With the implementation of the Affordable Care Act (ACA) more number of Americans became insured with the objective to gain increased access to healthcare. But, what if there aren’t enough specialists to handle the rising number of patients? According to a recent study published in the Journal of Clinical Endocrinology and Metabolism, there is a serious shortage of endocrinologists while the patient demands are increasing as a result of the growing prevalence of Type 2 diabetes. As per the 2010 analysis by the Centers for Disease Control and Prevention (CDC), the diabetes prevalence is expected to increase sharply over the next 40 years as the aging population in the U.S. is more likely to develop Type 2 diabetes and there is an increase in minority groups having high risk for Type 2 diabetes. The study found that there are no sufficient adult endocrinologists to meet the current patient demands as well as the future demands. Without any doubt, we can say this trend is quite alarming for the U.S. healthcare system.
Key Findings of the Study
- At present, there is a shortage of 1500 adult and 100 pediatric full-time equivalent (FTE) endocrinologists.
- The gap between the supply and demand for adult endocrinologists will expand with no increase in the number of trained fellows. The rising prevalence of diabetes mellitus increases the demand for adult endocrinologists. If the number of fellowship positions increased by 14.4%, this gap can be closed in 5 years and if the number of positions increased by 5.5%, it can be closed in 10 years.
- The shortage of pediatric endocrinologists is expected to end by 2016. After that, an excess supply over demand will develop in this case, at the current rate at which new entrants enter the workforce.
Specialist Shortage – Reasons and Adverse Effects
Healthcare experts have put forth several reasons why the number of practicing endocrinologists is falling rapidly. Some of them are as follows.
- Decline in the number of endocrinology training and fellowship programs is a major concern. If there were 140 fellowships in 1987, in 2010 there were only 122 fellowships. As reputable organizations including the National Institutes of Health (NIH) make careful decisions before they start to spend money, it is very difficult to secure training support from federal or other sources for endocrinology.
- Younger physicians are not attracted to the endocrine specialty as it is a specialty with relatively low reimbursement rates.
- Retirement of endocrinologists contribute to the shortage. Studies find that majority of current endocrinologists are expected to retire, which will intensify the shortage.
- Some experts consider gender distribution also plays a role in the shortage as there are more women endocrinologists than men and they work less than the full-time schedule to spend time with their family which may have led to shortage
The shortage of endocrinologists will be tough for both patients and physicians and therefore its effects will be adverse. Let’s see the major difficulties the shortage can cause.
- If there is a shortage of specialists who can treat diabetes patients, the wait times of patient will increase naturally. The average wait time for adults who make a non-urgent appointment during 2012 was 37 days which was same that of 1999. As the wait time increases, the complications related to diseases will worsen and it will affect the patient health
- As ACA insists that insurers must provide preventive services including diabetes screening without deductibles or co-payments, a number of patients seek diabetes care. If the number of endocrinologists is short, they won’t receive quality care even with coverage.
- The shortage of endocrinologists will increase the burden of primary care physicians and existing endocrinologists as they are the only option left for diabetes patients. They will have to see more patients a day and require professional help to manage their revenue cycle including verifying insurance details, filing claims and more in order to provide quality care without losing reimbursement.
Solutions to Deal with the Shortage
Experts suggest several solutions to deal with the specialist shortage and improve access to diabetes care:
- Let the public and government understand the urgency and visibility of the shortage problem.
- Developments that require hospitals with endocrinology training programs to fund for clinical fellowship training slots and streamline the accreditation and management of endocrinology fellowships.
- Increase federal and private third-party payers’ reimbursement for endocrinologists in order to make the specialty more competitive.
- Provide training programs for internists and family practice physicians in diabetes and obesity management and prevention.
- Extend the number, training and deployment of physician assistants, certified diabetes educators and nurse practitioners as the patients can find a better alternative in them.
- Encourage telemedicine facility for underserved areas that experience shortage of endocrinologists and provide third-party payment for such services.
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