FAST FACTS:
Number of fellowship positions offered in 2011 : 233
Competitiveness Ranking: Low
Positions filled by US graduates: 43.8 %
Length of training: 2 years after completing a 3 year internal medicine residency
Number of fellowship programs: 115
Number of fellows in training: 565
Number in US Board Certified in Endocrinology: 5,811
Starting median compensation: $175,000
Median compensation for all physicians in specialty: $250,000
Average work hours per week: 51
PHYSICIANS WHO SPECIALIZE IN ENDOCRINOLOGY AND METABOLISM deal with the diagnosis and treatment of the hormone-producing glandular and metabolic systems. There are three categories: clinical endocrinology, pediatric endocrinology, and reproductive physiology. Fellowship graduates are in moderate oversupply.
Endocrinologists often earn less than consultants in other areas of internal medicine, such as in cardiology or gastroenterology, both of which are more procedure oriented. Many endocrinologists practice in academic settings in departments of internal medicine, pediatrics, or obstetrics and gynecology. The majority of endocrinologists practice in large cities (one million or more people).
Further Information. The Endocrine Society, 8401 Connecticut Avenue, Suite 900, Chevy Chase, MD 20815 . Telephone: (301) 9410200. Internet address: www.endo-society.org.
Research projects and ward rotations in medical school left a positive impression on the respondents, but most did not make their final choice until residency years. Role models are cited as influential in the decision to be an endocrinologist.
Specialties such as neurology and oncology that deal with incurable patients are not appealing. Neither are specialties that have little patient contact, such as radiology, pathology, and anesthesiology. There is little interest in technical skills, with one respondent who prefers "understanding the basic processes and solving problems.''
All respondents like the fact that patients have treatable and even curable disorders, and gain a great deal of gratification from positive outcomes. Diagnoses are often precise and management can be readily accomplished. They also enjoy the wide variety of patient problems, the ability to work with and enhance the quality of life in others with chronic illnesses and get to know the patient and family over a long-term relationship, and the experience of "making a correct diagnosis where others have failed." Satisfaction level in this specialty is higher than a national physician sample with 44.9 percent reporting that they are "very satisfied" and only 10.2 percent, "dissatisfied."1
When patients do not follow recommendations for diet or exercise, the endocrinologist may experience frustration at not being able to influence the course of the disease. Other aspects of endocrinology that are disliked are the amount of nonreimbursed time spent talking to patients, night telephone calls, treatment of advanced complications of diabetes mellitus, the monotony of seeing several patients with the same problem, and those obese patients who ". . . are under the impression their obesity is glandular in nature while the only abnormal glands they actually have are the salivary glands."
Endocrinology is primarily an office-based referral practice, but there are hospitalized patients too. The patient population is of all ages and both sexes with the most common problems being diabetes mellitus and thyroid disease. There is long-term continuing care for diabetic patients and telephone calls after hours related to their problems. Those who work in an academic setting report that clinical research activities are pursued on evenings or weekends. Continuing medical education is a necessity because the field is changing rapidly, and respondents spend much time attending conferences and reading journals.
An endocrinologist should have an interest in basic disease processes and be a good general internist. It is important to have the patience and skill to perform a careful history and physical examination and adopt an organized approach to diagnostic studies.
Because patients "frequently have vague complaints, as many endocrine diagnoses present as vague, nonspecific, generalized complaints and do not categorize very easily," the endocrinologist needs to develop an understanding and supportive attitude toward patients.
A sympathetic and intellectually curious personality is described by respondents: "Being interested in patients and willing to listen to their complaints along with being willing to sort out large numbers of symptoms and laboratory data to achieve a diagnosis" is characteristic of the endocrinologist. The goal and resulting satisfaction involves being able to get answers and positive results.
"The student should be well grounded in endocrine metabolism and chemistry of the body, knowledgeable about cellular function of the body, and competent in all laboratory procedures to be able to appropriately identify which tests are to be done and when finished, if they have been correctly performed." It is important to decide if your area of interest in endocrinology is clinical or investigative in order to choose the best training program for your interests.
The rapid expansion of knowledge in the field of endocrinology in the past 10 to 15 years offers the challenge to bring the advances to the public as quickly as possible. Endocrinology is seen as "an extremely exciting area at present" with improvements in diabetic care, the discovery of new hormones, and a great deal of clinically pertinent research that is intellectually stimulating.
You can complete the questionnaires and obtain your scores for all specialties online at http://www.sdn.net/schools/selector.
Leigh JP, Kravitz RL, Schembri M, Samuels SJ,, Mobley S. Physician career satisfaction across specialties. Arch Intern Med 2002; 162:1577-1584