Why did I choose community practice over an academic-based practice
The decision to embrace community practice was one made long before the completion of my advanced training. There is a shortage of endocrinologists, due to various reasons (Also see a recent opinion piece in JCEM — Giulio et al). I will defer a discussion of these reasons at this time. I believe a community-based endocrinologist is a helpful resource for not only patients with endocrine problems but other generalists with puzzling endocrinology queries and concerns.
My patients exist in a 200-mile radius, and some have to travel a fair distance to seek endocrine care. Within my first few months of community practice, I diagnosed cases of acromegaly, thyroid hormone resistance, insulinoma, Riedel’s thyroiditis, Cushing’s disease, and Kallmann syndrome, to mention a few. You can imagine my pleasant surprise – so it is not all diabetes and hypothyroidism then. Indeed, this issue of diabetes being boring is misleading. I find diabetes care exciting and challenging. Diagnosing insulin-mediated lipodystrophy, Familial partial lipodystrophy, growth hormone excess as causes of poor diabetes control is rewarding. In some instances, poor patient education regarding optimal use of insulin and not a lack of adherence is the cause of poor diabetes control. General medicine and family practitioners are overwhelmed in this climate of modern medicine. Diabetes care becomes an additional clinical problem that is briefly glossed over. This leads to deficiencies in patient education and assessment. Diagnosing latent autoimmune diabetes of adulthood and MODY in patients with presumed type 2 diabetes alters diabetes therapy significantly. My training in endocrinology, I believe, has been helpful to not only my patients but my colleagues in general internal medicine and family practice.
What is my typical workday like?
My typical day includes rounding on the previous day’s consults between 7:30am and 8:30 am. This is dependent on the complexity and number of inpatient cases. I occasionally join a team of endocrinologists at my hospital’s affiliated university program via skype business to discuss unusual cases.
I see outpatients between 8:30 am and 5:00 pm on 4.5 days of the week – between 14 and 16 patients a day. I have half a day dedicated to administrative work. I juggle inpatient consults alongside my outpatient practice, and this requires proper time management skills. My weekends and weeknights are devoted to myself and my family. I occasionally carry out some clinical documentation outside my usual work hours. This is nothing new for modern-day physicians burdened with the beast called EMR.
What is the compensation for endocrinologists
I am obviously not going to share my reimbursement on this platform due to privacy concerns. Compensation scales differ based on your experience, value to a health system, and professional negotiation skills. Follow this link
What should influence your decision to choose subspecialty training in endocrinology
Ask yourself, what am I most passionate about? What sort of work schedule makes the most sense for myself and my family? Can I work in a specialty that requires frequent shift changes and pages at ungodly hours? Financial reimbursement should not be the overarching reason for choosing a specialty. The grass is always not greener at the other end, even if your economic liberation is dependent on the “greens” – no pun intended. All clinicians cannot be at the forefront of urgent care; some of us have to be dedicated to slow-paced cognitive-based specialties like endocrinology. I feel fulfilled in my role as an endocrinologist and will not change it for any other specialty.
Giulio R Romeo, Irl B Hirsch, Robert W Lash, Robert A Gabbay, Trends in the Endocrinology Fellowship Recruitment: Reasons for Concern and Possible Interventions, The Journal of Clinical Endocrinology & Metabolism, Volume 105, Issue 6, June 2020, dgaa134, https://doi.org/10.1210/clinem/dgaa134