Diabetes Management and the Empowered Patient
Diabetes management takes teamwork, and traditionally that team has been lead by doctors. With diabetes patient numbers screaming out of control, the question that needs to be asked is, do we have enough doctors to handle the load? In my opinion, every person with diabetes should see an endocrinologist, at least once a year. Endocrinology is the specialty field for diabetes and can vastly improve the outcome for patients.
But finding a doctor you connect with is hard. A successful patient is someone who takes an interest in their well-being and a good doctor-patient relationship is key. But, the fact is finding an endocrinologist, who is taking new patients, is getting harder and harder. And the seriousness of the problem seems to escape the media, who puts much of the blame on the patients for creating a diabetes epedimic and glut in the hospital system.
In 2009, Beth McNamera wrote about the lack of pediatric endocrinologists in the US. Beth did an excellent job laying out the reasons why the numbers of pediatric endos have dropped. What’s frightening is that the numbers of pediatric endocrinologists has not changed in the four years since her blog was written. In fact, the pain of the shortage of pediatric endos was felt loud and clear this past winter, when flu season hit. Across the country, the number of new cases of type 1 diabetes hit an all time high, but pediatric diabetes centers had to turn away patients who already had an existing doctor in order to handle new cases.
In May of 2011, Endocrine Today published an article that said the U.S. endocrinologist shortage was not just limited to pediatric endos, but adult endos as well. In 2003, another report predicted a decrease in the field of endocrinology from year 1999 to 2020. By 2010, the report’s factors for how bad our shortage will be on on track.
As a person living with diabetes, nothing could feel more ominous, as well as depressing. This also is a call for action from the patient community to push out and help bring attention to seriousness of an epidemic diabetes is really facing, which is a lack of professionals to treat and educate the patient population.
Taken from the AACE article, here is a snapshot of what we patients are dealing with:
- In 2010, American Board of Internal Medicine statistics showed that there were 5811 board certified endocrinologists. U.S. News and World Report surveys showed there are 6300 hospitals in the US, so we don’t have enough endocrinologists for every hospital in the US.
- Retirement will reduce roughly 10% of endocrinologists from the work force.
- There are approximately 2,000 academic endocrinologists, who may not see a lot of patients, and others disappear into the corridors of FDA, NIH and the VA system. As a result, this leaves roughly 1,000 clinical endocrinologists to serve 6,300 hospitals and 25.8 million patients.
- To add to the problem, endocrinology is not a med student's dream. In 1987, there were 140 endocrinology fellows. In 2010, there were just 122. For endocrinologists, the patient load is beyond their capacity, no matter how well staffed and organized their practice may be. Endocrinologists treat more than just diabetes; they also treat thyroid disease, metabolic syndrome and osteoporosis, which brings the patient population, who need these specialists, to approximately 50 million people. Waiting time for a patient to see an endocrinologist is longer than any other specialty.
What’s the fix? It will take a consorted effort to change the status quo and places to start are with helping to push the complex wheel of health insurance:
“I have to say that the solution of filling the ranks of doctors in specialties that Americans need, in part, gets back to healthcare reform. I've heard the tightly entwined issues of healthcare reform likened to a Gordian Knot, and couldn't agree more. Many areas need to be addressed. Third-party insurance providers, the big bad boy of this debate, are finally hearing the bell toll, and need to start offering fair reimbursement to doctors for services rendered.”
But it is also in our hands to find community to ask questions and filter your own education to know more and have more constructive conversations with your doctor.
Current options for patient empowerment are places like HealthCentral, as well as TuDiabetes.org and Diabetesdaily.com that offer patients a community of support Children with Diabetes is another space for parents to learn from one another. CWD just had their annual conference called Friends for Life in Florida. What each of these offer are voices from the industry in the form of pharma, researchers, doctors and certified diabetes educators who can give us a deeper understanding of the work that they do.
The endos are hard at work, but I want to give a special shout out to Jen Dyer who has been living in the trenches of being a caring, engaged doctor. Jen is a pediatric endocrinologist, who created an app called endogoal. This app allows patients and doctors to communicate directly, with an added feature, which allows for family members and caregivers to add rewards, such as an Amazon gift card, for when a patient meets their goal.
Creating empowered patients will help ease the doctors’ burden of care, because it engages patients to do more on their own. It is what our doctors hope we will do, and with so few of them in practice, it’s time we show them our support for all they are sacrificing in order to care for us.