In this study, we observed that ID specialists in Korea spent most of their time caring for patients with ID, although, they also participated in infection control, antibiotic stewardship, and education/training. Their weekly working hours (> 60 h) exceeded the legal limit of 52 h. Accordingly, the demands of ID specialists focused on appropriate compensation for their work and employment of more ID specialists.
Among the various roles of ID specialists, patient care is essential. Involvement of ID specialists in the care of patients with IDs results in reduced hospitalization rates, mortality, and healthcare costs . Additionally, interventions conducted by ID specialists have a positive effect in reducing patient mortality and hospital stay [14–16]. According to the present study, most ID specialists were engaged in several patient care activities, including inpatient and outpatient care and consultations in the same week. Furthermore, about one fourth of adult ID specialists were engaged in pediatric ID consultations. A possible explanation for the diverse clinical responsibilities may be the low staffing numbers of ID specialists.
Following the outbreak of the Middle East respiratory syndrome in medical institutions in 2015, the medical law in Korea was revised to strengthen the legal regulations for infection control personnel . Furthermore, since 2017, the Ministry of Health and Welfare has reimbursed medical institutions for infection prevention and management measures. However, for reimbursement, a hospital requires an ID doctor in charge of 300 hospital beds and for the doctors in charge of infection control to perform infection control duties for at least 20 h/week and complete 16 h of training related to infection control . Consequently, infection control rounding has become a mandatory activity for ID specialists in Korean hospitals . However, the pattern of weekly time use among ID specialists shows limited room for additional infection control activities. Despite this workload, the majority of ID specialists had to undertake multiple responsibilities, including being director of infection control. This results in insufficient time for infection control activities.
Participation in antibiotic stewardship mainly focused on approval for specific and restricted antibiotics . Like other activities related to the ID specialty, antibiotic stewardship in Korean hospitals is mostly conducted by one or two ID specialists . However, for more comprehensive ID activities, approximately 3.01 personnel are required per 1,000 beds . An increase in the emergence of antimicrobial-resistant pathogens emphasizes the importance of appropriate antibiotic use and antibiotic stewardship programs . Securing ID specialists is necessary to implement and expand the antibiotic stewardship program in Korean hospitals.
According to our results, ID specialists devoted similar amounts of time to research and patient care. This may be because a large proportion of ID specialists were stationed at university-affiliated hospitals. However, they were unlikely to receive research funds and perform basic research in their early careers. Given that a rapid response to emerging infectious and re-emerging diseases will be enhanced by a strong research base  promoting ID research is necessary to strengthen public health control efforts. Besides expanding ID research funds, emphasizing basic research in ID training courses should be considered . Promoting research in ID will most likely attract more applicants for training in ID specialties .
Unfortunately, the actual time that ID specialists allocated to education and training activities was 3 h per week. This time duration may be insufficient for providing adequate educational opportunities. Because of the increase in emerging IDs and IDs caused by antimicrobial-resistant pathogens, it is important to educate students/trainees and healthcare personnel on infection control. An adequately staffed ID workforce is necessary to achieve this.
ID specialists worked an average of 60.5 h per week. Given that more than half of the respondents were women and more than two thirds were married and had children, one can expect that it is difficult for ID specialists to achieve an appropriate work-life balance. In our previous survey , only 8.7% of ID specialists responded to having a work-life balance. In this study, working hours were based on work and leave hours. Only 2.6% answered that they did not carry work at home. It is known that long working hours can lead to health risks, including an increased risk of stroke .
Interestingly, this study revealed differences between adult and pediatric ID specialists. Adult ID specialists had a greater role in consultation, infection control, and antibiotic stewardship than pediatric ID specialists. Although, the satisfaction level was similar between the two types of experts, pediatric ID specialists responded more positively to reselecting the same major. It is estimated that more weekly working hours for adult ID specialists may be the cause of the reselection factor; however, further studies should be conducted in this regard.
This study had a few limitations. First, clinical microbiologists who can be classified as ID specialists were not included in the study. Second, the survey was conducted in the middle of the COVID-19 pandemic, which may have affected the operational times of ID specialists.