Re: Endo Shortage

On Mon, 7 May 2007 23:52:59 -0500, "William C Biggs MD"
<MIQMRBIKFCMU@spammotel.com> wrote:

>This truly is a dilemma. I don't see a resolution to this problem any time
>soon.
>
>Fewer medical students & residents are choosing endocrinology as a
>subspecialty. Several reasons are at play. Students now graduate with
>$200,000 or more in outstanding loans so they have an incentive to choose
>other, higher paying, specialties. The workload can be overwhelming at
>times. Diabetes patients are inherently more complex, and we have to see
>more per day to keep up with demand. You have insurance companies
>second-guessing every move you make.
>
>I have been quite busy to the point I've been away from the newsgroup for
>almost 6 months.
>
>We've made several changes to try to keep up. I formerly did a fair amount
>of 'primary care' for diabetes patients. It was more economical, and in many
>ways better in a quality sense to have one doctor take care of everything,
>even if it was non-endocrine. When I trained at Joslin, they encouraged
>this. We now require our patients to have a primary care doctor, so we can
>focus on the endocrine problems. This allows me to see more patients and
>reduce our backlog. The downside is that the care may be more fragmented,
>and probably costs more.
>
>We have added extenders to our practice to help out. Our patients really
>like our PA, so the change is positive. But extenders can only go so far.
>
>The number of new endos being trained is fewer now than it was 10 years ago.
>Plus younger doctors typically want fewer work hours. Add on the fact that
>25 years ago about 30% of med students were women, now it is about 50% or
>more. I don't want to sound like I am bashing women doc's as I married one.
>But I can tell you that my wife could not work my 70 hour schedule and have
>4 kids at the same time. She will be the first one to agree.
>
>So here is the crunch:
>
>Expect diabetes to double again in 15-20 years in the US.
>
>The number of endos will fall with retirements of the docs now in the 40+
>age range.
>
>The replacement docs, while lower in number, will not be working the same
>number of hours each.
>
>It takes 13 years after high school to train an endo. So if we start TODAY,
>we have have a chance.
>
>My prediction:
>1) No legislative changes, and no change in endocrinologist training
>numbers, leading to a severe shortage.
>2) All endos will be using extenders such as PA's and NP's.
>3) No endos will be doing primary care. (We are already there....).
>4) The 8% of diabetes patients now followed by endos will drop to about 5%.
>5)Group visits where 8 patients are seen at the same time in the same room
>will become commonplace. (Don't laugh, many endos ALREADY do this, and
>patients reportedly like them. You get a couple minutes alone with the doc
>to talk about your ED and such, but that's it.)
>6)Endos will drop out of the more onerous HMOs and insurance plans.
>
>7) Many endos may drop Medicare, particularly if the SGR formula that cuts
>reimbursement 10% a year actually begins in January. If you are on Medicare,
>and want an endo, I suggest you get established with one this year, if you
>can find one. Next year it may be close to impossible for a Medicare patient
>to get one.
>
>If this sounds like it may not be for the better, I agree with you. There
>isn't much we can do
>about it, except encourage our legislators to not cut Medicare, and to
>promote endo training programs.
>
>
>Cheers,
>William C Biggs, MD FACE
>
>


Thanks,

It's nice to get some facts from the other side of the fence.

--
Mâck©® Deltec CoZmore Pumper
Type 1 since 1975
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