My name is Arti Thangudu. I’m an endocrinologist, aka diabetes specialist. I have 3 goals for you for this article.
The goals:
For you to understand
- Why diabetes care stinks in America
- How this affects people – individuals, businesses, communities
- How we can do better
 |
By Arti Thangudu CEO & Founder HeyHealthy |
Key Takeaways from the Article
- Inadequate Access to Specialized Care: A significant issue highlighted is the severe lack of access to endocrinologists in the United States, with 75% of counties lacking a specialist. This scarcity contributes heavily to the inadequate management of diabetes, leaving many individuals with uncontrolled conditions for years, potentially leading to severe complications like heart disease and amputations.
- Economic Implications Affecting Diabetes Care: Economic factors play a substantial role in the quality of diabetes care. Endocrinology, being the lowest paying medical specialty despite its high demand, discourages new entrants into the field. This economic disincentive results in fewer professionals entering endocrinology, exacerbating the access issues and affecting patient care quality.
- Impact on Communities and Businesses: Diabetes not only affects individuals but also imposes significant costs on communities and businesses. With growing diabetes rates, especially in areas like South Texas, the disease’s impact is profound, influencing workforce productivity and increasing healthcare expenses for employers and patients alike.
- Potential Solutions through Innovation and Support: The article presents a hopeful outlook with solutions like integrating endocrinology expertise into primary care and utilizing telemedicine to overcome geographic and time barriers. These innovations have shown promising results, significantly improving patient outcomes by reducing A1c levels, facilitating weight loss, and enhancing overall patient health and empowerment.
The problem: Why DM care stinks in the US
Diabetes is so common that we as a society and healthcare community have forgotten that it is a highly complex disease, life threatening disease. It has been brushed aside as prevention is not profitable.
This has created an acceptance of diabetes. People think they have a “touch of sugar” until that touch of sugar becomes a touch of a heart attack and then our reactive health care system finally sees value in our patient.
For most diseases when a disease is not well-controlled in the general medical setting, we consult a specialist. If somebody has an ear infection that isn’t resolved with typical antibiotics, we send to ENT, right?
When it comes to diabetes, though, many patients are out of control for decades, with complications of diabetes – amputations, retinopathy, heart disease, dialysis – and still have never seen a specialist, a diabetes expert aka an endocrinologist.
85% of diabetics will never see an endocrinologist. This is despite tons of data demonstrating improved outcomes in diabetes when patients are seen by endocrinology.
Why?
Because access to great endocrinology is non-existent.
ACCESS: 75% of US counties don’t even have an endocrinologist. Endocrinology clinics have an average 3-6 month wait time to get in and stringent referral criteria.
We have a client in Lockhart, Texas and I did some reconnaissance work on the lay of the endocrinology land. I called the nearest endocrinology clinic about 45 minutes away pretending to be a newly diagnosed patient trying to get into see the endocrinologist.
After 30 minutes on hold, the receptionist ask if I had a referral from my PCP. I said well I’m paying cash so I don’t have a referral requirement from my insurance. She said I still needed one so I’d have to go back to my PCP for a referral, then the referral would be assessed by the clinic and if it was deemed appropriate, I could then make an appointment and the next available appointment was in 5 months. I felt disempowered and hopeless and I wasn’t even a real patient!
Even in endocrinology clinics many patients are seen by midlevel providers not even the specialist. It is understandable why PCP’s have given up on referring to endocrinology and are doing the best they can for their patients with the resources they have available.
Access to endocrinology is poor because there are only approximately 5000 endocrinologist in the US. There are more than 37 million people with diabetes in the US, not to mention the other hormonal conditions we treat.
Endocrinologists are retiring faster than we can make new fellows. This is because endocrinology is the lowest paying medical specialty despite being in highest demand. While it stinks that it comes down to dollars, it doesn’t make economic sense for physicians to go into a field where you have to train longer to earn less.
Access is a major reason diabetes care stinks but let’s say a patient has broken through the access barrier and actually gets to see an endocrinologist. Since endocrinology is the lowest reimbursed medical specialty, endocrinologists in the traditional model have to see a ton of patients.
TIME IS HUGE BARRIER. Diabetes is a complex disease where patients need education and support yet the most physiologically complex patients are given the least clinical time.
Care is better when physicians have time to think, build a relationship and coordinate care. Endocrinologists practicing in the traditional insurance model provide better care but still do not have the time to provide care at the best of their capabilities.
WITH A LACK OF TIME COMES A LACK OF SUPPORT
Diabetes is complicated, confusing. Patients are with their blood sugar every minutes of every day. They have complex medication regimens, often multiple shots/day, technology like pumps and continuous glucose monitors.
Patients are asked to think about their disease all the time with absolutely no guidance. Have you ever tried getting through to an endocrinology clinic? Well I have – it looks like 2 hours on hold, voicemail boxes that are never answered.
I once received a patient message from December the following April when I was practicing in the insurance model. This is unnacceptable.
I reject this as “care.”
PCP’s are working hard for all of our patients and it is our responsibility as endocrinologists to support them in caring for patients living with diabetes and hormonal conditions.
But this isn’t what is happening and usual “care” for diabetes in traditional American healthcare makes patients sicker.
How does this affect people, you – our communities, businesses, workforce –
Well per the diabetes is the costliest chronic disease our nation faces.
Employers and patients are footing that bill – both the financial burden and the emotional burden.
People with diabetes have more medical expenses, take more time off and are less productive at work when they are ill but still working.
Diabetes rates are growing – 30% of people have prediabetes and in some areas of the US, especially in South Texas where we do a lot of work, many communities have diabetes rates of 25% in adults. That is one in 4 people, y’all.
Diabetes is a major problem for all of us. Yet, I remain hopeful.
Solution
Diabetes is not our patients’ fault. Let me tell you how I know.
5 years ago, I was asked to take on my first employer client. I was super green and thought why do they want me? These patients have failed primary care. What can I do?
Within 3 months, I had my answer.
The clinic added my expertise to their primary care clinic model that valued time, access and support. I was afforded an hour to establish care with patients and sufficient time for follow ups. Staff responded promptly to the patient’s questions and looped me in quickly when needed.
We lifted the expertise, time and access barriers and voila, it worked!
By giving these patients expertise, time and access:
These patients reduced their A1c by an average of more than 2%, more than 3% for the very poorly controlled ones. 85% of them lost weight, they stayed out of the hospital, they changed their eating and exercise habits. They were healthier, happier, empowered.
In 2020 COVID came along and we switched to telemedicine. With telemedicine we had sustained outcomes as well as high patient satisfaction with telemedicine.
Falling into telemedicine opened up a huge opportunity for us because we realized we could create access for busy, working people (aka employees) even those in the majority of the US without a local endocrinologist.
In the past year have grown our team and added several employers in Texas and Oklahoma to our group who we care for via telemedicine with sustained results by providing expertise, time and access.
We’re extremely grateful for this work, passionate and ready to serve your groups. Check out our beautiful new website HeyHealthy.com and stay and chat or contact us to learn more.
Read HeyHealthy Validation report HERE.
