challenge to many ID physicians, who must either adapt or transition to another career track. This national cross-sectional study assessed the current working conditions and problems faced by ID professionals in China. Methods: A national questionnaire survey of ID physicians and their facilities throughout China was performed in MayeJune 2016 using stratified random sampling. Results: A total of 156/300 (52.0%) ID departments and 1071/2250 (47.6%) physicians from 21 provinces participated in the survey. Overall, 151 (96.2%) of 156 hospitals had ID wards and 141 (90.4%) provided outpatient consultations. The average number of ID physicians per department was 10.32 ± 6.57. The ratio of patient beds to doctors was 5: 1, and the ratio of patient beds to nurses was 5: 1.85. Training in IDs was available in 126 (80.8%), and ID research was performed in 108 (69.2%), of the 156 departments. The main service provided by ID physicians was the management of legally notifiable communicable diseases. The annual income of 942 (88.0%) of the 1071 physicians was below $15 000. Of these physicians, 870 (81.2%) felt high or very high pressure in their work, whereas only 514 (48.0%) were satisfied or very satisfied with their jobs. Conclusions: The limited medical service provided by ID physicians is poorly aligned with current healthcare demands. Moreover, the heavy workloads, high stress, poor compensation and limited career prospects for ID physicians in China impede the continued development of specialists and places them in a career dilemma. ID physicians should work to develop and diversify the field and to enhance their capacities by learning new technologies and collaborating with other medical disciplines. C. Zhang, Clin Microbiol Infect 2018;24:82.e5e82.e10 © 2017 European Society of Clinical Microbiology and Infectious Diseases. Published by Elsevier Ltd. All rights reserved. Introduction Infectious disease (ID) departments have existed as independent clinical departments for more than half a century in China. The main task of ID physicians was to treat and manage legally notifiable communicable diseases, including viral hepatitis, tuberculosis, epidemic cerebrospinal meningitis, typhoid fever, bacillary dysentery and cholera. Many such diseases were widely prevalent soon after the formation of the People's Republic of China [1]. However, economic development and improvements in public health have significantly reduced the morbidity and mortality rates of legally notifiable communicable diseases, resulting in dramatic changes in the spectrum of disease. According to the Chinese Ministry of Health, the yearly incidence of the 28 category A and B communicable diseases (see Supplementary material, Appendix S1) decreased from 7061.86/100 000 in 1970 to 238.76/100 000 in 2012. However, the rates of newly emerging IDs (e.g. AIDS, SARS, avian flu and Lyme disease), nosocomial infections and bacterial resistance to antibiotics have increased [1e3]. Antimicrobial resistance is worsening, with the prevalence rates in 2015 of methicillin-resistant Staphylococcus aureus, extended-spectrum blactamases Escherichia coli and carbapenem-resistant Acinetobacter baumannii being 35.8%, 36.5% and 58.0%, respectively [4]. * Corresponding author: Y. Xiao, Collaborative Initiative Centre for Diagnosis and Treatment of Infectious Diseases, State Key Laboratory for Diagnosis & Treatment of Infectious Diseases, the First Affiliated Hospital to School of Medicine of Zhejiang University, Qingchun Road No. 79, Hangzhou, Hangzhou City, Zhejiang Province, 310003, China. E-mail address: xiao-yonghong@163.com (Y. Xiao). Contents lists available at ScienceDirect Clinical Microbiology and Infection journal homepage: /© 2017 European Society of Clinical Microbiology and Infectious Diseases. Published by Elsevier Ltd. All rights reserved. Clinical Microbiology and Infection 24 (2018) 82.e5e82.e10 In contrast to their colleagues in Europe and the USA, Chinese ID physicians mainly treat inpatients with legally notifiable communicable diseases in ID wards and clinics. In western countries, hospitals may organize clinical consultations on IDs, hospital