PWDs: should we use endocrinologists or family practitioners?

Why not just manage with a family practitioner?

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Our boy’s family practitioner would probably be OK for the scrips, but they aren’t that knowledgeable about diabetes. We feel more comfortable seeing an endo.

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Feel free to split into a new thread

I’ve been contemplating the wisdom of this more and more in my own life lately. Certainly an endo is more likely to have a more in depth understanding of the disease process of diabetes than a family doctor. Does that mean they’ll provide higher quality care to a person with diabetes than a family doctor or pediatrician/ internist? In my observation it’s pretty debatable. I also think it varies throughout the country a lot… eg in rural areas primary care doctors tend to take on more responsibility because the specialty resources aren’t as available, and primary care becomes expected to, and generally more proficient at stepping up to the plate.

I also see online a general consensus that many endocrinologists are idiots and provide no additional value, and sometimes severely behind the times… so the universal wisdom In the doc that uncomplicated diabetes treatment should be managed by an endocrinologist is questionable to me. Basically I need a doctor who will fill scripts, recognize any long term complications and refer me to someone else if they require a specialized intervention… I think I’d trust a good primary care doctor to that just as well as an endo… (key word “good” one)

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While I don’t disagree with your reasoning, we are apparently lucky in that we have a great Primary for my boys, and now that we are back on a PPO, access to a great supportive endo group (endo plus diabetes educator).

We had our first endo appointment in 1.5 years, since Kaiser uses a GP model for treating pediatric diabetes patients, and it was great. They took 1.5 hours with us to ensure our education was up to snuff, tested my son’s knowledge, spent 30 minutes ensuring our prescriptions were correct and met our current needs. They supported us in going un-tethered for baseball season, educated my son on drugs and alcohol, and the endo gave us some strategies she wants us to try to deal with the night-time hormone highs, including spending time helping us realize there were three hormones being released at night and asking us to log some things to try and determine if there are predictable differences that we can exploit.

This is in comparison to our other visits for the last 1.5 years where they said we were doing great, and to keep at it then lost us to follow-up because they wanted to push us to 3 visits a year, but their system only let you make appointments 3 months into the future…

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That sounds like a case of the pediatric endo really is adding a lot of value and I would totally understand why you’d not want it any other way.

It will be interesting to see if you and your son feel that added value ratio remains consistent as he grows into adulthood…

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I suspect that in adulthood my son will be similar to you, but you never do know. I think that there are great consultative doctors out there in most urban areas, I agree that it is a bit hit or miss in rural areas. But if you don’t have a great endo, than a GP is probably easier to deal with since they won’t try to criticize your treatment approaches.

Once these hormone highs settle down, I am not sure what additional help he will need, he is pretty independent as it is now.

The endo, even had to remind him that he should at least try to program his pump to what is currently working, in case a mere mortal such as myself or my wife have to treat him when he is sick. currently, he just free-hands all of his calculations. Very successfully, I might add, his A1c dropped 0.5 from his last check about 8 months ago.

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My guess is that this is also different with pediatricians versus family practice docs that see adults too. Our pediatrician’s office probably has about 5 patients total with T1D. I’m guessing a family practice doctor that sees adults has at least a few dozen patients with T2, so while they may have the wrong knowledge, they at least have some experience with treating the disease.

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I also think endos know about what other testing to schedule and when. For instance, when should Samson be seen by an eye doctor, a kidney specialist, how often should he be tested for other antibodies, his cholesterol, etc. This is also auto-programmed into our endo practice’s system, meaning that we don’t have to think too much about it. A family doc can certainly learn those things but they’re unlikely to proactively order those tests for you on the exact right timetable.

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I suspect your numbers are significantly off. My mom is a pediatrician and has had hundreds (out of tens out thousands) of type 1 patients. Her clinic manages about 50,000 pediatric patients… actually I suspect it’s a whole lot higher than that now since they opened a second office in Vancouver

Typical family doc in the small town where I live probably has several thousand patients, probably a significant percentage of the adults have type 2… maybe 1/5 if I had to guess… and until very recently the family docs did all of the management for t1 both pediatric and adult…

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huh, that’s crazy. Our practice is pretty small – there are four doctors who all work part-time. I don’t think they have tens of thousands of patients. There are only 100,000 kids in San Francisco and there are dozens and dozens of pediatricians, at least according to my insurance list of providers!

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My moms practice has 13 full time pediatricians and 2 full time pediatric NPs… and I think that’s just at their
original location although I’ve been too far from home for too long to really understand how their second location works, for a long time people on Medicaid from all over SW Washington and some parts of NW Oregon were bringing their kids to them because they were one of the only ones who accepted Medicaid… and there’s a lot of Medicaid patients in sw Washington…

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And in Oregon. We expanded Medicaid so 25% of our state is on Medicaid. I understand they have considerable issues finding enough providers.

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Most of them refuse to see Medicaid patients because the reimbursement rates combined with the hassle just don’t make it worthwhile. It’s almost like they’re doing a charitable service instead of running a business

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The core question that @Sam asked is really intriguing to me. When is an endocrinologist more valuable?

I know our relationship with endos is fraught with trouble.

I guess I think rather more in terms is when is a physician valuable to me.

  1. They allow a trust relationship to be developed
  2. They listen to me and value my observations as a patient after #1 is completed
  3. They stay current and take a consultative approach, explaining all the options and include me in the decision making process
  4. They are willing to stray off-label if a good case can be made
  5. They treat me as an individual, and give me access to their knowledge within my ability to understand.

We have both a GP and an endo team that adhere to all these values. I wouldn’t trade in either of them, but if I had to choose, I would choose the GP just because she can treat everything, whereas the endo is obviously going to stay in their specialty lane.

I have read all of the people whose physicians aren’t able or won’t work like above, and of course I have personally seen physicians that don’t. I don’t mill through them, but I don’t find reasons to stay with them either. When I find a good physician I will move heaven and earth to stay with them.

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I don’t even have a gp. My last two gp’s almost succeeded in killing me.(I won’t bore you with the details, but they really almost did kill me)

I look for the best endocrinologist I can find in the city I’m in. Invariably when the endo sees that I’m very much on top of my various conditions they start to treat me almost as a colleague, and talk to me like they would speak to another doctor. (Even though @Sam knows I’m just a smarmy dentist😉).

I’ve had very good luck with the endo’s I’ve seen in the past twenty years.

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I have an utterly fantastic endo and an okay GP. I think maybe in “simple” well-controlled diabetes where the patient is mostly independent in their care, a GP may be fine, but there are a lot of situations (perhaps most, when it comes to Type 1) that aren’t that simple with diabetes…

My GP limits appointments to 10-15 minutes and it’s very difficult to discuss anything in-depth. He’s okay at coordinating care, for example he keeps up-to-date on all my blood work, specialist reports, referrals, and so on. But he’s not that great at actually treating issues beyond the most simple things, such as an infection that needs antibiotics and goes away. My GP goes very much by the published guidelines and is not willing to budge from them, and gets defensive if any questions are raised (which is why he’s okay and not great).

Meanwhile, my endo appointments are typically an hour long. Since I have two autoimmune endocrine diseases, we discuss both of those, but even when I just had diabetes the appointments were still a good 45 minutes each. My endo is up-to-date on all the latest diabetes technology and research and is willing to think outside the box in regards to treating issues.

Maybe this is just the difference between an okay doctor and a great doctor, and I’d have just as much success if I had a great GP. My previous endo was certainly nowhere near as good as my present one. But I feel that, for me at least, it’s helpful to have someone look over my glucose records, and especially because I have multiple endocrine diseases, it’s in my best interest to continue seeing an endo.

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I would believe this. EH has had both excellent GPs and lackluster GPs. He’s also had awful specialists, one of whom totally blew it on melanoma removal. So it can go either way I think.

Last week I had an urgent care PA look my T2 mom in the eye and tell her she’d be fine if she kept her BG under 300. I objected. That’s not a good choice.

I guess I feel like the benefit of an endocrinologist is that they theoretically understand how to go to bat for us when it comes to medically necessary diabetic stuff with our insurance. Better than our GP experiences have been. Jen’s point about the GP rushing people out the door has been our experience also. And generally the specialists office personnel are a little better at their job.

It really seems like an apples and oranges comparison to me. If I had I need to get my tooth worked on, I would go to a dentist, if I had broken my arm, I would go to somebody who specializes in that. I know that most people here have a sort of fraught experience now and again with their endocrinologist, but I suppose I tend to hope they know better or at least might have more insights. And if they really suck, find a new one.

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This has been the opposite of my experience… my gp would put far more effort into going to bat for me than my endo would.

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I feel like there is a reason Endocronologists specialize in that field. They have a more in-depth knowledge of the disease, the treatments, new research, etc since that is their sole focus. I would never expect a FP to keep up on all the changes in the world of diabetes no more than I would expect the GP to know how to treat cancer or any other disease. There are good reasons for the specializations within the medical profession (or any other profession for that matter). Would I trust my FP to administer my anesthesia? Or provide me with a treatment plan, up to date knowledge or guidance on any number of diseases? Probably not…I’d go see a specialist.

There is no way one can expect their FP to be up on all the latest and greatest for every disease in the world.

In addition to understanding general medical treatment of the human body and primary care that all physicians learn, endocrinologists complete additional training in treating the hormone system of the body, including ductless glands of internal secretion (thyroid, adrenal, pituitary, pancreas), and glands in reproductive organs of men and women. They gain specialized knowledge on how to diagnose, treat or manage diabetes, how to deal with irregular metabolisms, growth disorders in children with Diabetes, weight issues, hypo- and hyperthyroidism, hypo and hyperglycemia, and more.

There is just so much an Endo knows about that a regular FP wouldn’t have any clue about (unless they were diabetic themselves, or have a loved one with it.) There just isn’t enough time in a day to learn everything about every disease, or the disease that PWDs live with, and need to know about.

It’s easy to take for granted the knowledge an Endo may or may not have when you don’t need any of their knowledge after living with it for so long, but anyone new to Diabetes would be a fool, imho, to treat their diabetes based on their FP’s guidance alone.

Just my 2c.

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