communication. And so we really absolutely have to be fairly recognized and compensated for all of that. But in the end, you know, the members don't really need us to tell them all of this. They know it. And what they need is for us to help them fight this battle. And the board has heard this message has made comp a top priority with a large scale and a long term, it must be noted, initiative.
McQuillen: [00:10:05] So where are we now and how exactly is the compensation task force attacking this and what can we expect as members going forward?
Schmitt: [00:10:15] Again, you know, we established the comp task force last year and really want to thank folks who have given of their time in the middle of the pandemic. Everything's really a big lift right now. I know. And it's composed of physicians across really the gamut of career settings. And we try to stay curious and we try to recognize it as a long term journey on in our group. And we're starting to roll out some deliverables that are going to include some hard copy playbooks that are going to be complemented by educational pieces, including webinars that have already started some practice briefs, educational sessions and other things we're still thinking of. And we've split into a couple of work groups around these deliverables. We're going to focus on two goals. One is to improve physician education and training around negotiation, and the second is to take a look at value based contracting strategies, which is sort of a break from what we've traditionally done in ID. So in in the compensation negotiation arena, we're not really taught the culture and language of negotiation and compensation in general. And some docs as a consequence don't really negotiate at all. You know, as Dan mentioned, this has been going on for a while and we had some prior surveys that gave us some information, but we've collected now via a supplemental compensation survey and we really thank folks for weighing in and giving their time to fill this out.
[00:11:57] We've done gotten together some more robust and targeted benchmark data that I think is very helpful about how we're working in terms of. Hours, more granular data and then how we're spending our time. Issues of disparity in comp across gender, practice setting, etcetera, etcetera, and findings from that are on the website incidentally and as well. Then through dialogue with some comp experts with various ducks across various settings, we've found some barriers, some best practices, some facilitators, some novel approaches to how folks go about it that we hope can increase compensation. And then most immediately, we've used this to inform some hardcopy educational materials and some educational sessions. So at IDWeek, we had a session regarding compensation and negotiation. And you should go back and take a look at that if you can. We've also have a webinar series that has been very well received, but I really hope folks will go and take a look at that as well. And then again, there's going to be a hard copy playbook that should come out shortly to help guide folks efforts.
[00:13:38] And then in the area of value-based contracting, this is really so important because we found out through our surveys that folks who had their compensation tied to quality tended to earn a little more. And so we really want docs to learn how to look for those opportunities to engage with the payers and the administrators, the folks who hold the purse strings to figure out the opportunities and then to negotiate the arrangements. We will also have a guide, a hard copy guide that comes out regarding value-based contracting, and we've had a webinar on it and we'll continue to work on these materials and educational settings. And then lastly, really, I want everybody to know that we don't really see these hard copy guides as sort of the be all end all. We know that we have to help educate folks on how to implement all of that information, who to negotiate with, how to have the conversations, etcetera, what sorts of agreements might be workable and attractive. And so those are pieces that we'll also be working on and bringing forward over time. And it's an ongoing project, but really critical for our members.
McQuillen: [00:15:23] Yeah, I think the amount of work that's been done so far is is excellent. And I do want to echo and emphasize the point that we view this as the beginning of an interaction between the Compensation Task Force, the Clinical Affairs Committee and IDSA and our members. And we don't expect people to just look at a at a resource and be able to do this. So we're going to explore the opportunities that are available in many different forms to give people experience and practicing this before they go into negotiations. I think it's something that's critically missing in our training. When we send people out into the world to fend for themselves. I'm really happy with the effort so far, and I think, again, it's going to be an ongoing process. So finally, let's bring Emily into the discussion to talk about our investment and our advocacy efforts. The pandemic has put ID and IDSA itself in a spotlight. We've never been in before, even with the HIV epidemic, in part because of its immediacy and the fact that it affects virtually everyone. The board recognized that we need to ensure that we maintain this so seat at the table with policy makers. So we've been working on efforts in that regard. And Emily, can you tell us a little bit more about what that specifically entails?
Emily Spivak, MD: [00:16:44] Yeah. Thanks, Dan, and thanks for the opportunity to be here. So there's silver linings to everything, and COVID has really put a spotlight on ID, And so IDSA has been investing really more than ever in federal advocacy to drive policy to progress IDSA's really biggest policy priorities, which are addressing antimicrobial resistance and bolstering the workforce. Both of those things sort of dovetail with all this attention on COVID 19 very well because of the implications from the pandemic on antimicrobial use and antimicrobial resistance and everything that others have been talking about around the need, the role that we had in the pandemic and the roles that we need to continue to have and bolster and increase the workforce. And ID, one of the main advocacy issues that I've been involved around and that the Antimicrobial Resistance Committee has been focusing on has been the Pasteur Act, which helped develop. And this is a bill which at its simplest form is meant to strengthen the antimicrobial pipeline or the antimicrobial drug development pipeline. And as many know, many pharmaceutical companies and industry have gotten out of antimicrobial development because of just an inability to recoup the cost from R&D. This bill is different in that it really promotes or sets up a subscription model where the federal government enters into contracts with drug developers set for five or for ten years that they pay. The federal government pays up front essentially a fee for a supply of these clinically significant and valuable new antibiotics.
[00:18:24] And so it's really a pull incentive as opposed to a to a push incentive to pull the drug developers into antibiotic development. One piece that I'm especially proud of and I think really we need to be pushing on, is the role of antimicrobial stewardship in the fight against antimicrobial resistance. And one idea that I proposed is actually included in the Pasteur Act, which is new grant programs to support hospital antibiotic stewardship programs as part of this act and part of the money that would be again designated in this legislation. And I bring that up because for a long time it at least what seemed to me a lot of the discussion was about just new drugs, new drugs, new drugs, developing new antibiotics without bolstering antimicrobial stewardship is kind of like trying to treat us our way out of the COVID 19 pandemic without investing in a vaccine. And we really need to focus on stewardship. And IDSA is focused a lot of advocacy, and there's more work around bolstering the workforce, which dovetails with antimicrobial stewardship as well. And people may say, well, you know, IDSA has been talking to Congress for a long time about antimicrobial resistance. But what is different now and what is different is that IDSA is really dedicating more resources and committing to these bigger and bolder efforts. And that is in the form of, you know, many more meetings, high level lobbying meetings on Capitol Hill with the Biden administration and more interaction with media and advocating through media.
Spivak: [00:19:54] Some examples of that—myself and other members have written local op-eds in our local papers about antimicrobial resistance and the Pasteur Act, and some of these op-eds have led to our state legislators signing on essentially to co-sponsor this bill. So we are optimistic that it will move forward. Some congressional leaders are now actually developing a bigger package focused on bolstering biomedical research. The Cures 2.0 act, which Pasteur is going to be essentially added on to. And this will probably make it more likely that the Pasture Act will pass as well. It's been really fun to be involved with this advocacy and I think again, now is the time after the or during, hopefully maybe toward the end of the pandemic for this advocacy work to really take steam and to have an impact. That's just one example of some of the advocacy. But I would encourage members, you don't have to be on the board because I'm not you don't have to be a chair of a committee. If IDSA reaches out to you, the advocacy meetings or emails or calls to your representatives really do help and it can drive meaningful change. And so I would encourage all of our members to participate in that as well.
McQuillen: [00:21:04] Yes, having been involved in a number of those as well, it's crucially important, particularly with advocacy meetings with representatives and senators and their staff to have constituents there. That makes a huge impact on them, much more than me coming in in a meeting or any of our advocacy people. Can you tell us a little bit more about the advocacy directly for our members on Capitol Hill in the Bio Preparedness Workforce Act?
Spivak: [00:21:31] As I mentioned, the other main focus of advocacy to again, drive sort of the strategic vision and highest policy priorities of IDSA is bolstering the workforce. And last fall, IDSA drove the bipartisan introduction of into the House and Senate of the bolstering infectious diseases, sorry, bolstering infectious outbreaks or Bio Preparedness Workforce Act. I just know it by the Bio Preparedness Workforce Act. Dr Marrazzo actually testified in support of this bill at a congressional meeting, and the goal of this bill is, again, really to provide, to increase the workforce, to pull people or to make them not worried about going into ID if they're interested, because it will provide loan repayment to health care professionals. So not just physicians, but those in other professional areas who focus on bio preparedness, which does include antimicrobial stewardship and infection prevention and control and also so those in pandemic bio preparedness, but also those who provide ID care and underserved areas or federally funded facilities. You know, just like the Pasteur Act, IDSA is dedicating a lot of advocacy and attention to this bill. So members, may you may be reached out to by IDSA staff to advocate because you know all politics is really local.
[00:22:52] And so you know there are there will be need to get, you know, key stakeholders in the House and Senate to sign on from various areas around the country. And if IDSA reaches out to you, you know, I can't stress enough that it is really imperative and it actually has a lot of impact for somebody from, as Dan mentioned, you know, a senator or congressman or woman's state to talk to them. And you give local examples, which I have done with Senator Romney's office, about what is lacking for ID support in your state, at your institutions. And it really drives home the point to them and really gives them a home example from their area of how this is impacting their constituents. And it really, I think, will make a huge difference. So it will help us all in the end. And I hope we can, you know, bring this one across the finish line. And so if IDSA reaches out to you, I would strongly encourage everyone, don't be fearful. IDSA will give you all the talking points and help you through everything. Your experience, your clinical experience is really, really needed to make these things real.
Marrazzo: [00:23:59] And if I could just jump in, Dan and Emily, to really sort of amplify that message, having testified in support of that legislation, the fact that the legislation would not just impact physicians, but actually would benefit people who are doing real work at the real local level on real problems was a major, I think, positive that that was perceived by the committee and by lawmakers. I mean, actually heard from people that they thought that was a really good thing. And so it is an example of, I think, IDSA recognizing and the people who put this together and are advocating for it, that again, this just like the pandemic response really did take interdisciplinary efforts. So really important for us to tell our stories in this in this framework as well.
McQuillen: [00:24:52] Yeah. And I can tell you from a number of individual meetings with small groups, that is a crucial point. Just making the point that, you know, we don't have enough testing available as it is, but you might have enough tests, but if you don't have techs to run them, it doesn't really do any good. Those simple sorts of real-world examples make a great impact in getting support for this. So as a as a closing note for this, I hope this has given you at least a small picture of what our society is doing for us, the members. We have a lot of work ahead of us. I'm impressed, having seen the response that we get on Capitol Hill at how seriously we're taken and how important our voice is to our legislators, and it's time for us to use it. We definitely are going to need help and input from all of our membership.
[00:25:52] And before we close, I'd like to add that in the midst of a pandemic that has disproportionately affected people of color and underserved communities, IDSA is continuing our commitment to ensure the principles of inclusion, diversity, access and equity are woven into the fabric of everything we do. So thanks for joining us and we'll see you again probably in about a month.
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