The Future of Diabetes: Academic and Community Physicians

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Academic and community physicians can help fill gaps in care, especially with physician shortages.
Academic and community physicians can help fill gaps in care, especially with physician shortages.

How can academic physicians fill in the gaps?

We know that there is a marked imbalance between the number of patients with diabetes, and indeed, those with endocrine disorders in general, and the number of endocrinologists in this country — let alone primary care physicians — especially in underserved regions. We also know that not all of these individuals need to see an endocrinologist — at least not yet, for many. But what about the decreasing number of endocrinologists who choose careers in academia, in investigation, and/or teaching?

In 2016, the underlying causes of type 1 diabetes or type 2 diabetes still elude us. Despite significant advances in our understanding of these conditions and the development of novel treatments, we still have quite a ways to go for both diabetes and other endocrine diseases. While I fully realize we desperately need enough clinicians to help these patients, we also must recognize that there is a dearth of academic endocrinologists. Whether they conduct basic science or clinical research, discoveries at the bench and at the bedside can drive novel treatments, and perhaps one day, cures. These advances can result in delivery of innovative solutions in the clinic and at the hospital bedside. These physicians also play a substantive role in educating and inspiring tomorrow's endocrinologists.

But, at least in financial terms, what does our system reward? Procedure-intensive specialties. Unfortunately, endocrinology is most definitely not one of them. (The closest that we get is thyroid fine-needle aspiration.) If you combine this along with the ever-decreasing amount of National Institutes of Health (NIH) grant funds available, we have a worrisome situation on our hands, and it only seems to worsen.  I believe it is of very little use to just wring our hands and focus on the problems or, to put it in a more positive way, the challenges we collectively face. Why lament or rehash what is or the problems as they now stand? Why not envision what could be? What are some possible solutions, and how can we start acting to implement them? We are all well aware that there are no easy answers, and these are not exhaustive. I am certainly not offering quick fixes here, nor am I trying to make glib statements. With that said, here are a few potential paths I'm been mulling that we may explore.

1. Prioritize funding. 

I vividly recall my attendings looking stressed with furrowed brows and keeping a lower profile than usual. These were sure signs that a grant deadline was looming on the not-too-distant horizon. More than 1 talked about how “being established in your niche and having a great track record of getting grants doesn't mean you can get them.”

If that's the steep hill that seasoned scientists face, then what's the junior physician scientist to do? We can't expect them to thrive without funding. It's a struggle to secure internal grants of modest amounts, let alone NIH funds.

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