Editor's Note: In China, the Infectious Diseases Department has existed as an independent clinical department for over half a century, with the primary responsibility of infectious disease physicians being the treatment and management of legally defined infectious diseases. With economic development and improvements in public health, the disease spectrum has changed significantly. However, the emergence of new infectious diseases (such as AIDS, SARS, avian influenza, and Lyme disease), hospital-acquired infections, and bacterial resistance is on the rise. Unlike in Europe and the US, where infectious disease specialists are primarily involved in consulting on infectious diseases, hospital infection control, and antibiotic management, Chinese infectious disease physicians are mainly engaged in treating hospitalized patients with legally defined infectious diseases in wards and clinics. Given the changing medical demands in China, the capacity building of infectious disease physicians has become particularly important. Dr. Yonghong Xiao from the National Key Laboratory for Critical Infectious Disease Management, affiliated with the First Affiliated Hospital, Zhejiang University School of Medicine, discussed the responsibilities and capacity building of infectious disease physicians.1. Infectious Diseases
Infectious diseases are illnesses caused by pathogens, which include contagious and non-contagious diseases.
Contagious diseases are defined as those caused by pathogens that have the potential to spread under certain conditions, leading to an epidemic. The defining characteristics of contagious diseases include the presence of pathogens, transmissibility, the potential to cause outbreaks, and the possibility of immunity after infection.
2. Core Responsibilities of Infectious Disease Physicians
Infectious disease physicians specialize in treating a broad range of infections caused by bacteria, viruses, and parasites, which can affect various tissues and organs in the body. As specialists, they possess in-depth knowledge of microbiology, immunology, and antimicrobial pharmacology, as well as advanced clinical skills in internal medicine and diagnostic techniques.
The core responsibilities of infectious disease physicians include diagnosing and treating infectious and contagious diseases, providing cross-disciplinary consultations on infections, and participating in public health initiatives, such as infectious disease prevention, antimicrobial resistance (AMR) control, antimicrobial stewardship (AMS), and hospital infection control. Their professional development pathway integrates knowledge from basic medicine, clinical medicine, and public health, which they acquire through rigorous medical education and specialized training.
3. Challenges for Infectious Disease Physicians in China
To gain insight into the working environment and challenges faced by Chinese infectious disease physicians, Dr. Yonghong Xiao’s team conducted a nationwide cross-sectional study. The study revealed that while most hospitals have established infectious disease wards and clinics, there is a significant mismatch between the number of physicians and hospital beds, physician income levels, and job satisfaction. Physicians commonly reported high work-related stress and indicated that the medical services they provided were insufficient to meet current healthcare needs. The study highlighted the heavy workloads, high job pressure, low pay, and limited career development opportunities faced by infectious disease physicians. These challenges hinder the department’s growth and push physicians to seek diverse professional development paths and strategies for capacity building. Furthermore, the relatively narrow scope of the specialty limits its expansion.
An exemplary model of efficient infectious disease management can be seen in the Infectious Diseases Department at the University of California, San Francisco (UCSF). The UCSF team includes senior physicians, pharmacology experts, microbiologists, and research staff, working together in a multidisciplinary collaboration. The team focuses on treating hospital-acquired infections, infections in immunocompromised individuals, HIV/AIDS, and complex cases of unexplained fevers, while also guiding antibiotic use and providing outpatient services. Through effective ward rounds and real-time interaction with the microbiology laboratory, the team ensures accurate and timely diagnoses and treatments. This example offers valuable insights for infectious disease departments, demonstrating that strengthening interdisciplinary collaboration, enhancing clinical and research capacities, and optimizing resource allocation can help address the increasingly complex challenges of infectious diseases.
4. National and Global Capacity Building for Infectious Disease Physicians
In 2023, the General Office of the Central Committee of the Communist Party of China and the State Council General Office issued the Opinions on Further Improving the Medical and Health Services System, emphasizing the need to strengthen the training of urgently needed professionals in public health, general practice, pediatrics, critical care medicine, respiratory medicine, psychiatry, infectious diseases, and geriatrics. The policy aims to improve the training mechanisms for interdisciplinary talent in public health and clinical medicine.
Globally, prestigious institutions have developed training programs for infectious disease physicians.
Infectious Disease Fellowship at Emory University
The specialized training program lasts for at least two years. The first year focuses on clinical training in infectious diseases, during which fellows participate in various patient care rotations and learning experiences designed to teach all six core competencies. They also attend a series of formal teaching and educational conferences. In the second year and beyond, the focus shifts to research activities and training under the guidance of mentors.
Infectious Disease Fellowship at NIAID
The National Institute of Allergy and Infectious Diseases (NIAID) offers a three-year infectious disease fellowship. The first year focuses on clinical practice and basic theoretical learning. Fellows complete two months of clinical center rotations, covering a wide range of infections, including parasitic diseases and infections in patients with complex immune deficiencies. They manage both adult and pediatric cases and participate in infection and ICU infection consultations, especially for specialized groups such as stem cell transplant and chemotherapy patients. Weekly HIV follow-up clinics and various educational activities, including case-based learning, journal clubs, multidisciplinary consultations, and case discussions, aim to enhance clinical decision-making and research skills. In July, an orientation month features lectures by NIH experts covering infection control, microbiology, and clinical discussions.
In the second and third years, the focus shifts to advanced clinical practice and scientific research under the guidance of mentors. Fellows engage in research funded for 2-3 years, choosing between clinical, laboratory, or translational research, based on their interests. The HIV follow-up clinic continues, expanding to more diverse patient groups and other outpatient clinics, ensuring comprehensive growth in infectious diseases.
NIAID Physician-Scientist Training Program
This program focuses on training future physician-scientists, clinical researchers, microbiology lab directors, and public health administrators. It emphasizes the study of epidemiology, particularly hospital epidemiology, antimicrobial stewardship (AMS), and hospital big data processing capabilities. The program also promotes global health perspectives, engaging in international collaboration projects on tuberculosis (TB), parasitic diseases, and emerging infectious diseases (EID). In the HIV field, the training covers key topics such as pathogenesis, epidemiology, immune reconstitution, chronic viral persistence, resistance, and vaccine development. Furthermore, the program emphasizes microbiology expertise and laboratory management skills, aiming to help trainees achieve professional certification from the American Society for Microbiology (ASM). The management and prevention of infections, particularly those related to stem cell transplantation, are also key components of the training.
Building and Managing Infectious Disease Departments in China
China has established requirements for building and managing infectious disease departments, as well as the work of infectious disease physicians.
Standards for the Construction and Management of Infectious Disease Departments in General Hospitals (Draft Recommendations)
• Infectious disease wards are divided into general infection wards and infectious disease wards. General infection wards are an essential part of the infectious disease departments in medical institutions and admit patients with various infections, excluding legally defined contagious diseases. Medical institutions should establish infectious disease wards according to their conditions and relevant regulations.
• General hospitals must have independent or relatively independent infectious disease wards. The number of beds in these wards should not be less than 3% of the total hospital beds, with at least 30 beds in tertiary hospitals.
• General infection wards should meet the diagnostic and patient management requirements for infectious diseases. The setup can reference internal medicine wards to meet medical needs and patient admissions.
• Infectious disease wards must comply with national regulations, have clear functional divisions, and be equipped with specialized facilities to meet the diagnosis, treatment, emergency care, and isolation needs of patients with infectious diseases.
Infectious disease departments in China face increasing demands, with physicians required to diagnose and treat a wide range of infectious diseases. Their responsibilities include providing consultation services, rational use of antimicrobial drugs, working with microbiology laboratories to interpret pathogen test results, participating in hospital infection control, and managing emerging infectious diseases.
