Melissa Young, MD: An Open Letter to the AACE Regarding Their Name Change

November 13, 2020
Melissa Young, MD

A practicing endocrinologist offers her thoughts on a recent change by the AACE from the American Association of Clinical Endocrinologists to the American Association of Clinical Endocrinology.

I joined the American Association of Clinical Endocrinologists in 1999—just 8 years after it was founded and during my first year as an endocrinology fellow. I was encouraged to do so by my mentors as it was an organization designed to support practicing endocrinologists. I became a Fellow of the American College of Endocrinologists (which is through AACE) in 2004.

It was so important to me at the time to attend the induction ceremony that I went even though I was just a few weeks postpartum. So the baby and I traveled (along with my sister who agreed to watch him while I attended the ceremony) so I could receive my scarf and medal. I have since proudly put the initials FACE after my name.

When I was in training and then as an employed physician, it was much easier (and cheaper) for me to attend annual national meetings. Some years, I would attend both the Endocrine Society and the AACE annual meetings. I preferred the AACE meetings because they were geared more towards clinical practice, whereas ENDO had many basic science lectures, which while fascinating didn’t help me with the day-to-day management of my patients. Later, the demands of private practice and motherhood, as well as the expense of both, led me to attend less frequently. I did, however, attend our state’s chapter meetings.

AACE also had a political advocacy group, one that would bring our concerns about reimbursement and policy to congress and CMS. I say “had” because it was unfortunately dissolved. I don’t remember why, really. Perhaps lack of participation or support from the membership, perhaps it was felt that there were other similar groups that could do the job. Nonetheless, AACE was the organization that I and many other practicing endocrinologists turned to for education, practice support, clinical guidelines and national policy change.

Like many other things in 2020, things have drastically changed in AACE. Things that many of its members are unhappy with.

Let’s start with the name. It is no longer the American Association of Clinical EndocrinologISTS, but the American Association of Clinical EndocrinologY. Now, this may seem like a minor change to many, but to those of us in practice, it suggests that the organization is no longer for us, that it is no longer “a professional community of physicians specializing in endocrinology, diabetes and metabolism committed to enhancing the ability of its members to provide the highest quality of patient care” as its mission used to say.

In fact, they have opened membership to anyone willing to pay the dues. At a time when fellowship-trained endocrinologists are struggling every day against the tide of non-endocrinologist practitioners (both physician and nonphysician) who claim to be “hormone experts”, allowing them to claim membership to AACE gives them a veil of legitimacy.

This is a serious concern that endangers patients. Patients have a hard enough time figuring out who a real endocrinologist is without these practitioners flaunting their membership on their website or Facebook page.

Another change that has come about is the loss of support and recognition of state, regional, and international chapters. Throughout the country and the world, there were dozens, if not hundreds, of AACE chapters—each providing support and education to local endocrinologists. From what I understand, this was a financial decision. OK, fine. Most chapters plan on carrying on independently, but here’s the catch.

We are apparently not allowed to use the terms “clinical endocrinologist” or “clinical endocrinology” in the name of the new organizations because those are supposedly intellectual property of AACE. We fail to see how they can lay claim to what is a generic term. Our chapter has been told that legal action will be taken if we insist on using “clinical endocrinologists” in our name.

And lastly, my beloved FACE. In order to become a Fellow, there are certain criteria you must meet. You must have formal training in endocrinology and professional experience in endocrinology and you must have letters of recommendations from either a Fellow or Master of ACE.

So, once inducted, you have proven yourself to be a board-certified or eligible, formally trained practicing physician. Up until recently, once a FACE, always a FACE, provided you maintain your membership.

Now, in addition to maintaining fellowship, there are additional requirements. Granted, they are not onerous, and since we all must maintain a certain number of CME credits and participate in educational activities anyway, all FACEs would probably be able to meet the requirements. But it is being objected to in principle. At a time when many are complaining about MOC and recertification, and how neither of those reflect what we do in the trenches, requiring that we “prove” ourselves to ACE annually rubs us the wrong way.

As a result of the above changes, many private practice endocrinologists are upset and have vented their frustrations on social media. A couple of AACE’s board members have come forward to justify the changes. One said that thousands of people were asked and that the large majority were in favor of the changes. When asked who these thousands of people are, it turns out, they were non-endocrinologists.

Not everyone understands why we are so perturbed by these changes, and we have even been chastised for not wanting the public to be included or informed. That is certainly not the case.

We have no objections to providing patient education on the website and there can be links to clinical information for healthcare professionals. But endocrinology is one of the few specialities that still has a decent population of solo private practitioners and small practices, and many feel abandoned by what was our advocate. The board says that has not changed, but if the membership grows due to the addition of new members who are non-endocrinologists, naturally, the board and consequently the organization is going to have to cater to the needs and wants of those members, leaving small private practices in the dust.

We fight everyday not just against disease, but against insurance companies, government red tape, and internet misinformation. Et tu, AACE?