The (your) future in Infectious Diseases and Medical Microbiology

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The (your) future in Infectious Diseases and
Medical Microbiology

• Kevin Forward
• Professor, ID,MM and Path, Dalhousie U
• Past President CIDS
• Past Chair, Examination Cmtte for MM
• Past Chair, Nucleus Cmtte for MM
• Program director MM and ID

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In 1962 Sir McFarland Burnett stated, By the end
of the Second World War it was possible to say
that almost all of the major practical problems
of dealing with infectious disease had been
solved.
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Lessons learned

• Memorial U U Alberta Memorial U
• U Manitoba Memorial U U
  Toronto
• U Manitoba Dalhousie

U Toronto
Dalhousie
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The rest of medicine is two dimensional
Changing hosts
Advancing technology
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Changing/new bugs
Changing hosts
Advancing technology
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The most rapidly advancing technology
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Since I did my ID training

• Legionnaires disease/Pontiac fever
• Hantavirus pulmonary syndrome
• Lyme disease
• Helicobacter
• Bartonella
• Tropharema whipelli
• Numerous misc bacterial species
• P. marnefeii
• C. gattii

• Human metapneumovirus
• Human coronavirus (SARS)
• Hepatitis C and E
• Avian influenza
• Bocavirus
• Torovuruses
• Nipha/Hendavirus
• Pavovirus B19
• HHV 6-8
• West Nile
• HIV/AIDS/other retroviruses
• Cyclospora

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Since I did my ID training

• VRE
• CA-MRSA
• Super C. difficile
• 200 new beta-lactamases
• S. maltophilia
• B. cepacia
• S. lugdenensis
• Toxic shock syndrome/Necrotizing fasciitis
• Old bugs pushing others out..

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Since I did my ID training

• The personal computer
• PCR..and other amplification systems
• Molecular fingerprinting
• Instrumentation advances and robotics
• Gene chips
• Proteomics
• Diagnosis
• Understanding

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Since I did my training

• So many new drugsbeyond antibiotics
• An evolving population of immune compromised
  hosts
• Globalization

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Matrix-Assisted Laser Desorption-Ionisation
Time-Of-Flight Mass Spectrometry (MALDI-TOF MS)
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MALDI-TOF MS
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• The integration of
• semiconductor fabrication techniques
• solid phase chemistry
• molecular biology
• sophisticated robotics
• lasers
• microcomputers

Thousands of probes on a small glass chip
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So what does the future hold?

• Damned if I knowbut you be crazy to think that
  we are in some way near the end this story!!!!

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Your future in ID/MM
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Current trends in ID and MM

• There is an aging cohort of ID and MM docs
• Growth in positions in academic centers is now
  slow and measured
• There has been rapid growth in the number of
  positions in other non-academic centers
• All of you should easily get jobs

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Set your priorities!

• Working environment
• Living environment
• Clinical practice setting
• Research inclinationsdont fake ityoull be
  sorry!
• We all love to teach!
• Money and lifestyle

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Dont be in a hurry! In ten years an extra year
will mean nothing financially

• Go away for some of your training (not for one
  year only)
• Acquire skills that others dont have
• Learn other ways of doing things
• Clearly demarcate residency from your real job

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What to do when you visit for an interview

• Be proactive dont simply accept any schedule
  that they send you.
• Meet with the fellows, the sentinel chickens.
• Arrange to go to case presentations
• Ask about an office, resources.
• The director of research (if that is a priority)
• Identify future collaborators ahead of time and
  meet with them.
• How much time is protected, and for how long?
• Whats the experience of other junior faculty?

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Academic positions

• What research support is available?
• University start-up
• Hospital foundations
• Provincial foundations
• What collaborations can be entered into?
• Dont go anywhere to do research unless you know
  who you are going to work with.
• What are the other resources available?
  Stats/study design
• Is there a mentoring program?
• How do they define success?
• Publications
• CIHR

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Academic positions (contd)

• What are the links to pure scientists?
• Wet labs
• Statistical support
• Epidemiology and other support

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Community practice

• Extent of coverage
• On-call expectations
• Can you build a practice?
• Clinical infectious diseases (IP and OP)
• Count on one consult per bed per year
• HIV
• STDs
• Travel medicine
• Hospital epidemiology
• Antibiotic utilization
• Clinical microbiology
• Home IV

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When someone says its not about the money.
Its about the money!

• There is considerable variation in incomes!
• Incomes tend to reflect for the following
  determinants
• The provincial coffers
• Supply and demand
• Alternative funding plans
• Timing of the latest contract
• Local idiosyncrasies
• Skillful negotiation
• For MMlinks to pathologists

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Money (contd)

• Its not what you make its what others make!

• Information you need
• Other provincial numbers
• Range within the division
• Miscellaneous other issues
• Cost of living
• Potential for incorporation
• Credit for additional training
• Are specific responsibilities appropriately
  remunerated?

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Finding your first position

• Several approaches
• Customize your training to a vacant position
• Train in the area that you love and market your
  skills
• A combination of the two
• Create your own position

• What mix of ?
• General Medicine
• Infectious Diseases
• Medical Microbiology
• Hospital Epidemiology
• Travel Medicine
• Infection Control
• Clinical trials
• Basic research
• HIV
• Public health

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Quality of life

• You will work hard, but you will love it.
• You will spend few sleepless nights.
• You wont have to eat Kraft Dinner (but you will
  anyway).

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The world is your oyster