Health & Medical Endocrine disease

Who Will Manage American Patients With Diabetes?

Who Will Manage American Patients With Diabetes?

Abstract and Introduction


Objective: To identify the factors that encourage or discourage internal medicine and pediatric residents regarding specializing in endocrinology with a focus on diabetes.
Methods: We conducted an electronic survey of internal medicine and pediatric residents using a $10 participation incentive. A total of 653 residents responded to the survey (estimated response rate of 9.2%)—626 from residency programs that were contacted for our survey and 27 from referrals.
Results: Among internal medicine and pediatric residents surveyed, 39 respondents (6.0%) planned to specialize in endocrinology, and 27 of these (4.1% of total respondents) planned to focus on diabetes. "Intellectual satisfaction," "emotional satisfaction," and "work-life balance" were identified by respondents as the most important factors in their choice of a specialty, with ratings of 5.5, 5.4, and 5.3 on a 6-point Likert scale. Among these factors identified as most important to a medical career, endocrinology with a focus on diabetes scored poorly with regard to intellectual and emotional satisfaction but received high ranking with regard to lifestyle. With regard to other factors, endocrinology was rated negatively on "compensation," "number of procedures," and "patient adherence to prescribed treatment." Exposure to diabetes during training had no major influence on the decision to enter endocrinology.
Conclusion: Endocrinology with a focus on diabetes care is not an attractive specialty for most internal medicine and pediatric residents. Therefore, new strategies to attract residents to the field of diabetes care are needed.


According to the Centers for Disease Control and Prevention, the number of Americans with diagnosed diabetes has reached 17.9 million, and by the year 2030, this number may exceed 30 million. Diabetes is a chronic illness that requires complex and continued care from health care providers that goes beyond controlling glucose levels. Although most diabetes care in the United States is managed by primary care providers, approximately 8% of diabetes-related medical visits are made to diabetes specialists or endocrinologists. Endocrinologists may bring a unique perspective to diabetes care, and Lafata et al have demonstrated that patients with diabetes who are managed by both an endocrinologist and a primary care physician are more likely to receive optimal diabetes and general care than patients seeing either type of clinician alone.

According to the American Association of Clinical Endocrinologists, there is currently a 12% to 15% undersupply of endocrinologists needed to manage the number of patients with complex cases of diabetes and obesity, and this shortfall is expected to widen progressively during the upcoming decade as the prevalence of diabetes increases. Unless the shortage of health care workers providing diabetes care is resolved, the critical shortfall in diabetes specialists may result in compromised patient care.

It has been well documented that medical students in the United States are cautious about entering primary care specialties, but to the best of our knowledge, no study to date has investigated the attitudes of residents in the United States specifically toward the field of endocrinology with a focus on diabetes care. Therefore, we conducted an electronic survey of internal medicine and pediatric residents to understand current perceptions of the field among physicians-in-training and to identify the specific factors that encourage or discourage residents regarding specializing in diabetes care.

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