Where Have All The Pediatric Endos Gone?

Patient Expert

I have to admit that I feel lucky that I live in a big urban area (Washington, DC) which has a large number of doctors and specialists, including endocrinologists. But other areas of the country are not so lucky and a real shortage of pediatric endocrinologists exists across the U.S.

According to researchers at the University of Michigan C.S. Mott Children's Hospital, there is only one board-certified pediatric endocrinologist for every 290 children with diabetes. More specifically, for the roughly 230,000 American children with diabetes there are only 790 board-certified endos to treat them. These specialists are not evenly distributed geographically -- if you live in Montana or Wyoming, you are out of luck; there are no-board-certified pediatric endos in either state.

When diabetics can't find an endocrinologist to help them with the on-going management of the disease, they typically next will turn to the advice of a primary care, or family, physician. But good luck finding a primary care doctor; the plight of primary care is a shameful disaster in the U.S., with only 2% of all medical residents choosing to become a family doctor due to low comparative pay, long hours, laughable reimbursement rates by third-party insurance, among other issues.

Although there has been a 12% annual increase in the number of medical fellows going into pediatric endocrinology, it just isn't enough to meet the growing need. Job security certainly exists for those medical practitioners treating pediatric diabetics. The number of children diagnosed with Type 1 has doubled in the last two decades, and the increase in obesity has caused a significant increase in Type 2 diabetes amongst America's kids.

With such a need for board-certified endocrinologists and family practitioners that can help the growing number of diabetics, then why is there such a concerning shortage?

Maybe it's the salary. The median salary for an endocrinologist is roughly $187,000/year. According to Kevin Pho, MD and his blog, the average internist or family doctor makes $160,000, but if that doctor is solo in business, she nets $80,000. Comparatively, a cardiovascular surgeon on average makes about $559,000/year and a radiologist brings home on average $354,000. With the average debt for medical students topping $140,000, new residents will think hard about yearly pay.

Maybe it's the hassle and lack of reimbursement. According to a post by Richard Dolinar, MD, Editorial Board member of Endocrine Today, "The current shortage of pediatric endocrinologists can be traced back directly to the price controls imposed on them by the government and other third party payers [insurance]. Without price controls, there would be enough pediatric endocrinologists and we would not be facing the shortages ...."

Maybe it's the lifestyle. There is no doubt that endocrinologists don't always have the best hours (I have my endo's pager number and have used it during off hours), finding themselves on call at most times. Diabetics never get better and have constantly changing needs and regiments necessary to accommodate for life happenings (growth, stress, social). Emergencies can be frequent, particularly for very young and recently diagnosed patients. Long hours are the norm.

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.

Yet, I wish more doctors would take a stand in reform, demanding to be freed of the stranglehold that the government and other third-party providers have on reimbursement. More equitable reimbursement may mean that we can hope to fill the ranks of medical practitioners in the specialties that are in such high demand, like pediatric endocrinology and primary care.

Then, maybe, medical residents would not feel as much pressure to choose an area of medicine that comes with the biggest paycheck. I don't doubt that part of the reason as to why residents do choose to become high paying specialists is our country's cultural passion for money (we're more likely to reverently esteem someone who's made a bundle on Wall Street than someone who's chosen a life of service and has taught in a public high school. I ask who is the real hero?)

Kudos to those doctors who are in the trenches now working long hours to get their patients the care they need, while receiving much lower compensation than their medical peers, and fighting for every reimbursement dollar.   I wish there were more doctors like them, particularly when so many diabetics are in need of a good endo ... or even a good ole' family doctor.