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Charter AACE member receives Master of Endocrinology award
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BOSTON — Alan J. Garber, MD, PhD, MACE, professor in the departments of medicine, biochemistry and molecular biology, and molecular and cellular biology at Baylor College of Medicine in Houston, was awarded the Master of the American College of Endocrinology award by the American Association of Clinical Endocrinologists at its annual meeting here.
The MACE award is given to an AACE member who has received the Fellow of the American College of Endocrinology (FACE) distinction and is recognized as a distinguished endocrinologist, a role model for developing endocrinologists and a contributor to AACE and to the art and science of endocrinology.
Garber, a charter member of AACE as well as past president of both AACE and the American College of Endocrinology, has chaired multiple committees for both organizations, including writing committees for consensus statements, guidelines, algorithms, resource centers and task forces. Garber served as co-chair of the AACE annual meeting in 2005.
Endocrine Today spoke with Garber, who is also chief medical editor of the publication, about what led to the development of AACE as an organization, how to tackle the current U.S. endocrinology shortage and the future of the specialty.
You are receiving the Master of the American College of Endocrinology Award, which is conferred, in part, for contributions to the art and science of endocrinology. How would you describe the art of endocrinology?
Garber: You’re essentially trying to motivate people, particularly with obesity and diabetes, to do things that they haven’t done, either ever or, rarely. That’s more art than science, I’m sorry to say. It requires a great deal of motivational skill and competence in dealing with other people and getting them to do what they need to do. It’s a challenge in behavioral motivation.
AACE is approaching the 30-year anniversary of its founding. As a charter member, can you talk about what led to the development of this organization?
Garber: When I was running the section at the university hospital, it was astounding to me to learn that the accrediting body for endocrinology had never bothered to register endocrinology as a medical subspecialty with CMS. As a result, we could not independently bill for services if there was another allied specialist on the case. To me, this was a ludicrous position to take. How can you, in good conscience, train fellows in a subspecialty for which there is no future, or, essentially, doesn’t exist, at least according to CMS? That’s what prompted my interest in establishing an organization for clinical endocrinologists. It’s true that I am heavily research-based, but you must have a clinical outlet for a clinical specialty.
What are some of the biggest changes you have observed in endocrine practice, specifically diabetes over the past 3 decades?
Garber: Diabetes practice has moved from a relatively esoteric art in the management of blood sugar on an everyday basis using urine sugar tests to the much greater precision of using fingerstick blood tests. Over that time, the ability to spot blood sugars and respond to change has gone from almost infinitesimal to very substantial. Our industry partners have provided us with a much greater number of agents to use and from which to select — almost like an arsenal. Before, we had maybe insulin and sulfonylureas. Now, we have just a huge number of agents.
There is currently an endocrinologist shortage in the U.S. How can AACE support the specialty and address this need?
Garber: Through the AACE legislative accomplishment of the Clinical Care Commission on Diabetes. It must be led by a clinical endocrinologist. This is not an attempt to waylay federal funds into a larger research platform. To be sure, research is a good and proper thing, but we must take care of the patients with diabetes right now, with or without complications. If we don’t, we’re going to be drowning in them, right around the corner.
In the coming decade, where do you see the field of endocrinology going?
Garber: I think it should expand, rather dramatically. There have been calls by some organizations saying that there are not enough clinical endocrinologists to take care of all the patients, and we should develop midlevel personnel to do that management. Or, we should let it become a primary care operation. That is uniquely ignorant of the problems that one has in dealing with endocrine patients. You need an endocrine specialist, just as you need a cardiologist for cardiovascular problems. You don’t need a cardiologist strictly to do procedures — you need them to do the actual patient care in the trenches. This issue of trying to make it a primary care concept has failed. I’m not a fan of failure. I don’t see a reason to continue that. We should approach it by expanding real endocrinologists to meet the need. – by Regina Schaffer
Disclosure: Garber is chief medical editor of Endocrine Today.