The Shrinking Number of Infectious Disease Doctors

By: Marcus J. Hopkins, Health Policy Lead Consultant, ADAP Advocacy

Imagine having to travel 60 miles or more to reach an infectious disease (ID) physician who has the requisite expertise and training to address your HIV/AIDS. For many people living in nearly 80% of counties in the United States (n = 2,499), this is a reality (Figure 1; Walensky et al., 2020).

Figure 1 – ID Physician Density per 100,000 Population, by County

Photo Source: Walensky et al., 2020

This shortage of ID physicians isn’t new; for nearly a decade, the Infectious Diseases Society of America (IDSA) has been attempting to recruit aspiring or existing physicians into the field (Thompson, 2022), but those efforts have largely fallen flat.

In 2008, there were 6,424 physicians in the U.S. with active ID licenses; by 2018, that number was 9,136 (a 42% increase over 10 years); by 2025, however, it was just 9,774—barely a 7% increase over 7 years (Bearman et al., 2025).

So…what’s driving this shortage?

As with most things American Healthcare System-related, much of the issue has to do with money. Infectious disease doctors are historically paid less than physicians in other specialties, such as cardiology and gastroenterology (Goldman, 2026). According to the IDSA:

• The average medical student carries more than $241,000 in educational debt
• ID physicians make on average $260,000/year compared to those working in plastic surgery ($575,000/year), orthopedics ($557,000/year), cardiology ($490,000/year). According to the IDSA, of the fields measures, ID was the fifth-lowest paid specialty out of 29 fields examined (Figure 2, IDSA, 2022)

Figure 2 - Physician Compensation for Infectious Diseases Specialists Lower than Most Specialists

Photo Source: IDSA, 2022

In addition to financial issues, other issues exist that make placing ID physicians in unserved or underserved counties.

Rural counties are simply unable to attract and retain talent.

One of the primary issues that exists across the economy is the fact that rural areas simply lack much of what educated professionals want:

1. Available affordable housing
2. High-quality infrastructure, including safe, well-maintained roads, reliable utilities, including heating, electricity, and mobile phone coverage, and close, reliable emergency services, including law enforcement, fire departments, and other emergency personnel
3. Good schools that can provide any existing or potential children with a quality educational experience
4. Strong, inclusive communities that are welcoming to and accepting of non-White, non-Christian professionals
5. Close proximity to entertainment and dining opportunities
6. Close proximity to healthcare services other than those provided by the physicians themselves

The reality for many people who move to rural areas is that the touted “benefits” of living in rural communities, including more physical space, lower costs of living, a slower pace of living, and “fresh air,” as the Green Acres theme song reminded us, are simply outweighed by the inconveniences of rural life.

For patients in these unserved and underserved counties, however, they don’t really care why ID physicians aren’t located near them; they only care that they aren’t.

Photo Source: PlusInc | iStock

If you were to explain to patients with chronic illnesses that it’s hard to fill a position that pays “just” $260,000/year, you would likely be met with disbelief and scorn. When nearly 40% of people living in rural areas have median incomes of less than $50,000/year, trying to sell them the line that “ID physicians just don’t make enough” is a very hard sell (Federal Housing Finance Agency, 2024).

For many people dedicated to rural living, it’s hard to understand why people would want to live anywhere else. And this is part of the problem: if your area offers little in the way of modern comforts, job security, and job growth potential, it’s no big surprise that people who live there want to leave, and those who don’t live there want to avoid it.

And while 65% of nonmetro counties have seen population growth since 2020, almost all of that growth has come not from domestic relocation, but from international/foreign migration (United States Department of Agriculture, 2026).

All of these issues combined make for a bleak picture.

Disclaimer: Guest blogs do not necessarily reflect the views of the ADAP Advocacy Association; rather, they provide a neutral platform for the author to promote open, honest discussion of public health-related issues and updates.

References:

[1] Bearman, G., Mullin, R., & Nori, P. (2025, December 10). The Receding Specialty of Infectious Diseases and Implications for U.S. Healthcare. Open Forum Infectious Diseases, 12(12), ofaf756. https://doi.org/10.1093/ofid/ofaf756

[2] Federal Housing Financing Agency. (2024, December 23). Who Lives in Rural America? Washington, DC: Federal Housing Financing Agency: Blog: Insights. https://www.fhfa.gov/blog/insights/who-lives-in-rural-america

[3] Goldman, M. (2025, March 02). Why new doctors aren't specializing in infectious diseases. Arlington, VA: Axios. https://www.axios.com/2026/03/02/doctors-not-specializing-infectious-diseases

[4] Maamari, J., Chen, Z., Motairek, I., Al-Kindi, S., & Fleisher, J. (2024, April 18). Mapping Proximity to Infectious Disease Physicians Across the United States. Open Forum Infectious Diseases, 11(5), ofae208. https://doi.org/10.1093/ofid/ofae208

[5] Sajani, A. (2024, August 05). The infectious disease doctor shortage will hit marginalized people the hardest. Boston, MA: STAT. https://www.statnews.com/2024/08/05/infectious-disease-doctor-shortage-bio-preparedness-workforce-pilot-program/

[6] Thompson, D. (2022, December 19). America Facing Shortage of Infectious Disease Doctors. Norwalk, CT: HealthDay: Health News: Public Health. https://www.healthday.com/health-news/public-health/physicians-2658968654.html

[7] United States Department of Agriculture. (2026, February 13). Population & Migration. Washington, DC: United States Department of Agriculture: Economic Research Service: Rural Economy Population. https://www.ers.usda.gov/topics/rural-economy-population/population-migration

[8] Walensky, R. P., McQuillen, D. P., Shahbazi, S., & Goodson, J. D. (2020, June 03). Where Is the ID in COVID-19? Annals of Internal Medicine, 173(7), 587-589. https://doi.org/10.7326/M20-2684