09 Jul Diabetes, Age and Obesity Drive Demand for Endocrinologists
Medical Research: What type of patients do endocrinologists typically treat and why is the demand for their services anticipated to grow?
Dr. Vigersky: Endocrinologists are physicians trained in managing, diagnosing, and treating disorders of the endocrine system: thyroid, parathyroid, adrenal glands, hypophyseal and hypothalamic axes, ovaries, testes, and pancreas. Their role involves controlling diabetes mellitus, menopause, hyperthyroidism and other conditions involving metabolism.
A major factor affecting the anticipated demand for health care services is the aging population. In 2010, there were 37.5 million people age 65 or over, constituting about 12.7 percent of the total population, and by 2025 the population age 65 or over will number 62.5 million (17.9 percent of the population). Due to the greater prevalence of many of the diseases in older age groups, like osteoporosis, diabetes, obesity, and thyroid nodules, the growth in the population age 65 or over will exert a major influence on the demand for endocrine services.
Diabetes, by itself, is a major driver of demand. The incidence of Type 2 diabetes rises dramatically with age, and with obesity. In an increasingly overweight population an estimated 22.3 million people in the U.S. are diagnosed with diabetes as of 2012, representing about 7 percent of the population. This estimate is higher than but consistent with those published by the CDC for 2010. The percentage of the population with diagnosed diabetes continues to rise, with one study projecting that as many as one in three U.S. adults could have diabetes by 2050 if current trends continue.
Medical Research: How large is the projected shortfall of adult endocrinologists?
Dr. Vigersky: Our baseline projections indicate that there is a substantial gap, about 1,484 full-time equivalent endocrinologists between the adult endocrinology services demanded, measured in terms of the services that an adult endocrinologist can provide when working full time in patient care, and the amount that can be supplied by the current and projected numbers of clinically active adult endocrinologists, in 2015. The gap between the supply and demand of full-time equivalent endocrinologists is likely to persist through 2025, where we estimate it to fall slightly to 1,344. That is the best case scenario. If the prevalence of diabetes rises from a current rate of 7.4 percent to 12 percent by 2025, there will be a shortage of nearly 2,900 endocrinologists serving adults. Without a concerted effort to recruit more endocrinologists, the gap between the number of endocrinologists and the demand for their care will increase even further and patients will struggle to get the care they need.
Medical Research: What factors contribute to the relative lack of endocrinologists?
Dr. Vigersky: A significant proportion of the adult endocrinologist workforce is Baby Boomers (born between 1946 and 1964). Those physicians who are over age 60 will leave the workforce or will greatly reduce hours of clinical work, over the next decade. The next generation of endocrinologists also are working fewer hours and seeing fewer patients in an average week than their predecessors. Although the number of fellowship positions in the field is increasing, the modest growth is not sufficient to keep pace with the growing demand.
Another factor that discourages physicians from specializing in endocrinology is compensation rates. Since much of the care they provide is not based around specific procedures, endocrinologists tend to earn less than their counterparts in specialties such as noninvasive cardiology and gastroenterology.
What recommendations do you have to increase the number and productivity of endocrinologists, in order to meet the current and anticipated demand for their services?
Dr. Vigersky: The creation of additional fellowship positions would help ensure an adequate supply of endocrinologists to serve patients for years to come. The Endocrine Society’s workforce analysis found the number of new entrants to the workforce must grow at a rate of 14 percent a year to close the gap in five years.
In addition, improved reimbursement rates that reflect the true value of endocrinologists’ care are required to encourage more physicians to choose endocrinology as a specialty. Meaningful salary increases may incentivize medical school graduates to select endocrinology as a specialty rather than the higher paying procedural-based specialties.
The Clinical Endocrinology Workforce: Current Status and Future Projections of Supply and Demand
Vigersky RA1, Fish L, Hogan P, Stewart A, Kutler S, Ladenson PW, McDermott M, Hupart KH.
J Clin Endocrinol Metab. 2014 Jun 18:jc20142257. [Epub ahead of print]