Romeo Giulio R, Caputo Tiziana, Stanescu Izabela W, Alkhaddo Jamil B
Joslin Diabetes Center, Harvard Medical School, Boston, MA 02215, USA.
Beth Israel Deaconess Medical Center, Department of Medicine, Harvard Medical School, Boston, MA 02215, USA.
J Endocr Soc. 2024 Jul 15;8(9):bvae134. doi: 10.1210/jendso/bvae134. eCollection 2024 Jul 26.
Multiple factors contribute to the widening gap between supply and demand of endocrinology services. In addition to the inadequate growth of the workforce, the inefficient utilization of endocrinologists' expertise coupled with the rising prevalence of endocrine conditions has generated a crisis in access to specialty care. This mismatch is magnified in underserved communities and among certain racial/ethnic groups that carry a disproportionate burden of chronic diseases, like diabetes and osteoporosis, thus perpetuating the cycle of health disparities in vulnerable populations. Reorienting the framework of endocrine care toward more effective and equitable access will require comprehensive changes in operational processes, system-based policies, and in the diversity of our workforce. Specifically, the progressive transition to outcome-driven, team-based models of care can extend endocrinology services beyond the traditional boundaries of in-office referrals and promote job satisfaction. Further, the implementation of policies that directly tackle structural determinants of health is a prerequisite to a more precise and equitable deployment of specialty care. In this view, the recruitment and professional growth of clinicians underrepresented in medicine along the career ladder, including leadership roles, is a key conduit to revitalize our field and to innovate the delivery of endocrine care across all communities.
多种因素导致内分泌科服务供需差距不断扩大。除了专业人员增长不足外，内分泌科医生专业知识利用效率低下，再加上内分泌疾病患病率不断上升，导致专科护理服务获取出现危机。在服务不足的社区以及某些慢性病负担过重的种族/族裔群体中，这种供需不匹配的情况更为严重，如糖尿病和骨质疏松症，从而使弱势群体的健康差距循环持续存在。要使内分泌护理框架转向更有效、更公平的服务获取，就需要在运营流程、基于系统的政策以及我们专业人员的多样性方面进行全面变革。具体而言，逐步转向以结果为导向、基于团队的护理模式，可以将内分泌科服务扩展到传统门诊转诊范围之外，并提高工作满意度。此外，实施直接解决健康结构决定因素的政策，是更精确、公平地部署专科护理的前提条件。从这个角度来看，在医学领域代表性不足的临床医生在职业阶梯上的招聘和职业发展，包括担任领导职务，是振兴我们这个领域并在所有社区创新内分泌护理服务提供方式的关键途径。
