As endocrinology fellowships go unfilled, leaders in the field are growing more concerned about the ability for endocrinology to meet the needs of future patients grappling with diabetes, obesity, and other endocrine disorders. To mitigate this potential gap, the Endocrine Society launched the Medical School Engagement Program (MSEP) to boost the interest of medical students across the country.
In 2014, a paper by Vigersky et al. appeared in The Journal of Clinical Endocrinology & Metabolism that concluded, “There are insufficient adult endocrinologists to satisfy current and future demand. A number of proactive strategies need to be instituted to mitigate this gap.”
A 2020 paper in JCEM by Romeo et al. about trends in endocrinology recruitment and possible solutions, asking the question, “How do we make endocrinology appealing for all our trainees and promote the growth of a diverse and competitive workforce?” and concluding that “the inadequate growth of the endocrinology workforce supply will have long-term ramifications on all aspects of academic medicine and clinical care. Bold measures coupled with a renewed focus on values that influence job satisfaction are required to attract top talent in endocrinology fellowships, ensure retention, and revitalize our community.”
A 2022 paper in JCEM by Tsai et al. reported that there are about 8,000 currently active endocrinologists in the United States, “which amounts to 41,460 individuals in the general population who may receive potential care by each endocrinologist.”
In 2010, endocrinology was the most competitive of internal medicine fellowships. But by 2014, cracks were already starting to show, as Vigersky and his co-authors pointed out. And now, just ten years after that paper and stark warning, endocrinology ranks as one of the least competitive.
To meet these significant challenges, the Endocrine Society launched the Medical School Engagement Program (MSEP), building on previous work taking it to the next level with a program to directly address the shortage of endocrinologists in the U.S. Training programs have been working to address this shortage, increasing the number of fellowship positions in endocrinology by 78% over the last 15 years. However, many of these spots are not filling, and worse yet, the number of U.S. medical school graduates applying to endocrinology fellowships has fallen over that time.
“With huge shortages of endocrinologists in the United States, and a pipeline that may actually be shrinking, finding novel ways to attract bright, energetic, U.S.-trained medical students into our field is paramount,” says Stephen R. Hammes, MD, PhD, the Louis S. Wolk Distinguished Professor of Medicine, chief of the Division of Endocrinology, Diabetes and Metabolism, executive vice-chair of the Department of Medicine at the University of Rochester in Rochester, N.Y. and the Society’s immediate past-president. “The Medical School Engagement Program is exactly what we need at exactly the right time. I am thrilled that the Endocrine Society is once again showing tremendous support for their members and for our profession by starting this program, and I am almost certain that it will have a direct and significant positive effect on the pipeline for years to come.”
In the program’s first year (2024-2025), the Endocrine Society is providing 10 medical schools [see box] with support for endocrinology-focused programming including:
- Establishing Endocrinology Interest Groups for medical students and providing funding to support faculty-led sessions highlighting the best of endocrine practice and research.
- Supporting two Excellence in Endocrinology awards at each institution, for a pre-clinical and a more senior medical student.
- Funding attendance at ENDO for each award winner, where they will meet experience all the annual conference has to offer, meet with inspirational leaders in the field and participate in eMD (Endocrine Mentor Day).
“While the Society has established programs that support clinicians during fellowships and early in their careers, the Medical School Engagement Program is focused on increasing interest in the field before students have made their career choices,” says Sacha Uelmen, RD, CDE, the Society’s director of professional and clinical affairs who is heading up these efforts. “We know that most medical students choose a specialty early in their medical school journey.”
Providing Access and Hope
And these efforts are needed now more than ever. Based on the latest statistics on diabetes and endocrine diseases, there were 38.4 million people living with diabetes, an estimated 10 million people over age 50 with osteoporosis, and another 13 million people in the U.S. with undiagnosed endocrine disorders, not to mention patients with thyroid, adrenal, or pituitary disorders. Along with the alarming shortage of medical students choosing to enter the field of endocrinology, there is also a decrease in the number of practicing endocrinologists. This creates barriers and challenges for patients, endocrinologists, primary care, and the entire healthcare community.
“The Medical School Engagement Program is exactly what we need at exactly the right time. I am thrilled that the Endocrine Society is once again showing tremendous support for their members and for our profession by starting this program, and I am almost certain that it will have a direct and significant positive effect on the pipeline for years to come.” — Stephen R. Hammes, MD, PhD, Louis S. Wolk Distinguished Professor of Medicine; chief, Division of Endocrinology, Diabetes and Metabolism; executive vice-chair, Department of Medicine at the University of Rochester in Rochester, N.Y.; immediate past-president, Endocrine Society
Here Uelmen relates a story of a personal experience when she was a diabetes care and education specialist working in a clinic setting: A young man from a rural area with diabetes was being managed by his primary care physician and was being treated as if he had type 2 diabetes. He was working closely with his doctor, but still had multiple hospitalizations, including a partial amputation of one foot. He eventually drove seven hours to an endocrine clinic, where he was diagnosed with late-onset type 1 diabetes. Because he was now seeing an endocrinologist, he was able to access diabetes education and started using a CGM and insulin pump. He now has a hope for a healthy life, but that’s not the case for so many other people who do not have access to an endocrinologist.
A Dearth of Procedures
But why this sharp drop in a relatively short period of time? Uelmen tells Endocrine News that the issue is complex, but to put it most simply, it’s because the number of fellowship spots has outpaced the number of applicants. But that brings up another question: Why aren’t applicants interested in endocrinology anymore?
“One important reason is that students have fewer opportunities to work in outpatient endocrine clinics, where the more ‘interesting’ aspects of endocrine diseases will be experienced,” Uelmen says. “Given that endocrinology is not a ‘procedure-based’ specialty, and inpatient rotations focus a lot of time on insulin titration, students and residents are not seeing the wide range of care that is provided and the long-term relationships with patients that keeps those in the field engaged and satisfied. Finally, the salary of clinical endocrinologists is among the lowest of physicians in internal medicine.”
Uelmen wrote in a recent Society blog post about the minimal exposure to more complex and clinically diverse topics, and sure, a low salary may cause some potential applicants to apply for another specialty, but there are other benefits to endocrinology. Again, a lot the interesting work in endocrinology occurs in the outpatient setting and a lot of the exposure for students is only happening inpatient.
“It’s not a representative exposure to a field that focuses on fascinating science, interesting pathophysiology, and, most importantly, patients who can benefit from the care endocrinologists provide!” Uelmen says. “Our [MSEP] awardees have offered a variety of ways that they can make an impact here, and with these enthusiastic leaders making change in their own academic settings, we hope to gain valuable insights to share best practices learned through this work that will help everyone in the field.”
An Excited Reaction
The 10 inaugural recipients of the MSEP Awards were chosen out of 25 medical schools who completed a simple application to ensure basic requirements were met and to answer to critical questions around what they planned to do to increase medical student interest in the field through initiating endocrinology interest groups at their institution as well as demonstrating a commitment by faculty to oversee this work over the long term. Applications were blinded and scored by staff and volunteer members.
“In general, the reactions were positive and along the lines of ‘finally, so excited this is happening, this is much needed,’” Uelmen says. “Overall, the reaction has been very positive and I’ve heard from several people that want to be included in our next application cycle as we grow this program over the next few years.”
Endocrinology Mentor Day: Hope for the Future
Another of these “proactive strategies” the Society has employed to address the endocrinology pipeline is Endocrine Mentor Day at ENDO. Three years ago, the Endocrine Society Clinical Affairs Core Committee (CACC) began talking about ways to increase the number of endocrinologists and found that one way to do that was to have trainees, residents, and medical students attend ENDO and devote a day to them. The committee arranged for mentors in the Society to engage with mentees and help them network so they could have a positive experience at the annual meeting and hopefully set them down the path to a career in endocrinology.
“While the Society has established programs that support clinicians during fellowships and early in their careers, the Medical School Engagement Program is focused on increasing interest in the field before students have made their career choices. Research shows that most medical students choose a specialty early in their medical school journey.” — Sacha Uelmen, RD, CDE, director, professional and clinical affairs, Endocrine Society
This year, in Boston, was the second Endocrine Mentor Day. Uelmen says there was a wait list for attendees and the students really enjoyed the day. “As a first-time attendee myself, this was a very exciting event,” she says. “The mentors were enthusiastic and engaged. They shared exciting aspects of endocrinology and connected with students from around the Boston area and beyond.”
“One of the highlights was getting to learn more about diabetes technology and wearing a CGM for the day,” Uelmen continues. “I would say the strong interest in this event and the demand outpacing the spots available certainly gave me hope for the future of the field.”
For now, Uelmen hopes we can spread awareness of the sincere and deep commitment by the Society to take on real issues that impact our members and the human community at large in a meaningful way to address a huge challenge for the field, while offering multiple pathways to get engaged in endocrinology. And then, get involved, as there are 160 medical schools across the U.S. and the Society hopes to support many, if not all of them in the years to come.
“Get involved in whatever capacity you are able,” Uelmen says, “whether it’s encouraging your medical school colleagues to apply next year, mentoring students and introducing them to the Society, or simply being a super engaged mentor to a medical student to show them what an important and exciting field they could be part of.”
Bagley is the senior editor of Endocrine News. He wrote about reconsidering BMI restrictions for gender-affirming surgery in the June issue.
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