Factors influencing internal medicine residents’ selection of infectious diseases as a specialty in South Korea: A nationwide cross-sectional survey

Infectious disease (ID) specialists play a vital role in diagnosing and treating IDs, managing infection control, implementing antimicrobial stewardship programs, and responding to pandemics. Despite their importance, the number of ID specialists has been declining. This study aimed to identify the factors influencing the choice of ID fellowship among internal medicine residents in South Korea and explore strategies to increase application rates. A nationwide survey was conducted among internal medicine residents in South Korea to investigate the factors influencing their decision to apply for ID specialties. The survey included questions on demographic characteristics, career preferences, perceptions of ID specialties, and areas requiring improvement to increase the number of ID applications. Comparisons of each group used χ2/Fisher's exact, t test or Mann-Whitney U tests, followed by multivariate logistic regression to identify independent factors associated with intention to apply for ID fellowship. Among the 250 respondents, only 2.4% applied to the ID specialty, 19.2% considered but did not apply, and 78.4% did not consider the specialty. More than 80% of the respondents recognized the diverse roles and importance of ID specialists. Respondents who applied to the ID specialty were more likely to find the medical school ID curriculum to be of high-quality (P = .029). Responders whose career choices were influenced by the medical school ID curriculum were significantly more likely to consider an ID fellowship (adjusted odds ratio [aOR] 3.09, 95% confidence interval 1.61-5.90, P = .001), and those positively influenced by the diverse roles of ID professors showed increased likelihood (aOR 2.62, 95% confidence interval 1.24-5.53, P = .012). Strengthening the compensation system (86.4%) was identified as the most critical factor for attracting more residents to ID specialties. Ensuring adequate educational time (P < .001), expanding research opportunities (P = .008), and increasing salaries (P = .012) were identified as the key factors for attracting more applicants. Enhanced educational experience, mentorship, and improvements in compensation and workload are essential for increasing interest in ID specialties among internal medicine residents, thereby strengthening the ID workforce and ensuring preparedness for future ID threats.