The Shortage of Endocrinologists and Its Impact on Thyroid Patients

People regularly complain to me that the waiting list to see an endocrinologist in their area is three months, six months, sometimes even as long as nine months or more —- if you can even get on the new patient waiting list at all. Even then, once you're at your appointment, most of your time is spent waiting, filling out forms, being seen by a nurse or physician's assistant, having blood drawn, and so on. You are lucky if you get more than five to ten minutes of face time with the actual doctor.

Why Is It So Difficult To See An Endocrinologist?

In a nutshell —- it's a supply and demand problem. We have a major shortage of clinical endocrinologists throughout the United States. According to a commentary in the April 2008 issue of the Journal of Clinical Endocrinology and Metabolism :

"...the endocrinologist shortage has impaired access to care by patients with diabetes, obesity, metabolic syndrome, lipid disorders, thyroid nodules, thyroid cancer, osteoporosis, pituitary disease, adrenal disease, menopausal symptoms, and reproductive disorders. It is standard to encounter waits of 3 to 9 months, and many endocrinology practices are closed to new patients."

Endocrine disease is also on the rise. The extent of diabetes —- in particular, lifestyle and obesity-related Type 2 diabetes —- is an epidemic, and on the rise. As people live longer, more people develop and require treatment for osteoporosis as well. Thyroid cancer rates are also increasing. Eventually, if the recommended narrower TSH normal range of 0.3 to 3.0 is adopted, that will also mean that millions more Americans will fall into the 3.0 to 5.0 TSH range and may potentially be diagnosed and treated for hypothyroidism.

According to the American Board of Internal Medicine, there were 5,341 board-certified endocrinologists in the United States in 2006. Among them, 1,500 do not provide clinical care —- they are working in research, teaching, or for drug companies. This leaves approximately 4,000 endocrinologists available in the United States.

At present, there are approximately 122 accredited endocrinology fellowship programs in the United States, and these programs are capable of generating only 160 new endocrinologists per year. (And some of these 160 go into research or the pharmaceutical industry, and do not do not go into clinical care.)

Overall, then, the experts have estimated that we have only half the endocrinologists necessary to meet the current demand. We have 4,000 endocrinologists, who are supposed to provide endocrinology support for the approximately 25 to 100 million Americans who might reasonably wish to be seen by an endocrinologist.

This means that it's difficult, and sometimes nearly impossible, to get in to see many endocrinologists. And it leaves many rural and suburban areas with no access whatsoever to an endocrinologist.

The problem is going to get worse, unless major changes are made to the way endocrinologists are trained. The Journal commentary has outlined a list of things that might help:

• Enhancing the awareness, urgency and visibility of the problem with the public and the government
• Requiring hospitals with endocrinology training programs to fund clinical fellowship training slots
• Requiring agencies to streamline the accreditation and management of endocrine fellowships
• Adding to federal and private third-party payors' compensation for endocrinologists to make the specialty more competitive with other specialties
• Providing waiver visas for international medical graduates who wish to practice endocrinology in the United States
• Increasing training for internists and family practitioners in diabetes and obesity management and prevention
• Expanding the numbers, training, and deployment of nurse practitioners, physician assistants, and certified diabetes educators
• Providing third-party payment for telemedicine services to underserved areas that lack an endocrinologist
• Broad public health and regulatory approaches to diabetes and obesity prevention programs

Comment From Mary Shomon

Interestingly, the Journal of Clinical Endocrinology & Metabolism's recommendations overlook anything focused on thyroid treatment. They talk about diabetes and obesity management training, but what about thyroid disease? Why there isn't an interest in increasing the training for internists and family practitioners in diagnosis/treatment of thyroid problem. Why aren't we looking at expanding the numbers, training, and deployment of nurse practitioners and physician assistants in the area of thyroid diagnosis and treatment. And why don't we have a program to train certified thyroid educators, similar to certified diabetes educators?

Unfortunately, it seems that thyroid disease and thyroid patients are still viewed even by the endocrinology profession as being less important when compared to diabetes. And given the shortage of endocrinologists to begin with, this does not bode well for thyroid patients, as we struggle to get better diagnosis.

Do You Need an Endocrinologist?

You may believe that an endocrinologist is the physician best qualified to diagnose and treat all thyroid disease. The truth is, that is not always the case.

Whether or not you need an endocrinologist actually depends on the type of thyroid problem that you are experiencing, the nature of your symptoms, and where you are in the treatment process.

Read more about it in the article, Do You Need an Endocrinologist?

_{Source: Stewart, Andrew, "The United States Endocrinology Workforce: A Supply-Demand Mismatch," The Journal of Clinical Endocrinology & Metabolism Vol. 93, No. 4 1164-1166.}