COMMENTARY

Endocrinology: Growing Need, but Shrinking Workforce

Robert W. Lash, MD

Disclosures

June 29, 2017

Editorial Collaboration

Medscape &

Endocrinologist Compensation Report: What Does It Mean?

Endocrinologists play a critical role in treating patients with some of the most complex and prevalent conditions faced in America today. Growing rates of such chronic diseases as diabetes and obesity, coupled with workforce shortages and poor compensation, have created an access problem that may have far-reaching consequences.

The Medscape Physician Compensation Report 2017 provides an interesting opportunity to delve into these concerns and discuss prospects for addressing workforce issues through new healthcare delivery models.

A Growing Shortage of Endocrinologists

Currently, fewer than 6500 endocrinologists in the United States are available to care for the millions of patients who suffer from diabetes, thyroid disease, osteoporosis, and other hormonal conditions. Although this shortage has many contributing factors, poor compensation is a key driving force.

As seen in the 2017 Medscape Endocrinologist Compensation Report, compensation for endocrinologists is the lowest of any internal medicine specialty and is even lower than that of internists with no specialty training. It is ironic that the three additional years of training to become an endocrinologist are rewarded with a $5000 salary reduction.

Until endocrinology is appropriately compensated, the workforce shortage will continue to mount and exacerbate existing access problems.

This additional time, effort, and expertise are not recognized under the current payment system, even though care by endocrinologists is associated with lower morbidity rates, fewer readmissions, and lower healthcare costs.[1] This situation has prompted many physicians to choose other specialties, resulting in a workforce shortage, with 3- to 6-month wait times for an appointment and an estimated 46,000 patients for every endocrinologist.[2]

In 2014, the Endocrine Society conducted a workforce analysis that projected a substantial gap between endocrinologist supply and demand through the year 2025. This gap of 1484 full-time equivalent endocrinologists is related to a number of factors, including age and gender shifts, lifestyle factors, and health reform; a growth rate of 5.5% annually over a 10-year period will be required to close it.[3]

Meeting the demand for endocrinologists is difficult with so many unfilled fellowship slots. A national survey of resident matching program directors found that undesirable income potential and an insufficient number of applicants in the specialty were the top two challenges in recruiting applicants to endocrine fellowships.

US-trained physicians are increasingly unlikely to choose endocrinology as a profession. International medical graduates represented 37% of the US endocrine workforce,[2] and 47% of first-year fellows, in 2015.[3]

Potential Solutions

Endocrinologists provide cost-effective, efficient treatment without the use of unnecessary diagnostic testing and procedures. Because of disease complexity and associated complications, endocrinologists are often seen by patients as their primary care providers. The benefits endocrinologists bring to the healthcare system are clear, but until endocrinology is appropriately compensated, the workforce shortage will continue to mount and exacerbate existing access problems.

As healthcare moves forward in transforming to a quality- and outcomes-based field, it will be critical that payments for physicians (including endocrinologists) appropriately account for expertise and the cost-effective, high-quality care they provide. Increased payments for evaluation and management services of greater complexity, care coordination and disease management, and consultations will be key areas of improvement. Incentivizing physicians who specialize in endocrinology, similar to the primary care bonus, will also be a step forward.

Payers should also consider ways to better utilize new technologies that allow specialists to advise primary care physicians and engage with more patients. This will enable physicians in specialties that are in short supply to use their time more effectively and reach more patients.

It remains to be seen how rapidly the healthcare system will transform, given the current political climate. But with the growing number of Americans with chronic diseases like diabetes, it's vital to address these issues sooner rather than later.

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