I chose endocrinology to be my lifelong profession out of love for the complex interactions of endocrine glands and intricate feedback loops. I take pride in preventing medical complications, prolonging life expectancy, and providing complex care to type 1 and type 2 diabetics. At times, this field of work requires spending hours — either with the patient or before or after patient visits — counseling, examining blood glucose data and meticulously adjusting medications and insulin. Luckily, I love what I do, and my passion for it helps me to get through the trials I encounter in my field.
Endocrinologists help hospitals and clinics to provide care for complex diabetic patients, prevent infections, avoid costly hospitalizations, and shorten hospital stays. More often than not, I see patients with complicated medical issues that are not resolved by standard or primary medical physicians. Doctors have referred patients to me, stating, “endocrinologists think outside of the box, and diagnose and treat different symptoms that are difficult to manage.” This speaks to the skills my field demands: knowledge, analytical skills, and a therapeutic approach (and this requires an additional two to three years of fellowship training which I completed after my internal medicine training).
Although patients and providers often complain about the scarcity of well-trained endocrinologists and the long waiting period patients have to endure, our field is not attracting new medical graduates. Those of us who are currently in practice are struggling with the harsh realities of working in a cognitive field, touted as crucial by many, yet not given the due respect and financial backing to keep us motivated and to attract “new blood.” And to think that it is only getting worse!
Endocrinologists, including myself, deal with the increasing cost of running endocrinology practices due to the mind-boggling prior authorization process and complexity of insurance verification and payment systems. We strive to educate our patients in diabetes, self-management, and nutritional intervention, while neither the payers, nor the patients, want to pay for these services. With a stroke of a pen, our payers (and Medicare) took away the fee for ultrasound guidance for thyroid biopsies (why would a new endocrinologist purchase a $35,000 machine?). We were deprived by CMS of the ability to charge for consultations when we see new Medicare patients. We are threatened by CMS as the office visit codes will soon be “simplified.” This means that we would have to code lower for patient visits that are complex, but not immediately life-threatening. Really, taking care of a type 1 diabetic patient with hypertension, hyperlipidemia, and kidney disease is in the same category as a stable type 2 diabetic patient with stable arthritis and hypertension. Ridiculous, isn’t it? Who will teach diabetes self-management? Who will pay for the thyroid biopsy that will be done at hospitals at five times the cost?
Our system needs endocrinologists. Why? Because it is estimated that approximately 1.35 billion adults in the United States will be obese, and approximately 50 percent will be diabetic by the year 2030. If that is not bad enough, thyroid cancer and autoimmune dysfunction are on the rise. Every other person is dealing with multiple endocrine problems, including fatigue, polycystic ovarian disease, or menopause. This is alarming, to say the least.
Now, more than ever, I desire to do what I am trained to do — not copious amounts of paperwork. I want to treat patients with what is best for them– not battle with the “system” and the politics of health care. I want to spend time counseling patients to understand the diseases that they fight against– not increase numbers to make ends meet. I want patients to have access to prescribed medications — not go head-to-head with insurance companies that try to control treatments for patients.
As much as myself and other endocrinologists want the above, it can only happen with action. We have to take charge and convince patients that we are their advocates, and there needs to be a change in the system. We have to find alternatives to insurance companies creating administrative hurdles to reduce cost of care. The medical insurance system is unnecessarily complicated and only serves the insurance industry, which forces physicians to increase their staff and spend more time dealing with hurdles. We need to reduce the administrative burden on physicians.
So how can we start tackling the system? We all have to educate our state representatives and CMS that the strategy of cutting physician reimbursement is a shortsighted approach. It is only right that we are compensated for our time and efforts; and if physicians have time to think rationally, they will choose cost-effective strategies with patient welfare at the core. True patient-centered homes are effective when the roles of physicians are valued.
Despite how discouraging the system is becoming, I wake up every morning with the same passion and the zest to solve complex medical problems and make a real positive impact in the lives of patients who are generally considered the most difficult to treat. I do it because I love endocrinology, and this is why I have as much passion about reforming the system to be in support of physicians such as myself, future physicians, and most importantly, patients in need of effective care. I hope that you will join me in this effort. Let us come together to make our presence felt: individually and, more importantly, collectively.
Sameera Tallapureddy is an endocrinologist.
Image credit: Shutterstock.com