A Shortage of Diabetes Doctors
There are too few of the diabetes doctor specialists called endocrinologists
Sarah Mart would like to see her endocrinologist every three months. That’s a tough thing to schedule—but not because Mart, the 41-year-old director of research at a nonprofit public health organization in Petaluma, Calif., is too busy.
It’s difficult to get an appointment with Mart’s endocrinologist and the other endos in the practice because they have too many patients and not enough open appointment times, says Mart, who has type 1 diabetes. “I’ve seen other endocrinologists in San Francisco and the Bay Area as well and it’s been that hard for all of them.”
According to a study recently published in the Journal of Clinical Endocrinology and Metabolism (JCEM), there were only 4,841 U.S. endocrinologists in adult practice in 2011. Endocrinologists are doctors who specialize in the endocrine system, the body’s glands and the hormones they produce (the pancreas is both a gland and an organ). Endocrinologists treat diabetes and other health issues, including thyroid diseases, metabolic bone disease such as osteoporosis, and sexual hormone irregularities.
While the number of endocrinologists has increased since 1999 (when there were 3,623 adult-practice endocrinologists), there are not enough of them to meet the demand of the estimated 29 million people living with diabetes in this country, says Robert Vigersky, MD, director of the Diabetes Institute at Walter Reed National Military Medical Center and chair of the technical expert panel of the Endocrinology Workforce Study.
With diabetes cases rising, the limited number of diabetes doctors, and the Affordable Care Act’s improved coverage for people with diabetes, more people than ever want to see an endocrinologist—and the endocrinologists who are available are overwhelmed. “What’s happening is, because of the increase in the rate of [type 2] diabetes, and the increase in type 1 as well, the gap between that supply and demand is actually widening,” Vigersky says. “The Affordable Care Act just compounded the problem, because it gives more people access to care—which is a good thing—but we can’t meet the demand, because there just aren’t enough people to see the folks who need to be seen.”
With the demand for diabetes care, you’d think young doctors in training would be knocking down doors to become endocrinologists. But endocrinology is not reimbursed as well as other specialties. A Merritt Hawkins & Associates 2012 review of physician salaries reported the average endocrinologist makes $248,000 annually. The average orthopedic surgeon makes more than twice that, at $519,000 annually.
In addition to worrying about medical education debt and future compensation, students often get little exposure to endocrinology in hospital settings, where they do their rotations. And fellowships—the ultra-specialized training that doctors receive after their residencies—in endocrinology are few and far between. The JCEM study estimated there were 280 endocrinology fellowships available in 2012. Six years before that, the American College of Cardiology estimated 2,302 cardiology fellowships were filled.
Vigersky and his fellow authors have a theory that the gap between available endocrinologists and patient needs could be closed in five years if fellowships were increased by 14.4 percent annually or in 10 years if fellowships were increased by 5.5 percent annually.
To encourage endocrine fellows to stay and thrive in diabetes care and research, the American Diabetes Association hosted more than 80 fellows at a multiday event, Focus on Fellows: Unlocking the Future for Diabetes Care, during ADA’s 2014 Scientific Sessions. Fellows learned about cutting-edge research and therapies and networked with senior scientists and clinicians at this career-focused education program supported by a grant from The Leona M. and Harry B. Helmsley Charitable Trust.
Beyond specialized training, certain aptitudes are important in endocrinology. Because the specialty deals with temperamental and ever-changing hormones, rather than procedural medicine, it takes a certain type of doctor to make a good endocrinologist, says Vigersky. “The understanding of how these hormones work in both health and disease is a challenge because you’ve got to know about every organ system and every hormone, and how it works, and how it all works together,” he says. “I would say it’s the most scientific of all the medical specialties.”
So who represents the next generation of endocrinologists? Certainly Jeremy Pettus, MD, 35, an endocrinologist and assistant professor at the University of California, San Diego. Pettus was both drawn to endocrinology and perhaps resisted it because of personal experience—he was diagnosed with type 1 diabetes at age 15.
“I always knew I wanted to be a doctor, and being diagnosed made a huge impression on me,” he says. But Pettus says when he first explored endocrinology, he was turned off, because he felt he might not be able to relate to patients with type 2 diabetes. “I wasn’t sure I’d have the empathy.”
Fortunately, Pettus found there definitely is some common ground. Now, he treats patients with all kinds of diabetes, and is able to share his own experiences in addition to learning more about the entire diabetes community.
Pettus also encourages other young doctors to pursue endocrinology. “I think it is a fantastic field,” he says. “It’s a bit of a hidden gem, actually. There’s real value in getting someone’s A1C down.”
Diabetes wasn’t the initial draw for Joanna Spencer-Segal, MD, PhD. The 33-year-old fellow in metabolism, endocrinology, and diabetes at the University of Michigan was inspired by training in neuroendocrinology. The complicated dance of endocrinology keeps her excited about the field. “We’re not focused on one organ; we have to think about the whole body,” Spencer-Segal says. “It includes the brain, but hormones are the way the body communicates among its different organs. That’s ultimately why I chose it.”
The appeal of the field goes beyond the science, too. What’s special about endocrinology—what might turn off more procedural doctors, and what endocrinology patients often say they’re looking for—is the doctor-patient communication that’s essential to practice. That’s what sold Vigersky and Pettus on the field, and it’s what keeps Spencer-Segal inspired.
“It’s so important to actually talk to patients,” she says. “It’s such an integral part of the evaluation, especially for diabetes, which includes so much patient work. ... It’s really a partnership with the patient and I like that.”
Who Needs an Endo?
Not everybody with diabetes needs to see an endocrinologist—in fact, many people with diabetes will never meet with one. The American Diabetes Association suggests that most people with type 1 diabetes should see an endocrinologist, especially when they are first diagnosed. Many people with type 2 diabetes may see an endocrinologist if they are having trouble getting their diabetes under control or are developing severe complications.
- There are 29.1 million people with diabetes … and 21 million are diagnosed (An estimated 8.1 million people live with diabetes but don’t know it.)
- That's 9.3 percent of the U.S. population
- There are 4,841 practicing endocrinologists in adult medicine
- 1,500 is the estimated shortage of full-time adult endocrinologists
Sources: National Diabetes Statistics Report, 2014; Journal of Clinical Endocrinology and Metabolism
How to Find an Endocrinologist
Search by ZIP code at the American Association of Clinical Endocrinologists website, aace.com.