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Changing landscape of medicine forms future of endocrinology
PHILADELPHIA — Despite endocrinology’s “glorious history,” many physicians harbor questions about the future of the field. According to Lynn Loriaux, MD, PhD, the answer may lie in shifting trends in medicine.
During a presentation at the American Association of Clinical Endocrinologists 21st Annual Scientific and Clinical Congress, Loriaux, who is professor and chairman of the department of medicine at Oregon Health & Science University in Portland, provided an overview of the history of endocrinology, noting the great strides that researchers have made.
“In the last hundred years, we’ve moved from not knowing what various organs and hormones do to dominating endocrine diseases,” Loriaux said. “It’s extraordinary what’s happened….Now people don’t die from endocrine diseases; they die with them. We should be happy, but we’re not.”
One reason for this dissatisfaction is a lack of endocrinologists. Currently, he said, there is one endocrinologist for every 57,000 people in the United States. The number of physicians entering the field, according to Loriaux, has remained steady since endocrinology became a recognized specialty in the 1970s instead of growing as other specialties have. Although several factors contribute to this issue, payment is a factor.
“Endocrinology is one of the cognitive subspecialties,” Loriaux said, noting that procedures do not comprise any of the current therapies for endocrine diseases. “Endocrinology has no reliable way to fund itself other than usual fees for service. Unfortunately, the complexity of the average endocrinologist’s patient prohibits a reasonable clinical income based solely on the fee-for-service model. We have become victims of the way people in medicine are paid.”
Furthermore, physicians in other specialties have now assumed care for many patients with endocrine diseases.
“As endocrinologists sorted the many endocrine diseases and formalized standards for diagnosis and treatment, most of these diseases have ‘migrated’ to other subspecialties,” Loriaux explained. For instance, oncologists often care for patients with endocrine cancers; cytopathologists address thyroid nodules; and cardiologists care for those with dyslipidemia, hypertension and more.
“We’ve given away the farm,” Loriaux said.
As health care reform ushers in change and the concept of the medical home and coordinated care organizations become more popular, endocrinologists now have the opportunity to once again play integral roles in caring for these patients. By working with other specialists while managing these patients, complications and comorbidities can be prevented, which translates to various benefits such as shorter hospital stays and decreased mortality. This is especially important in light of the worsening obesity and diabetes epidemics.
“Diabetes is the disease of this century; it is the plague of our time,” Loriaux said. “We cannot give this away. We have to keep this. Ultimately, everyone will recognize that this disease is where so many of these complications come from.” – by Melissa Foster
For more information:
- Loriaux L. Where will the future of endocrinology come from? Presented at: the American Association of Clinical Endocrinologists 21st Annual Clinical and Scientific Congress; May 23-27, 2012; Philadelphia.
Disclosure: Dr. Loriaux reports no relevant financial disclosures.