Infectious Disease Fellowship Matches Decline in 2025, Raising Workforce Concerns
The number of physicians matching into adult infectious disease (ID) fellowships has significantly decreased in 2025, signaling a potential challenge for the future of the specialty. According to data released in December, only 272 physicians matched wiht adult ID programs, a nearly 14% drop from the 316 matches in 2024 . This translates to just 45% of available fellowship positions being filled,compared to 51% the previous year.
While pediatric ID fellowship matches remained relatively stable, with 44 matches in 2025 compared to 43 in 2024, the overall trend in adult ID is causing concern among leaders in the field. This decline follows a period of increased interest in ID during the COVID-19 pandemic – often referred to as the “Fauci effect” – when applications surged in 2021 and 2022 (404 and 387 applicants, respectively) . The current numbers suggest a return to pre-pandemic levels, with 330 residents applying to ID programs .
Factors Contributing to the Decline
Several factors are believed to be contributing to the decreased interest in ID fellowships. Wendy S. Armstrong, MD, president-elect of the Infectious Diseases Society of America (IDSA) and head of the division of infectious diseases at the University of Colorado, attributes the downturn to a challenging habitat for infectious disease and public health professionals. “We all knew it was going to be a bad year as of the onslaught that infectious disease (care) and public health have been under in the public eye,” Armstrong stated in an interview with Healio.
This “onslaught” includes consistent funding cuts and public backlash against ID specialists, often fueled by misinformation and distrust during the pandemic. Armstrong emphasizes that these factors influence career choices, particularly when considering the viability of a career path with limited financial support for both patient care and research.
Compensation Concerns
Financial considerations remain a significant barrier to entry for many aspiring ID specialists.ID clinicians consistently rank near the bottom in terms of salary compared to other medical specialties . The burden of medical school debt further exacerbates this issue, making it difficult for physicians to justify choosing a lower-paying specialty.
Potential Solutions and Future Outlook
Despite the current challenges, there is cautious optimism within the ID community. The Bio-Preparedness Workforce Pilot Program,a federal initiative passed in 2022 aimed at boosting ID recruitment,offers a potential solution. This program proposes medical school loan forgiveness for physicians entering the ID field, but it currently awaits Congressional funding approval .
While Armstrong doesn’t anticipate immediate funding approval from Congress, she remains hopeful for the future of ID, stating, “If you’re doing good work, there’s always hope.” The IDSA is also actively working to improve compensation, expand loan repayment options, optimize work-life balance, and reduce barriers to entry for international medical graduates.
Expert Perspective: A Call for Continued Investment
Darcy A. Wooten, MD, MS, Editorial Board Member for Healio Infectious Disease News and Director of the ID Fellowship Program at Washington University School of Medicine in St.Louis, emphasizes the importance of post-match recruitment – often called the “scramble” – in filling remaining fellowship positions. She highlights the IDSA’s investment in a toolkit to support effective and equitable post-match recruitment efforts.
Wooten also underscores the need for continued advocacy for improved compensation and streamlined pathways for international medical graduates. She concludes with a hopeful outlook, citing a quote from Lauren Jackson: “While optimism is the belief that the future will be better, hope is the belief that we have the power to make it so.”
Key Takeaways
- The number of physicians matching into adult ID fellowships declined by nearly 14% in 2025.
- Low compensation, public backlash, and funding cuts are contributing to the decline.
- The Bio-Preparedness Workforce Pilot Program offers a potential solution through loan forgiveness.
- Continued investment in recruitment efforts and advocacy for improved conditions are crucial for the future of the ID specialty.
For more details:
Wendy S. Armstrong, MD, can be reached at wendy.armstrong@cuaschutz.edu.
Sources/disclosures
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Disclosures:
Armstrong reports no relevant financial disclosures. Wooten reports no relevant financial disclosures.
