Surveys confirm endocrinologists’ value to primary care physicians, but some may need to be more available.
Primary care physicians consider endocrinologists to be influential information sources and thought leaders, but rank them lower when it comes to accessibility, according to a pair of surveys commissioned by the Endocrine Society
The two surveys were designed to gather data on the influence of endocrinologists on general practice decisions related to endocrine diseases and the adoption of new diabetes products by primary care physicians. “The results indicated that primary care physicians apply the recommendations of their endocrine consults with little to no modification,” says report author Alison Kim, PhD, associate director of grant development and strategic research at the Endocrine Society. “Endocrinologists are a highly trusted source of information about diabetes products that are new to primary care physicians. In most cases, endocrinologists are comparable to articles in peer-reviewed journals and lectures in terms of trust, accuracy, balance, and value.”
This finding of a very high level of trust did not surprise Robert L. Wergin, MD, president-elect of the American Academy of Family Physicians and a family physician in Milford, Neb., a town of about 2,000 residents some 30 miles from Lincoln.
The surveys found that the most common reasons primary care physicians seek endocrine consults and treatment discussions are related to diabetes and obesity cases, followed by thyroid disease. These were the conditions Wergin brought up first in an interview with Endocrine News, noting that “an important part of being a family doctor” is recognizing when a patient reaches a level requiring additional help and expertise.
Primary care physicians are hungry for information on diabetes, and find the proliferation of new diabetes drugs and technologies challenging, according to incoming Endocrine Society President-Elect Lisa Fish, MD, head of the Diabetes and Endocrinology Clinic at Hennepin County Medical Center in Minneapolis. Fish bases that assessment on her experience chairing the Society’s CME program, “Endocrine Essentials for Primary Care.” “There has been a lot of change in the management of diabetes,” she says. “There has been such a proliferation of new types of drugs, new drugs in the same family, and new families of drugs. Most primary care physicians are quite confused as to how to add some of the new drugs, when to start insulin, and how to best utilize these new drugs to optimize patient care.”
The surveys reinforced the need for such information because the respondents reported that the second-most common category of prescriptions they write are for “diabetes and obesity,” closely following those for cardiovascular conditions. The third and fourth most common categories are “women’s health” and “thyroid,” respectively.
The surveyed physicians ranked endocrinologists among their top three most trusted sources of information on diabetes products. Endocrinologists scored above 8 on a scale of 1 to 10, similar to peer-reviewed journals and accredited lectures.
The physicians also said that endocrinologists were among their most often-used information sources about new diabetes products, just behind peer-reviewed journal articles, sales representatives, and accredited lectures.
The respondents displayed a hesitance to be early adopters of new diabetes products, with 35% indicating that they were likely to wait to try a product only “after it becomes standard” and 30% waiting until “after many others have tried it.” Endocrinologists could potentially influence the timing of new product adoption, because 43% of the respondents said they would “certainly” try a new diabetes product earlier if it were recommended by an endocrinologist, and 47% said they would “possibly” do so.
Wergin says he appreciates his consultants’ specialized knowledge about fast-changing new products, and after a referral, “sometimes when my patients come back, they are on a new type of pump that I haven’t seen.”
The family physicians and internists also said that they tend to follow treatment plans as recommended by endocrinologists, with some three-quarters of them reporting that they change fewer than one in 10 treatment plans.
The main concern that the surveys raised related to accessibility. Asked to rank various information sources in terms of “access,” the survey respondents ranked endocrinologists last among a list of eight sources. “These results complement the conclusions of the Society’s workforce study, which suggest that there are insufficient numbers of endocrinologists for the volume of patients with endocrine diseases in the United States,” Kim says.
Robert A. Vigersky, MD, director of the diabetes institute at Walter Reed National Military Medical Center Diabetes Institute in Washington, D.C., and professor of medicine at the Uniformed Services University of the Health Sciences, and a former Endocrine Society president who has studied workforce issues, says it has been clear for years that there are not nearly enough endocrinologists to deal with all the people who need treatment for diabetes and many other conditions.
He says that endocrinologists who have the time can help spread endocrine knowledge by speaking in the community. Wergin finds these talks valuable, especially the opportunity for give and take with a local endocrinologist: “I’ll question him, ‘Why do you say that?’ What’s remarkable is he will often say, ‘Well let me show you this study, this is why.’ It is very evidence-based.”
The Endocrine Society is active in this kind of outreach with programs in different parts of the country such as its “Endocrine Essentials Live.”
The Personal Touch
All three experts stressed the importance of personal relationships. Fish and Vigersky say the “curbside consults” with colleagues one encounters in the hall or cafeteria can be invaluable, but only help with physicians in one’s institution. When seeing a patient from an outside referral, Vigersky says, “The consultation often can be supplemented with a quick phone call, because that establishes a more personal relationship. I think that a very important way to work with primary care providers is to make this a little bit more personal than just a letter.”
“In my area, there are not a great number of endocrinologists, and they are very busy,” Wergin says. But he has built good personal relationships with endocrinologists in the nearby cities of Lincoln and Omaha, and they manage to see the patients he refers on a timely basis. And if a patient has an urgent need to be seen, he picks up the phone. “If you communicate effectively, my experience is it has worked out okay,” Wergin says, both in terms of having patients seen and working together to develop treatment plans truly tailored to the patient’s needs — which, as a family physician, Wergin knows intimately.
— Seaborg is a freelance writer based in Charlottesville, Va. He wrote about treating transgender patients in the May issue.