Melissa Young, MD, is an endocrinologist in private practice in Freehold, NJ. She blogs for Endocrinology Network on topics that just might ring true for colleagues in other parts of the United States.
Will Endocrinology Survive?
My Friendly "Go-to." My typical go-to response when asked how my practice is going is the simple truth: "Busy. Very busy." To the majority of those who ask, that is a positive reply. But, is it really?
If I ran a café.... "Busy... very busy" in a business sense is a good state of being; restaurants that aren't busy, close. So, of course I'd rather be busy -- maybe. So many patients, so little time.
Me + 5999 vs the 8 million. Time for simple math: ~6000 endocrinologists, 8 million patients to see (thank you to the PCPs who care for 90% of the patients with type 2 diabetes and thyroid disorders).
Let's Assume "full-time." By full-time, I mean working 5 days/wk, 52 wks/year, with no vacation and no conference time. No research, teaching, or "licensed but not seeing patients." At 3 visits/yr for these patients the result pencils out, per endocrinologist, to ~1333 patients, 4000 visits/yr, 15 patients/day.
Not so Bad? No, it doesn't sound horrible--but it also doesn't include the pituitary, adrenal, hypogonad, osteoporosis, hyperparathyroid, and PCOS cases, and account for the fact that not all licensed endocrinologists see patients full time… what happens to CME time? ME time?
Back to Earth. The reality is that most private-practice endocrinologists are seeing 20-28 patients/day; the wait for a new-patient appointment is up to 9 months, and many practices, including my own, aren’t taking new patients. Need to cancel? Please try not to.
I Like Hard Work...and my Patients. I don’t mind working hard. And I like seeing my patients. But the overload bothers me because I am distinctly aware of access issues. A patient cancels and can’t be seen again for 3 months; I can’t even think about seeing the patient who just moved to town.
Acts of Nature. Word of mouth is our best promotional tool, but I can't see a patient's friend or family member becuase I have no space anywhere on the schedule. Bad weather, other acts of fate and nature can wreak havoc on our schedule. How is that fair? And my staff takes the brunt of the frustration expressed by patients.
Breaking Point. The problems are expanding but our ranks are static, at best. We are in crisis now. Training programs are too small, the incentives for going into endocrinology non-existent.
I'd Like to Help... I don’t know what the immediate solution is. I’d like to spend the time figuring it out. But, I have to go take care of patients now.
