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The fight for social justice and diversity in medicine stems from racial inequalities and discrimination that have permeated our society for centuries. As America has become more diverse in recent years, African American physicians remain largely underrepresented in the healthcare workforce and academic medicine. In the field of infectious diseases, one man, George W. Counts, has shouldered the struggle to end disparities in education, training, research, and academic advancement. This article celebrates his legacy and rekindles the discussion about inclusion, diversity, access, and equity in infectious diseases.

Infectious diseases as a specialty is tilted toward social justice, and practitioners are frequently on the front lines of the battle against health inequity in practices that are diverse and sometimes cross international borders. Whether caring for patients living with the human immunodeficiency virus, tuberculosis, or Ebola, infectious diseases practitioners often interact with those at the margins of societies (eg, racial/ethnic/sexual/gender minorities), who disproportionately bear the brunt of these conditions. Therefore, cultural barriers between providers and patients are often salient in the infectious diseases context. In this article, we discuss cultural competence broadly, to include not only the knowledge and the skills needed at both the organizational and the individual levels to provide culturally appropriate care, but also to include “cultural humility”—a lifelong process of learning, self-reflection, and self-critique. To enhance the quality and the impact of our practices, we must prioritize cultural competence and humility and be mindful of the role of culture in the patient-provider-system interactions, in our larger healthcare systems, and in our research agendas and workforce development.

Opportunities for leadership in the specialty of infectious diseases (ID) have markedly increased over the last decade, including in newly recognized areas. Commensurate with the expansion of opportunities in ID, pathways to leadership positions within the Infectious Diseases Society of America (IDSA) are expanding as the Society seeks to advance the field for IDSA members. Acknowledging both the importance of diverse leaders to organizational success and shortfalls in diverse representation within IDSA leadership led to concentrated efforts to enhance transparency and opportunities for members to participate broadly in the work of IDSA. Herein, IDSA leaders reflect on their paths to IDSA leadership, hoping to help guide members seeking to partner with the Society. Features identified as important to individual success include mentorship, networking, participation in ID and IDSA volunteer experiences, passion for ID, and working with IDSA staff to advance the programs and initiatives of IDSA on behalf of members.

Background The drivers of the gap in advancement between men and women faculty in academic Infectious Diseases (ID) remain poorly understood. This study sought to identify key barriers to academic advancement among faculty in ID and offer policy suggestions to narrow this gap. Methods During the 2019 IDWeek, we conducted focus groups with women faculty members at all ranks and men Full Professors, then we administered a brief survey regarding work-related barriers to advancement to the Infectious Disease Society of America (IDSA) membership. We report themes from the 4 focus group discussions that are most closely linked to policy changes and descriptive analyses of the complementary survey domains. Results Policy change suggestions fell into 3 major categories: (1) Policy changes for IDSA to implement; (2) Future IDWeek Program Recommendations; and (3) Policy Changes for IDSA to Endorse as Best Practices for ID Divisions. Among 790 faculty respondents, fewer women reported that their institutional promotion process was transparent and women Full Professors were significantly more likely to have been sponsored. Conclusions Sponsorship and informed advising about institutional promotions tracks may help to narrow the advancement gap. The Infectious Disease Society of America should consider ambitious policy changes within the society and setting expectations for best practices among ID divisions across the United States.

In response to the opioid crisis, IDSA and HIVMA established a working group to drive an evidence- and human rights-based response to illicit drug use and associated infectious diseases. Infectious diseases and HIV physicians have an opportunity to intervene, addressing both conditions. IDSA and HIVMA have developed a policy agenda highlighting evidence-based practices that need further dissemination. This paper reviews (1) programs most relevant to infectious diseases in the 2018 SUPPORT Act; (2) opportunities offered by the “End the HIV Epidemic” initiative; and (3) policy changes necessary to affect the trajectory of the opioid epidemic and associated infections. Issues addressed include leveraging harm reduction tools and improving integrated prevention and treatment services for the infectious diseases and substance use disorder care continuum. By strengthening collaborations between infectious diseases and addiction specialists, including increasing training in substance use disorder treatment among infectious diseases and addiction specialists, we can decrease morbidity and mortality associated with these overlapping epidemics.

Research documents significant gender-based salary inequities among physicians and ongoing inadequacies in recruitment and promotion of physicians from underrepresented minority groups. Given the complexity of the social forces that promote these disparities, their elimination will likely require quantitative and qualitative research to understand the pathways that lead to them and to develop effective solutions. Interventions to combat implicit bias will be required, and structural interventions that hold medical school leadership accountable are needed to achieve and maintain salary equity and racial and gender diversity at all levels.

While a career in infectious diseases (ID) has always been challenging and exciting, recognition of the value that ID physicians provide to the healthcare system as a whole, over and above the value they provide to individual patients, has been poor in this system. In response to this disparity, the Infectious Diseases Society of America Clinical Affairs Committee has long endeavored to quantify the value of ID physicians to the system, which is challenging in part because of the many avenues through which they influence healthcare. We discuss data showing that ID physicians improve clinical outcomes, positively impact transitions of care, and direct system-level improvements through infection prevention and antimicrobial stewardship. We identify areas where value-based care provides additional future opportunities for ID physicians. A Clinical Affairs Committee–sponsored study of ID physicians’ positive impact on patient outcomes shows that few medical specialties are better positioned to positively impact the Triple Aim approach—better health, better care, and lower per capita cost—that is the principle tenet of healthcare system reform.

The decline in applications for infectious diseases (ID) fellowships has been an area of active introspection for the leadership of the Infectious Disease Society of America (IDSA). This prompted actions to address the problem, including surveys of current and former fellows. Ironically, the decline in applications to ID programs is occurring at a time when the need for ID providers has never been greater and the excitement and variety in the practice of ID has never been higher. Data regarding the current ID workforce are presented here, along with perspectives about the future of the profession in the decades to come.

Public health offers infectious disease physicians a variety of rewarding career options. Our training and skills make us well suited to a variety of roles in public health. This article summarizes some of the options for careers in public health and describes why ID physicians are so well suited to them.

Medical science is undergoing a genomic revolution. In coming years, insights from human genomic research will increasingly influence all aspects of infectious diseases, ranging from fundamental laboratory research and clinical care to epidemiology and global health. Infectious disease specialists unfamiliar with genomic methods and computational techniques may shy away from publications that involve human genomics analyses. In this article, we discuss selected aspects of study design and statistical analysis in this area, emphasizing important pitfalls that may compromise the validity of some studies. Our goal is to provide the infectious diseases specialist with information that will aid in the critical evaluation of publications that include human genomic analyses.

As we enter into the 21st century, infectious disease specialists will be managing a greater number and proportion of patients with infections who are > or = 65 years old. Much has been learned about aging, host resistance, and infections over the past 15 years. However, if we are to meet the challenge of the complex issues of geriatric infectious diseases, infectious disease clinicians, teachers, and researchers must assume a more proactive role in clinical care, training, education, and research on problems and issues confronting the aging population.

A survey designed to assess the number, type, and current practice patterns of all infectious disease (ID) physicians active in the United States in 1986 was carried out in early 1987. Of 4328 mailed questionnaires, 48.3% were returned. One-third of respondents were in private practice, one-third in academics, and the rest in industry or government. Women accounted for 12.4% of the total; they were younger and as a group spent a greater proportion of total effort in ID. Sixty-five percent of all respondents had greater than or equal to 2 years training in ID. Overall, private practitioners worked longer hours than academicians but spent slightly less effort devoted solely to ID. The proportion of total effort devoted to ID has increased among physicians newly entering practice. Seventy-five percent of all respondents held a teaching appointment. Older ID physicians worked less than 50 h/week and tended to have more administrative than patient care responsibilities. In 1986, there were the equivalent of 1792 full-time ID physicians in the United States or 1:134,000 population.

I am greatly honored to join the ranks of those fortunate enough to receive the award named for Maxwell Finland, an outstanding clinical investigator and teacher who started many of us on our careers in infectious disease research. I shall refer later in more detail to his achievements. Because clinical investigation was so close to Max's heart and because he pursued it at the Boston City Hospital for his entire professional life, I have chosen as the theme of this lecture the relation of the hospital to the clinical investigation of infectious diseases; also I will raise a few questions about the future of this relation. Clinical research occupies a unique position: it lies between research in basic sciences and clinical medicine. T. Hale Ham compared the place in which it is carried out to the tidal estuary, where the currents of the river meet the tides of the ocean, and the water is neither fresh nor salt but a mixture of the two. This special blend sustains characteristic forms of life-some of them novel, some of them extraordinary all together contributing significantly and uniquely to the nurture and survival of many varied species both near and far. The analogy is apt. The resemblance between the environment of the tidal estuary and the workplace of the clinical investigator is striking. In each case the peculiar conditions of the environment are crucial to the outcome [1]. Clinical investigation as an organized discipline is relatively young. In the United States at the end of the 19th century it was just beginning. The first clinical laboratory to be placed in a hospital in the United States was installed in 1887 at the Hospital of the University of Pennsylvania, and a few small laboratories for research were established in hospitals and clinical departments of universities around the turn of the century. The American Society for Clinical Investigation was founded in 1908; the Journal of Clinical Investigation did not begin publication until 1924.