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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. The (your) future in Infectious Diseases and Medical Microbiology.

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The (your) future in Infectious Diseases and Medical Microbiology

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  1. 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 The (your) future in Infectious Diseases and Medical Microbiology

  2. 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.’

  3. Lessons learned Memorial U U Alberta Memorial U U Manitoba Memorial U U Toronto U Manitoba Dalhousie U Toronto Dalhousie

  4. The rest of medicine is two dimensional Changing hosts Advancing technology

  5. Changing/new bugs Changing hosts Advancing technology

  6. The most rapidly advancing technology

  7. 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 Since I did my ID training

  8. 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…..

  9. 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

  10. Since I did my training… • So many new drugs…beyond antibiotics • An evolving population of immune compromised hosts • Globalization

  11. Matrix-Assisted Laser Desorption-Ionisation Time-Of-Flight Mass Spectrometry (MALDI-TOF MS)

  12. MALDI-TOF MS

  13. The integration of: • semiconductor fabrication techniques • solid phase chemistry • molecular biology • sophisticated robotics • lasers • microcomputers Thousands of probes on a small glass chip

  14. So what does the future hold? Damned if I know…but you be crazy to think that we are in some way near the end this story!!!!

  15. Your future in ID/MM

  16. 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

  17. Set your priorities! • Working environment • Living environment • Clinical practice setting • Research inclinations…don’t fake it…you’ll be sorry! • We all love to teach! • Money and lifestyle

  18. Don’t 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 don’t have • Learn other ways of doing things • Clearly demarcate residency from your real job

  19. What to do when you visit for an interview • Be proactive don’t 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? • What’s the experience of other junior faculty?

  20. Academic positions • What research support is available? • University start-up • Hospital foundations • Provincial foundations • What collaborations can be entered into? • Don’t 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

  21. What are the links to pure scientists? Wet labs Statistical support Epidemiology and other support Academic positions (cont’d)

  22. 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

  23. “When someone says it’s not about the money…. It’s 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 MM…links to pathologists

  24. Money (cont’d) “It’s not what you make it’s 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?

  25. 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 Finding your first position

  26. Quality of life • You will work hard, but you will love it. • You will spend few sleepless nights. • You won’t have to eat Kraft Dinner (but you will anyway).

  27. “The world is your oyster”

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