hospitals and 301/750 (40.1%) for physicians at secondary hospitals. Totals of 700, 850 and 700 questionnaires were sent to junior, attending and senior ID physicians, respectively; of these, 332 (47.4%), 398 (46.8%) and 341 (48.7%), respectively, were returned. Infectious disease departments and physicians The educational level, number of physicians and extent of scientific research in ID departments were generally better at tertiary than at secondary hospitals (p 55 years. The clinical practice of most ID physicians was focused on the diagnosis and treatment of legally notifiable communicable diseases, such as viral hepatitis and tuberculosis (Fig. 1). Of the 156 departments, 126 (80.8%) provided training for medical students, including 88 (93.6%) of 94 departments in tertiary hospitals and 38 (61.3%) of 62 in secondary hospitals. Research activity was reported by 107 (68.6%) of the 156 departments, but was more prevalent in tertiary (88.2%; 83/94) than in secondary (38.7%; 24/62) hospitals. Of the 1071 physicians, 534 (49.9%) conducted scientific research, mainly focused on hepatitis, tuberculosis, diarrhoea and other notifiable communicable diseases, with 375 (35.0%) having microbiology laboratories or conducting research on bacterial cultures. Job satisfaction and remuneration Of the 1071 ID physicians, 870 (81.2%) felt highly pressured at work, 514 (48.0%) reported feeling satisfied or very satisfied with their job, and only 363 (33.9%) indicated that they would take again C. Zhang et al. / Clinical Microbiology and Infection 24 (2018) 82.e5e82.e10 82.e6 their current job if given another opportunity. The annual income of 942 (88.0%) physicians was below $15 000 (Table 2, Fig. 2). Of the 460 ID physicians responsible for hospital infection control and of the 287 responsible for hospital antimicrobial stewardship, 234 (50.9%) and 149 (51.9%), respectively, reported feeling satisfied or very satisfied with their jobs. Main problems and complaints The ID department chiefs identified a number of problems blocking the development of the ID specialty in China. First, higher costs, such as for isolation wards and air conditioning systems specific to isolation wards, and lower revenue than other specialties Table 1 The resources and medical services of ID departments in general hospitals in China Items All Hospitals (156) Tertiary Hospitals (94) Secondary Hospitals (62) p-valuea Range Mean ± SD Median Range Mean ± SD Median Range Mean ± SD Median Number of beds 28e70 40.00 30e80 50.00 20e55 34.00 Bed utilization (%) 8.30e100 81.66±19.23 40e100 87.64±15.17 8.30e100 74.93±21.15 35 years of age, with only 41.4% aged 55 years. According to the Ministry of Health of China, the proportion of ID physicians in hospitals decreased from 2.2% in 2005 to 1.1% in 2010 and to 0.7% in 2012. By contrast, the proportion of internists increased from 18.4% in 2005 to 21.2% in 2010 and to 23.4% in 2012 [1]. In this survey, only 9.3% of the ID physicians held a doctoral degree and about one-third were senior doctors, a pattern that was more prominent in tertiary hospitals. The aging of ID physicians will impede the future development of this medical specialty. Although traditional frameworks have restricted the working scope of ID physicians, these physicians have not taken on the responsibilities needed in a modern healthcare system [11]. Because emerging infections are assigned to specific tertiary hospitals, physicians in other institutions find it difficult to participate in treatment and research. The survey indicated that only 9.8% of ID physicians participated in the national scientific research programme. Some ID physicians mentioned that the government does not pay enough attention to or fund new techniques. Microbiology laboratories are unavailable to the majority of ID physicians, especially in secondary hospitals. This situation is different from that of western countries, where ID physicians now focus on bacterial infections, including nosocomial ones, emerging infections, infections in the immunocompromised and antimicrobial resistance containment with antimicrobial stewardship [5,12e17]. Moreover, rapid advances in diagnostics and therapeutics in Europe and the USA