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Endo Shortage Represents Significant Threat to Public Health

Feb 4, 2008

A new analysis supports what many in the healthcare field already suspect, that demand for endocrinologists in the United States far exceeds supply, and this shortfall in medical care will only get worse in the coming years.

This gap between supply and demand may have serious consequences for public health, according to commentary in the Journal of Clinical Endocrinology & Metabolism (JCEM).

According to Andrew Stewart, M.D., chief of the endocrinology division at the University of Pittsburgh, the endocrinologist shortage has impaired access to care by patients with diabetes, obesity, metabolic syndrome, lipid disorders, thyroid cancer, osteoporosis, pituitary disease, adrenal disease, menopausal symptoms, and reproductive disorders. It is now typical to encounter waits of 3 to 9 months, and many endocrinology practices are no longer accepting new patients.
“Overall, there appear to be only one-half the endocrinologists required to fill the needed positions in the United States,” said Dr. Stewart. “Seen another way, there are some 4,000 M.D. endocrinologists to care for approximately 25 to 100 million patients who might reasonably wish to be seen by an endocrinologist.”

Demand for endocrinologists can clearly be seen when examining the number of patients in the United States with diabetes, thyroid nodules/cancer, and osteoporosis—collectively representing 44 million people. This does not even include the sizable populations with metabolic syndrome, reproductive disorders, postmenopausal symptoms, and the 150 million Americans who are obese or overweight.

The supply of endocrinologists to meet this need is woefully low. In 2006, according to the American Board of Internal Medicine (ABIM), there were 5,341 board-certified endocrinologists in the United States. Their average age was 49 years in 2002 and is likely higher now. Approximately 1,500 of these individuals are not clinical care providers, instead performing primarily research, administrative, or teaching activities. Thus, there are approximately 4,000 M.D. endocrinologists available in the United States whose primary focus is to provide clinical care.

Despite the need for endocrinologists, the number of training programs in the United States to train M.D.s in endocrinology has declined over the past decade. The ABIM and the Accreditation Council for Graduate Medical Education report that there are 122 accredited M.D. endocrinology fellowships in the United States. This number is down from the 140 such training programs in 1996.

“Efforts are urgently needed to analyze these forces in greater detail, to enhance the visibility of this problem to the public and the government, and to identify solutions that could avoid a workforce shortfall that will have enormous consequences for public health,” said Stewart.

The commentary “The U.S. Endocrinology Workforce: A Supply-Demand Mismatch” will appear in the April issue of JCEM, a publication of The Endocrine Society.