Trends in the Endocrinology Fellowship Recruitment: Reasons for Concern and Possible Interventions.
The rising prevalence of endocrine disorders over the past two decades -primarily driven by chronic conditions like diabetes- has resulted in a shortage of adult endocrinologists. Despite the wide gap between workforce supply and clinical care demand, a career in endocrinology is not viewed as an attractive choice for internal medicine (IM) residents. Indeed, the number of applicants to endocrinology training programs relative to available positions has declined since 2008, and endocrinology is now one of the least sought-after IM subspecialties. The reduction of endocrinology fellowship applicants is even more pronounced for three-year research positions aimed at training physician-scientists. While compensation, workload, and an increasingly competitive funding environment are major contributors to these trends, we believe other factors are also responsible. These include a lack of exposure to outpatient endocrinology in medical school and residency, excessive service work on inpatient diabetes teams, increasing levels of dissatisfaction and burnout among endocrinology attendings, and insufficient exposure to endocrine mentors during pre-clinical and clinical training. Without intervention, these trends will result in: deleterious public health consequences due to suboptimal delivery of endocrinological care (especially in rural areas); inadequate training of future generations of endocrine clinical educators and scientists; and blunted development of innovative research activity. Concerted efforts involving all stakeholders are necessary to tackle this set of challenges and reenergize the field. In summary, we analyze root causes for the waning interest in endocrinology training, review anticipated consequences on the configuration of the endocrinology community, and propose ‘real world’ interventions.