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.

Dr. Jubbal, MedSchoolInsiders.com.

Welcome to our next installment in So You Want to Be.

In this series, we highlight a specific specialty within medicine, such as endocrinology, and

help you decide if it’s a good fit for you.

You can find the other specialties on our So You Want To Be playlist.

If you want to vote in upcoming polls to decide what future specialties we cover, make sure

you’re subscribed.

If you’d like to see what being an endocrinologist looks like, check out my second channel, Kevin

Jubbal, M.D., where we’ll be covering a day in the life of an endocrinologist in the

future.

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.

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.

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.

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.

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.

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.

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.

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.

Huge shout out to Endocrinologist Dr. Karl Nadolsky for helping me with the creation

of this video.

Check out his Instagram, TikTok, and other social media handles in the description.

Are you hoping to become an endocrinologist?

To get into medical school, match into internal medicine residency, and get into an endocrinology

fellowship, you’ll need a rock-solid application, not only with test scores, but also essays

and interview skills.

As you look at resources and companies to work with, seek out those who are actual M.D.

physicians, not Ph.D. or other types of doctors that didn't go to medical school.

Look for those who have achieved stellar results themselves, a track record of success with

positive ratings from customers, and a systematic approach so you know you'll always receive

high-quality service.

If you decide on Med School Insiders, we'd love to be a part of your journey in becoming

a future physician.

Visit us on MedSchoolInsiders.com.

Thank you all so much for watching!

If you enjoyed this video, check out our So You Want to Be an Internist video, or another

specialty in our So You Want to Be playlist.

Much love and I’ll see you guys there.