Dr. Ronald Nahass vividly recalls the looks he used to get when he told someone he was an infectious disease specialist. It was a cross between intrigue and fear — and came with a strong sense of, ‘Now, why would anyone want to do that?’
“Then,” he said, while starting to laugh, “they always take a step back — because I must be contagious with something.”
For more than 30 years, Nahass took the look as a badge of honor. He was an expert in something everyone should be concerned about — even if most viewed it as something they would only find in a bad sci-fi movie.
Then, the COVID-19 pandemic hit. And his profession got some serious recognition.
Nahass, the president of ID Care, the largest physician group for infectious disease specialists in the state, said he is happy about the attention it has brought. He hopes it may attract more to a specialty that has long struggled to attract new members — and is facing a crisis of too many of its members aging out.
And, while Nahass said he didn’t deserve the side glances he faced for decades, he said he also doesn’t deserve the accolades that are coming to the specialty now.
“I don’t know about all that ‘hero’ stuff,” he said.
Nahass, a pioneer in state-of-the-art treatments for HIV, hepatitis B and C, as well as other complex infectious diseases, said it’s just nice to see recognition of the value of those in his specialty.
“It’s now very clear to people what infectious disease doctors do,” he said. “Whether it is because of the media or Dr. (Anthony) Fauci or any of the other infectious disease physicians who are now getting interviewed by any one of a number of cable news stations, it’s pretty clear that people are recognizing that, ‘Oh, there is a specialty in medicine that deals with germs.’
“And, because of COVID, they understand the value of that.”
Nahass has seen the value at ID Care, a physician group he helped form in 1997, when it had just six doctors. Today, it has more than 40 physicians and 10 offices — although it practices at more than 130 locations around the state if you count hospitals, long-term care facilities and any other type of health care establishments.
Last year, his group had 300,000 patient visits. ID Care has never been more in demand, he said.
Nahass took a few minutes to talk with ROI-NJ about all things involving infectious diseases — including ID Care’s growing role in health care. Here’s a look at the conversation, edited for space and clarity:
ROI-NJ: Let’s start with ID Care — how would you describe it?
Ronald Nahass: We’re a very large, independent, shareholder-owned, physician-owned practice in infectious diseases. We cover the northern half of New Jersey. Our focus is strictly on infectious diseases. And, in the past year, that role obviously has become front and center.
ROI: That explains the 300,000 patient visits. Can you break that down a bit? How many were related to COVID?
RN: We saw somewhere around 23,000 unique patients with COVID over this past year, and that represents close to about 20% of the hospitalized COVID patients in the state. (And those patients all likely had multiple visits.)
But we do a lot of things other than COVID.
ROI: Take us through the issues that ID Care deals with?
RN: This year, it’s COVID. But, in prior years, it was all around complicated infections — such as infections from devices, like a pacemaker; superbugs, like MERSA; and these unusual organisms, like Clostridium difficile, and other bacteria that are difficult to treat with antibiotics.
We also have a large role on an outpatient basis dealing with things like hepatitis C, hepatitis B, HIV, Lyme disease and other chronic viral infections. That’s a big part of what we do.
And, we’ve been integrally involved with a lot of organizations to help them with the concept of disease prevention — or trying to limit risk of disease being disseminated within the organization or within their environment.
ROI: How does the relationship work with hospitals and health systems?
RN: It depends on the hospital and the situation. In the context of COVID, we have very much been involved in taking care of the patients as part of a COVID medical team. And, at various hospitals in which we have specific arrangements or agreements, we might be more integrally involved in more than just caring for the patients — we may be helping to direct others to provide the care and setting protocols for care within organizations.
Outside of COVID, we have other responsibilities as it relates to the questions around response to other infectious disease-related problems: limiting risk to patients and limiting risk to the staff.
ROI: When dealing with infectious disease, it feels as if you would be the second call, following a visit to a primary care physician or an emergency department. Is that the way it works?
RN: That’s probably the bulk of the way we see patients. But, as recognition of what we do becomes more clear, people are starting to seek us out primarily. It’s not uncommon that people will find us by what I call ‘Dr. Google.’ They Google, ‘Doctor for HIV,’ or Lyme disease or hepatitis C, and we’ll come up.
But, normally, it’s when an urgent care or primary care doctor sees a patient with an infection that is very complex. They’ll search us out.
ROI: The ‘us’ in that sentence — your physician group has more than 40 physicians. Is that enough right now? Is it enough for the future?
RN: In the context of what’s happened with COVID, there is a concern that there might be a situation in which you get to a point where the demand is just so great that you have to then start to either pick and choose or figure out how you’re going to allocate resources to meet the most pressing needs.
That’s why we are constantly in a recruiting mode. We almost never seem to be able to find enough people to come on board. So, yes, I think that’s a concern.
ROI: Let’s talk about that need — that ability to fill a role that almost certainly will grow in demand as we adjust to the new normal. Could the pandemic be an impetus for more doctors to join the specialty?
RN: We certainly hope so. Infectious diseases has suffered as a specialty in regard to being able to attract individuals. It has been a challenge for the profession.
Look at Match Day, when a medical student has to make a decision on their specialty. They say, ‘I want to enter into X.’ The infectious disease spots have not filled for about 10 years. It’s been a problem to attract individuals. And there’s a lot of concern that the specialty itself is at some risk of aging out of enough people because we’ve been slow to recruit newer members.
So, we’re hopeful that, actually, with the greater cachet, the greater recognition, that will change. This year was the best year for matching in the last decade. So, we’re hopeful that the attention will help address some of the concern.
ROI: It sure has changed the view of the specialty, yes?
RN: There’s certainly been recognition that the specialty of infectious disease is very important — and that there are people who are experts in it. Patients always have had a cardiologist or an orthopedist. Now, people may want an infectious disease doctor, too. Right now, being an infectious disease doctor carries a little street cred.
ROI: And that brings a whole new look.