Letter from the Editor #721:

This past Friday I had the pleasure of presenting a CE program at the annual meeting of the Washington Association of Diabetes Educators. There were 250+ diabetes educators in attendance and we were talking about the use of new technology. During the program I asked those in the room about the endo’s in their areas and when I asked if they knew any endo’s in their late 30’s or 40’s, only 1-2 hands went up. In fact the consensus was that most of the endo’s practicing were in their late 50’s and older, and that no one was going to medical school to be an endocrinologist.

There is a good reason for this, and it was explained to us by David S. H. Bell, MD. It appears that many third-party payers don’t see endocrinologists as specialists anymore and reimbursement for consults have disappeared making it harder to bill for complex patients. He points out in a recent commentary in Endocrine Today,  "When I call for an approval for my patient to have one of these newer agents, I am treated by the pharmacy technicians employed by third-party payers as a non-specialist. Invariably, a negative decision is given based on the criteria provided to these technicians, and although there is an ‘appeals process’, I have never once been able to talk to a health care professional (nurse, pharmacist or physician) to make my case and/or voice my concern. Often, the only way for the patient to obtain his medication is for the patient and not the endocrinologist to appeal the decision." He goes on to say, "During my conversations, I have never been asked if I was an endocrinologist or a specialist. With other specialties, third-party payers utilize the expert’s opinions; e.g., only an orthopedist or a neurologist may have the ability to order procedures such as MRIs with many third-party payers."

After reading this I had to guess that this could be one of the reasons that fewer and fewer new graduates are picking Endocrinology as a speciality. This lack of enough endocrinologists means more primary care prescribers are taking care of complex diabetes patients and for those on insulin, this may make tight management much more difficult. A good way to help these patients control their glucose is to use automated bolus calculators (ABCs) for diabetes. These devices can make it easier for insulin patients to dose properly. Check out Item #6 to see what they can do for your patients. 

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Dave Joffe, Editor-in-chief