The United States Endocrinology Workforce: A Supply-Demand Mismatch

Extract

The shortage of clinical endocrinologists in the United States has become apparent to patients seeking appointments, hospital administrators, and private practices seeking to hire endocrinologists; physicians referring to endocrinologists; and the pharmaceutical industry, healthcare insurers, and physician recruiters. The difficulty in accessing diabetes care has appeared recently in the front pages of the New York Times and Philadelphia Inquirer (1, 2).

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 3–9 months, and many endocrinology practices are closed to new patients. In this brief commentary, I provide an overview of the supply and demand issues surrounding the clinical practice of endocrinology.

The Demand Side

In the United States, there are approximately 6000 hospitals (www.aha.org). As a result of payer incentives and regulatory pressures (e.g. diabetes quality improvement programs), many hospitals now believe that they require the services of at least one full- or part-time endocrinologist. Indeed, many would see two endocrinologists as a minimum. Of course, some large medical centers have 20–40 endocrinologists, with a significant component of their combined efforts devoted to clinical care. One might speculate that these hospital responsibilities nationwide might require several thousand endocrinologists to fulfill.