So, endo is a term we toss around here a good bit, but a recent post had me thinking about terminology we use. In my area seeing an actual endocrinologist doesn’t seem possible. In both offices in which I’ve been a patient, I’ve been shuttled to a nurse practionioner for management. By shuttled, I mean I’ve never been seen by a doctor. I’m mostly okay with this, but wondered whether others see an NP in an endo clinic over against an endocrinologist. Have you seen an actual endocrinologist for diabetes? When I was initially diagnosed, I even wrote to top docters 4 hours away to beg entrance into their practices (letters were unanswered). But as thigs have settled down a bit, I’ve grown more accustomed to the arrangement.
In many places, the practice is to alternate NP appts and Endo appts. My son sees each of them twice a year.
To tell you the truth, we like the NPs a lot better than the Endo’s in our practice… still, you should see an Endo in person at some time or another every year.
With PPO insurance I have the luxury of being able to see any practitioner. I would only see an endocrinologist, not because a NP is not capable of taking care of most problems but because when I go to the doctor I want to see a doctor.
I would say it depends on what you are going to the practice for. An appointment with an NP/PA should allow you to spend at least 2x the amount of time with the practitioner that an MD appointment would allow for. Often these interactions can be valuable, especially for routine issues. When your needs vary from routine to unusual, having an MD around is better in my opinion.
We see endos only. NPs sometimes do things like pump trainings or nutrition education. We live in a big city though. I think the NPs are great for more practical knowledge since most have diabetes or a kid with diabetes…they’re the ones who tell us how to use mini-gluc, or little tips and tricks, that sort of thing.
Whoever will responsively meet your needs and actively and competently manage your case. I am not terribly concerned with titles myself… Neither of them can solve your problems… some of the best and most effective healthcare providers in the country are NPs, so are some of the worst, same can be said for MDs of all stripes…
I listen to what the Endo or NP say, then I run it through the real world check (you guys and gals) either way. Doesn’t matter who I talk too honestly because I know they are both well trained and both have the same goal in mind. Although the institution did matter… We are now with number 8 on the top 10 list. We didn’t want garbage in, garbage out.
I see an NP at the endo. I have not seen an endo MD since the hospital when i was dx’d. I LOVE my NP!! She patiently explains things, asks my input, and we set goals for my D mgmt together. I would follow her wherever she goes!
I called after hours once & got the MD. No personality & not helpful at all.
Hey Alex, glad you could join us!
There is an intro page somewhere to go say hi and tell us about yourself.
During my daughter’s diagnosis at the Pediatrician’s office we were given the choice between closest Hospital/ER or best. (In fact the Ped doc should have told us over the phone to just go direct to the ER as the symptoms were classic and severe. Never went back to that Doc again.) 30 seconds to make a huge decision in which we had zero information at the time to go on. My natural impulse is that you can’t get better than the best. Best choice I ever made.
Particularly when it turned out this was just the first diagnosis in a string.
Love our NP. Love our Endo. Love all our other Docs and providers. It is very sad when I hear other kids not getting proper care from their providers.
I wish it was as easy as just picking the best facility near you. I have personally worked with two of the institutions on that list, and they are indeed very good hospitals that have many good and great physicians on staff. But the situation is so fluid and difficult to tease out, that it really is a crap-shoot.
For instance, when faced with the same decision I was lucky enough to call on a friend whose wife works at the best rated hospital in my area, and she let me know that they had just let go half of their diabetes educators, so they were only able to work with parents after they were discharged, and the education during hospitalization was provided by floor nurses.
She directed us to the second best program in the city, and it was a fantastic experience. Knowledge is power. Note: On the east coast you can often see a great physician at more than one facility, and frequently the best interaction doesn’t occur at the highest rated facility.
We had a 3~5 day hospital stay - don’t recall exactly how long. Class after class after class. Initially the medical staff took 100% responsibility for stabilizing and then caring for my child. After a couple days of classes, this was transitioned over such that we were entirely comfortable going home by the end. For a completely overwhelming situation I don’t see any improvements they could have made.
Which is exactly what happened to us, once the diabetes educator saw that we were interested and capable, she trained us in two 8 hour doses, and had us managing the care within a couple of days. This wouldn’t have happened at the top rated facility. Looking back, I was very glad for where we landed. It worked out great.
This was exactly my experience at Joslin Diabetes Center way back in the day (although I stayed almost a week; I think it was easier to stay longer then). I was only 10, but I learned so much from that intensive experience. I had great care there afterward, and would alternate between NP and endo, and I found them useful in different ways, with the NP having more practical advice and the endo useful for in depth medical insight. I think for more newly diagnosed folks and for families/kids, NPs are an extremely valuable part of the team.
As an adult however, I currently just see an endo. I’m kind of over having mid-level providers generally—I find that they tend know less than I do about most aspects of diabetes and thus they can’t really help much at this point. (I’m sure there are exceptions.) To be fair, not all endos are good either—I love mind because he’s both really smart and very open/warm, and he figured out quickly that I want and understand the medical details.
We also had a 2-day stay in the hospital and several educators coming to teach us the ins and outs of insulin and food. I can see how that would have been a godsend if Samson had been sick or in DKA.
But for us it would have been better if we could have done some outpatient intensive training. Mitch was out of town and my in-laws had to fly in to care for my older son, and we had to spend time on the pediatric cancer ward. It made the situation seem much more intense and catastrophic.
Now we only see our endocrinologist at regular appointments. Once a year we have to see a nutritionist, and for pump training or other issues we can either have an NP or call into a hotline where nurses sometimes give advice.
I’m with @cardamom, though; it’s really not worth our time to see an NP, as we typically know a lot more about Samson’s care at this point than the typical NP and the main questions we have are about things like long-term complications or other non-D health conditions that could crop up – and that’s really the purview of the endo.
i stated a bit of this on another thread (can’t remember which one).
my endo and my CDE work in the same office together which is wonderfully convenient. they operate like ying and yang. my endo doesn’t see beyond outside of the box. and its weird b/c he is T1D since college and he wears a pump. my CDE is the wife of a T1D and is totally into experimenting and knowing that all Ds are different and have different needs. she believes me when i tell her that i have to bolus for all proteins. he thinks i am over-bolusing and that i am wrong to bolus for proteins. WTF. i mean, i show him my notes, my A1cs, how much info does this man need to see how well i am managing my D??? if he weren’t so good at micro managing my D, and if i didn’t have her in the office to play my advocate, i would probably change endos. but i have been with him for about 30 years. we have a report that i am use to. i know that we will disagree on many things, but all in all, his attitudes don’t really bother me enough to change. i just love seeing my CDE; she’s the best.
For a contrapunctic point of view: our NP is very experienced and pragmatic, as well as extremely well read in diabetes research. She has been able to respond to all of our difficult questions, when our endo frequently ignores them or answers them in a way that does not reply to our core needs: she sees the question with her eyes, not ours.
I would say find the best practitioner you can find, regardless of credentials, and then realize the limitations. Can an NP be a great diabetes manager, absolutely, but their training has limitations, and when you get to complicated cases with significant comorbidities, a physician’s training will allow them to see the bigger picture better, especially when dealing with pharmaceuticals and the affected pathways.
i have the exact same situation. my endo is living in the 1800s, and he is a T1D on a pump since he was in college.
my CDE is awsome. i couldnt have asked for anyone better. she is all about experimenting and finding out what works for me, not other Ds, just me. she respects all the “crazy” ideas i might share with her, etc. she never tells me “no, dont do that”. she’s more about: try it and see if it works for you.