The supply of adult endocrinologists is insufficient to meet the demand, and this gap is expected to widen as the number of adults diagnosed with diabetes and other hormone conditions rises, according to a recent Endocrine Society workforce analysis published online June 18 in the Journal of Clinical Endocrinology & Metabolism.
A number of strategies including increasing the number of endocrinology fellowships and encouraging endocrinologists to delay retirement or expand clinical hours may help to reduce that gap.
Robert A. Vigersky, MD, from the Diabetes Institute, Walter Reed National Military Medical Center, Bethesda, Maryland, and colleagues analyzed proprietary and publicly available databases and the results of an online survey of board-certified endocrinologists, and consulted with a technical expert panel to develop a workforce model.
The researchers determined that the workforce is short by about 1500 adult and 100 pediatric full-time equivalent endocrinologists. At this time, the mean wait time for an initial nonurgent consultation visit with an adult endocrinologist is 37 days compared with an average wait time of 15 to 22 days for a visit with family medicine, cardiology, or dermatology specialists.
Several factors contribute to the excess demand, according to the authors. First, the rate of use of endocrinology services, particularly those related to osteoporosis and type 2 diabetes, increases with age. Because the number of people aged 65 to 85 years has increased in recent years and will keep rising, the demand for endocrinologists will, in turn, increase substantially. By 2025, the population aged 65 years and older is expected to comprise 17.9% of the population, a substantial increase from 2010, when the same cohort constituted about 12.7% of the total population.
Second, a large number of practicing endocrinologists are Baby Boomers and are expected to retire or greatly reduce their clinical work hours within the next decade. Increasing evidence suggests that those who replace the older cohort may see fewer patients and work fewer hours than their predecessors.
Finally, the rise in insured individuals in the population because of the Affordable Care Act has increased the need for all doctors, endocrinologists included.
The authors predict that the need for pediatric endocrinologists is not as dire, as the younger population is less susceptible to endocrine-related diseases. "The demand for pediatric endocrinologists is expected to be met by 2016 as the workforce grows,” according to an Endocrine Society news release. “The gap between supply and demand for adult endocrinologists, however, is expected to remain the same or grow worse as more people are diagnosed with endocrine conditions."
Reimbursement as a Factor
One factor that discourages physicians from specializing in endocrinology is that of compensation, the report maintains. Because they do not base their practice around specific procedures, endocrinologists tend to earn less than their counterparts in such specialties as gastroenterology and noninvasive cardiology.
"Improved reimbursement rates that reflect the true value of endocrinologists' care are required to encourage more physicians to choose endocrinology as a specialty," Dr. Vigersky said in the news release.
The workforce analysis suggests that through certain interventions, the gap between supply and demand for endocrinologists could be narrowed. The interventions include expanding the number of fellowship positions, providing more remunerative evaluation and management codes for endocrinology services, offering reimbursement for more efficient means of delivering healthcare services, truncating the training duration, and disseminating information on best practices.
The authors project that by increasing the number of fellowship positions by 14% per year, the gap in adult endocrinologists can be closed within 5 years. An increase of 5.5% per year would close that gap in 10 years.
If adjustments are made on the supply side, the authors propose, the gap between the number of endocrinologists and the demand for their care can begin to close.
The authors have disclosed no relevant financial relationships.
J Clin Endocrinol Metabol. Published online June 18, 2014. Abstract
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Cite this: Demand for Endocrinologists Outweighs Supply - Medscape - Jun 24, 2014.