So You Want to Be an Endocrinologist

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So you want to be an endocrinologist. You like the idea of being the master of diabetes and believe that every medical issue can be fixed by prescribing the right hormone. Let’s debunk the public perception myths and give it to you straight. This is the reality of endocrinology.

 

What is Endocrinology?

Endocrinologists are the experts in the disease and dysfunction of the endocrine system. This network of glands secretes hormones into the bloodstream which travel throughout the body and regulate a variety of processes including growth and development, metabolism, reproduction, sleep, and mood.

Metabolic diseases such as obesity, diabetes, and thyroid disease are the bread and butter of endocrinology. Close to two-thirds of all endocrinology patients fall into this category. The other third consists of a variety of endocrine conditions including pituitary disease, adrenal disease, bone disorders, and sex hormone imbalance.

Endocrinologists are also involved in the evaluation and treatment of a variety of tumors and cancers involving the pituitary gland, adrenal glands, and thyroid.

The typical day for an endocrinologist involves splitting their time between the clinic and the hospital. Outpatient clinic days consist of quick follow-ups and e-visits to review lab results, review continuous glucose monitor data, and evaluate treatment response.

On inpatient days, endocrinologists will generally serve as consultants to the primary medical or surgical admitting service. They also lead the inpatient glycemic management team to help hospitals improve outcomes by optimizing inpatient and perioperative blood glucose levels.

If the endocrinologist is part of an academic center, they’ll have to further divide their time between academic responsibilities, including teaching and research. This brings us to an important method of differentiating an endocrinologist’s practice.

Academic vs Community vs Private Practice

In academia, endocrinologists tend to see more complex or rare diseases including advanced thyroid cancer, Cushing’s disease, acromegaly, and lipodystrophy. They may also subspecialize in a particular niche of endocrinology and focus on teaching, researching, and practicing within this specific area.

As a private practice or community-based endocrinologist, you will spend most of your time in the clinic, evaluating and treating patients referred by their primary care physician. Presentations are generally less rare or complex on average, with the majority falling into obesity, diabetes, and thyroid concerns. Compared to academic practice, community and private practice endocrinologists have higher average compensation.

Misconceptions About Endocrinology

Let’s clear up some of the misconceptions about endocrinology.

A lot of people think that endocrinologists are only good for prescribing hormones. Not only is this a vast oversimplification of what an endocrinologist does, but it is simply incorrect. Although hormone therapy may be a part of the treatment plan, it is not indicated for every patient – nor is it the only tool in the endocrinologist’s toolbelt.

Endocrinologists are diagnosticians who work hard to diagnose the underlying cause of endocrinopathies and help patients get to the root of the problem. As such, treatment plans often consist of lifestyle changes, surgical referrals, and medications aimed at treating the root cause of the endocrine dysfunction.

Another common misconception is that endocrinology is limited only to the treatment of diabetes and obesity. Although these metabolic diseases comprise a large part of an endocrinologist’s census, their actual scope is much broader.

 

How To Become an Endocrinologist

To become an endocrinologist, you must first complete four years of medical school, followed by three years of internal medicine residency, and two to three years of endocrinology fellowship.

Two-year endocrinology fellowships typically consist of one year of clinical training and one year of research; however, endocrinology prospects desiring a career in academics should opt for the three-year fellowship path which includes an additional year of research.

In terms of competitiveness, endocrinology is one of the less competitive IM fellowship specialties with cardiology, oncology, and gastroenterology sitting at the more competitive end of the spectrum.

As for the type of medical students who typically go for endocrinology, they’re usually the ones who care more about work-life balance than procedures or absolute income.

They are the students who tend to practice what they preach and prioritize good nutrition and exercise habits above all else. This is fitting since a large component of endocrinology is based upon obesity, diabetes, and the prevention of cardiometabolic disease.

 

Subspecialties within Endocrinology

Although there are few opportunities for endocrinologists to pursue additional fellowship training, some endocrinologists may choose to subspecialize in a specific area of endocrinology and focus on research, teaching, and/or practice in this specific area.

Diabetologists focus on the treatment of type I, type II, and other rarer forms of diabetes mellitus.

Thyroidologists focus on all diseases of the thyroid and often specialize in thyroid cancer.

Neuroendocrinologists focus primarily on hypothalamic-pituitary disorders.

Reproductive endocrinologists work alongside OB/GYN colleagues and focus on conditions such as hypogonadism and menopause.

And more recently, transgender medicine has also become another viable subspecialization – focusing on addressing the needs of the transgender patient population.

 

What You’ll Love About Endocrinology

There’s a lot to love about endocrinology.

To start, endocrinologists tend to work reasonable and regular hours. Even if you take call for inpatient duties, it is not generally intense or high-volume typically.

Additionally, endocrinology is not a procedure-oriented specialty. Instead, the emphasis is placed on building patient relationships and exercising clinical reasoning.

Because endocrinologists are concerned with “lifestyle” diseases like obesity and diabetes, you also have the opportunity to help your patients be more proactive with their health. This means guiding them to make healthy lifestyle choices that will prevent future disease and positively impact their health for years to come. While preventive medicine isn’t perceived to be cutting edge and doesn’t make headlines, it’s arguably more important and impactful in terms of lives saved.

The top two leading causes of death in the United States are heart disease and cancer, which are both heavily impacted by dietary and lifestyle choices. As an endocrinologist, you can take pride knowing that you’re helping your patients make better lifestyle choices that will prevent these issues before they occur, which is something we often don’t focus on enough in Western medicine.

 

What You Won’t Love About Endocrinology

While endocrinology is an awesome specialty, it’s not for everyone.

With a total of 5 or 6 years of additional training after medical school, depending on whether you opt for a 2- or 3-year fellowship after your internal medicine residency, becoming an endocrinologist takes longer than average. And while most specialties with longer training are offset by higher average compensation, endocrinology is at the lower end with an average annual salary of $245,000.

Additionally, about two-thirds of your caseload will revolve around a select few conditions – namely diabetes, obesity, and thyroid disease. So, if having a lot of variety in your patient presentations is important to you, endocrinology may not be the best fit.

Endocrinology also requires a great deal of patience. Acquiring insurance approval for treatments is often difficult and requires filling out large amounts of paperwork. And even when you finally get insurance approval, there is the issue of patient adherence and lifestyle modification to contend with.

To combat this, endocrinologists are trained extensively in motivational interviewing techniques aimed at empowering their patients to make lasting behavior change. But if you’ve lived off nothing but junk food for the past 30 years, it’s unlikely you’ll simply flip the switch and start eating chicken breast and salad every day.

Medications affecting the endocrine system are also often slow to take effect which further compounds the issue of patient adherence.

This can be a huge source of burnout for some endocrinologists; however, the success of many patients generally outweighs the frustration that comes with a few non-adherent ones.

 

Should You Become an Endocrinologist

How can you decide if endocrinology is right for you?

If you’re patient and willing to weather the ups and downs of habit change alongside your patients to improve their health, endocrinology might be for you.

You should love learning about physiology, lifestyle medicine, and pharmacology and value positive lifestyle modification.

If you prefer lower acuity and enjoy the cerebral side of medicine more than procedures, endocrinology has you covered.

And if you prioritize work-life balance, endocrinology won’t make you choose between your family or your work, although you might have to sacrifice a bit of income in return.

If you enjoyed this article, check out So You Want to Be an Internist or another specialty in our So You Want to Be series.

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