Endocrinologist or Primary Care? You May Need to Shop Around for the Right Doctor
Your primary care doctor may or may not be the right person to treat diabetes.(HEALTH/SEAN LOCKE/ISTOCKPHOTO)
Like many aspects of type 2 diabetes, it may take some trial and error before you find the right doctor. Primary care doctors, such as family physicians and internists, treat most people with type 2 diabetes.
But even if you like your primary care doctor, he or she may not be the right person to manage type 2 diabetes.
You might be happier with someone else, or with an endocrinologist, a specialist in hormone-related diseases such as diabetes.
In general, family physicians are trained in all areas of medicine and treat adults and children. Internists specialize in internal medicine and only treat adults. Internists may or may not have in-depth training in diabetes (they can choose to do one to three additional years of training in one of 13 sub-specialties, such as endocrinology or cardiology).
Your primary care doctor may be a great fit—or not
Anil Verma, a 38-year-old Seattle-area resident, was diagnosed with type 2 diabetes in 2005. He had been seeing one doctor in a large practice, but wasn't that happy with his care.
Verma asked four nurses in the practice who they would recommend, and they all suggested the same doctor, who was in the same practice as his current one. So he switched.
"With diabetes, if you don't have a good doctor, it just becomes a pain. This guy's not a specialist in diabetes—he's a primary care guy, but he seems to have a lot of experience with diabetic folks and really keeps up-to-date. And he works well with me," Verma says.
The software developer likes to keep detailed logs of his blood sugar readings, and the doctor spends plenty of time reviewing them at their quarterly visits. He also heeds Verma's well-researched requests on how he'd like to manage his diabetes. And he has an online system to send his patients' test results to them.
"It's the small things that make life a little easier," Verma says.
Next Page: Finding an endocrinologist
[ pagebreak ]A shortage of endocrinologists in the U.S.
At first, Nancy Chiller Janow, of South Orange, N.J., was relatively happy with her primary care doctor, who also happened to be newly diagnosed with type 2 diabetes. "We sort of were in the same boat at that point," she says.
But her blood sugar continued to go up, even though she was watching her diet, exercising, and taking the oral diabetes drug metformin. Then her hemoglobin A1C tests, which should have been between 6% and 7%, also began to rise. "When it went over 7%, it was at this point, I think, 7.2 or 7.3. I was concerned enough that I really wanted to see a specialist."
However, it was harder to find an endocrinologist than she thought. There's a serious shortage of these specialists in the United States.
"To find an endocrinologist that was available quickly, had a good reputation, and would take my insurance, was a very difficult thing," she says. "I couldn't find one. Even living in the New York City metropolitan area, you would expect there to be so many. There are very few. So I'm lucky I found one."
There are about 3,000 endocrinologists and 25 million people with diabetes in the United States, notes Gerald Bernstein, MD, director of the diabetes management program at the Gerald J. Friedman Diabetes Institute at Beth Israel Medical Center in New York. "Of the 3,000 endocrinologists, only half really have expertise in diabetes. The other half really focuses on the thyroid, the pituitary, the adrenal glands, etc."
To find her endocrinologist, Janow talked to a physician friend, posted a message on the community website and checked out a list of New Jersey's top doctors in a local magazine. It took some time, but "I'm very, very happy with him," she says.
"He knows his field very well, but he also has this incredible bedside manner," she says. "As my diabetes got worse, I was worried that I was going to die. He alleviated that."