Workforce issues for pediatric endocrinology

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When asked about increasing demand for their services, almost half of pediatric endocrinologists answered that not only were they receiving increased numbers of referrals, but that there was increasing complexity of management of referred patients. Treatment of diabetes is increasingly intense and technical, requiring large amounts of time and a team effort for education and counseling. Children with obesity, previously seen by pediatric endocrinologists only to rule out syndromic or endocrine causation, are now being referred in large numbers for management of features of the metabolic/insulin resistance syndrome, including type 2 diabetes, acanthosis nigricans, hypertension, and dyslipidemia. These patients also require a large amount of time for education and counseling, provided by a team which includes dietitians, social workers/psychologists, and nurse educators. Bottom line: more pediatric endocrinologists are needed to deliver the services.

Shortage of pediatric endocrinologists can be indicated by wait time for appointments, length of time to fill open positions, and numbers of referrals. The average wait time for a patient with a non-urgent problem is 9 weeks. Furthermore, positions in both private practice and academic medicine usually take months or even years to fill. In addition, although many practice well into their 70s, the average age of pediatric endocrinologists is 52.8 years. Thus, many of the practicing pediatric endocrinologists will be retiring soon, and, although the numbers of young people entering pediatric endocrine fellowships has been steadily increasing over the last 5 years, it is not clear that there will be enough to replace retiring physicians, much less meet the increased patient demands. Even if adequate numbers were trained, their geographic distribution might not meet the needs of the population as a whole. Rural areas are underserved, with two states having no pediatric endocrinologists. With approximately 75% of this workforce being female, it is expected that there will be a substantial number wishing to work part-time.

It is, therefore, imperative that we implement creative solutions to our changing health-care environment: 1) Expand the numbers of part-time or shared fellowships to accommodate the lifestyle issues which are so important to young physicians; 2) Lobby for expansion of loan repayment programs for subspecialty training; 3) Incorporate telemedicine as a means of serving distant communities; this has been extremely effective for the long-term management of diabetes, although reimbursement is problematic; 4) Lobby for adequate reimbursement for care requiring extensive education and counseling; and 5) Finally, we must make certain that physicians in training receive adequate exposure to subspecialties such as endocrinology that are underrepresented in the hospital environment.

Acknowledgment: information obtained from “The Pediatric Subspecialty Workforce: A Policy Primer,” Ethan Alexander Jewett, MA, Senior Health Policy Analyst, July 2005, available at www.aap.org