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1.
Fertil Steril ; 117(2): 421-430, 2022 02.
Article in English | MEDLINE | ID: mdl-34980431

ABSTRACT

OBJECTIVE: To identify changes in current practice patterns, salaries, and satisfaction by gender and by years in practice among board-certified reproductive endocrinology and infertility (REI) subspecialists in the United States. DESIGN: Cross-sectional web-based survey including 37 questions conducted by the Society for Reproductive Endocrinology and Infertility. SETTING: Not applicable. PATIENT(S): None. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): The primary outcome measures were total compensation and practice patterns compared by gender and the type of practice. The secondary outcomes included demographics, the number of in vitro fertilization cycles, surgeries performed, and the morale of survey respondents. RESULT(S): There were 370 respondents (48.4% women and 51.4% men). Compared with a similar survey conducted 6 years earlier, a 27% increase in the number of female respondents was observed in this survey. There was a marginally significant trend toward lower compensation for female than male REI subspecialists (17% lower, $472,807 vs. $571,969). The gap was seen for responders with ≥10 years' experience, which is also when there was the largest gap between private and academic practice (mean $820,997 vs, $391,600). Most (77%) felt positively about the current state of the reproductive endocrinology field, and >90% would choose the subspecialty again. CONCLUSION(S): There has been a substantial increase in the number of recent female REI subspecialists showing less disparity in compensation, and the gap appears to be closing. There is an increasing gap in compensation between private and academic practices with ≥5 years of experience. Reproductive endocrinology and infertility remains a high morale specialty.


Subject(s)
Endocrinologists/trends , Endocrinology/trends , Gender Equity/trends , Infertility/therapy , Physicians, Women/trends , Practice Patterns, Physicians'/trends , Reproductive Medicine/trends , Sexism/trends , Adult , Aged , Aged, 80 and over , Career Choice , Cross-Sectional Studies , Endocrinologists/economics , Endocrinology/economics , Female , Gender Equity/economics , Humans , Infertility/diagnosis , Infertility/physiopathology , Job Satisfaction , Male , Middle Aged , Physicians, Women/economics , Practice Patterns, Physicians'/economics , Reproductive Medicine/economics , Salaries and Fringe Benefits/trends , Sexism/economics , Specialization/trends , Surveys and Questionnaires , United States , Women, Working
2.
Thyroid ; 32(1): 9-13, 2022 01.
Article in English | MEDLINE | ID: mdl-34806424

ABSTRACT

Background: The 2021 Year in Thyroidology-Recent Developments and Future Challenges: Clinical Science Review featured key clinical research within five categories: Thyroid Nodules and Cancer, Thyroid Function and Thyroid Eye Disease, Thyroid and Pregnancy, Thyroid and Pediatrics, and Disparities in Thyroid. Methods: A literature search of PubMed from November 2019 to August 2021 was performed to identify relevant peer-reviewed articles published in English and with a focus on human subjects. Results: There were three nominees for each of the five categories and one featured article per category. The featured articles had the most potential to change clinical practice, focused on a novel topic, and/or included of strong methodology. Conclusions: There were many strong publications on thyroid between November 2019 and August 2021; the 15 nominees and 5 featured articles span a breadth of topics and methodological approaches. The featured articles all have potential to change practice patterns or to stimulate further research that will ultimately change practice patterns.


Subject(s)
Forecasting/methods , Thyroid Neoplasms/therapy , Thyroid Nodule/therapy , Endocrinologists/trends , Humans , Thyroid Neoplasms/diagnosis , Thyroid Nodule/diagnosis
3.
Eur J Endocrinol ; 185(2): C1-C7, 2021 Jul 05.
Article in English | MEDLINE | ID: mdl-34132200

ABSTRACT

Changes that COVID-19 induced in endocrine daily practice as well as the role of endocrine and metabolic comorbidities in COVID-19 outcomes were among the striking features of this last year. The aim of this statement is to illustrate the major characteristics of the response of European endocrinologists to the pandemic including the disclosure of the endocrine phenotype of COVID-19 with diabetes, obesity and hypovitaminosis D playing a key role in this clinical setting with its huge implication for the prevention and management of the disease. The role of the European Society of Endocrinology (ESE) as a reference point of the endocrine community during the pandemic will also be highlighted, including the refocusing of its educational and advocacy activities.


Subject(s)
COVID-19/epidemiology , COVID-19/therapy , Endocrinologists/organization & administration , Endocrinology/organization & administration , COVID-19/complications , COVID-19/prevention & control , Community Networks/organization & administration , Community Networks/trends , Delivery of Health Care/history , Delivery of Health Care/organization & administration , Delivery of Health Care/trends , Endocrine System Diseases/diagnosis , Endocrine System Diseases/epidemiology , Endocrine System Diseases/etiology , Endocrine System Diseases/therapy , Endocrinologists/history , Endocrinologists/trends , Endocrinology/history , Endocrinology/trends , Europe/epidemiology , History, 21st Century , Humans , Pandemics , Phenotype , Physician's Role , Practice Patterns, Physicians'/history , Practice Patterns, Physicians'/organization & administration , Practice Patterns, Physicians'/trends , Societies, Medical/history , Societies, Medical/organization & administration , Societies, Medical/trends , Telemedicine/history , Telemedicine/organization & administration , Telemedicine/trends
7.
Endocrinol Metab (Seoul) ; 35(2): 197-205, 2020 06.
Article in English | MEDLINE | ID: mdl-32372573

ABSTRACT

The world is entering an era of disaster and chaos due to coronavirus disease 2019 (COVID-19), which is caused by severe acute respiratory syndrome coronavirus 2. Since its first emergence in December 2019 in Wuhan, China, COVID-19 has swept through Asia and propagated throughout the world to Europe and North America. As of April 13, 1,773,084 people were infected and 111,652 people had died from COVID-19 globally, and new record levels of infection are being reported every day. Based on the data that have been amassed so far, the primary risk factors for a severe disease course or even mortality from COVID-19 are underlying diseases such as diabetes and hypertension. As the global prevalence of diabetes continues to increase, patients with endocrine diseases such as diabetes mellitus and those who are on long-term corticosteroid therapy due to adrenal insufficiency or hypopituitarism are at risk for a poor prognosis of COVID-19. As endocrinologists, we would like to briefly review the current knowledge about the relationship between COVID-19 and endocrine diseases and to discuss what we can do for the safety and health of our patients with endocrine diseases in this globally threatening situation.


Subject(s)
Betacoronavirus , Coronavirus Infections/epidemiology , Coronavirus Infections/metabolism , Endocrine System Diseases/epidemiology , Endocrine System Diseases/metabolism , Endocrinologists/trends , Pneumonia, Viral/epidemiology , Pneumonia, Viral/metabolism , COVID-19 , Coronavirus Infections/diagnosis , Diabetes Mellitus/diagnosis , Diabetes Mellitus/epidemiology , Diabetes Mellitus/metabolism , Endocrine System Diseases/diagnosis , Humans , Hypertension/diagnosis , Hypertension/epidemiology , Hypertension/metabolism , Pandemics , Pneumonia, Viral/diagnosis , Risk Factors , SARS-CoV-2
8.
Ann Pharmacother ; 54(9): 858-865, 2020 09.
Article in English | MEDLINE | ID: mdl-32100551

ABSTRACT

Background: Previous studies show patients with type 2 diabetes (T2D) and a mental health (MH) disorder exhibit poorer glycemic control compared with those without. Objective: Compare mean change in glycosylated hemoglobin (A1C) after 6 months in the Diabetes Intense Medical Management (DIMM) "Tune Up" Clinic in patients with and without MH disorders. Methods: Retrospective cohort study in T2D patients, with A1C at baseline and 6 months, divided into subgroups of those with ≥1 MH diagnoses and without MH. Primary outcome was mean change in A1C from baseline to 6 months. Secondary outcomes were mean change in other metabolic parameters and proportion achieving A1C and related goals. Results: Of 155 patients meeting inclusion criteria, 66 (42.6%) had at least 1 MH disorder (MH group) and 89 (57.4%) did not (non-MH group). Mean A1C, fasting blood glucose (FBG), and triglycerides (TG) change (improvement) did not differ significantly between MH and non-MH groups at 6 months (eg, A1C reduction: -2.1% [SD = 2.0] vs -2.3% [SD = 2.1]; P = 0.61, respectively). Percentage at A1C goal did not differ significantly between groups, though a higher percentage of the non-MH group achieved FBG and TG goals than the MH group. Conclusion and Relevance: In 6 months, both groups in the DIMM clinic achieved a statistically significant mean A1C reduction (over 2%) with no statistical or clinical difference in the magnitude of change between groups. Patients with T2D benefitted from the DIMM model and personalized visits with a pharmacist regardless of having a MH disorder.


Subject(s)
Diabetes Mellitus, Type 2/blood , Disease Management , Endocrinologists/organization & administration , Glycated Hemoglobin/analysis , Mental Disorders/blood , Pharmacists/organization & administration , Adult , Aged , Ambulatory Care Facilities/organization & administration , Ambulatory Care Facilities/trends , Blood Glucose/analysis , California , Diabetes Mellitus, Type 2/complications , Diabetes Mellitus, Type 2/drug therapy , Endocrinologists/trends , Female , Humans , Hyperglycemia/prevention & control , Hypoglycemic Agents/administration & dosage , Hypoglycemic Agents/therapeutic use , Male , Mental Disorders/complications , Mental Disorders/drug therapy , Middle Aged , Models, Organizational , Pharmacists/trends , Retrospective Studies , Veterans
9.
Diabetes Care ; 42(6): 1136-1146, 2019 06.
Article in English | MEDLINE | ID: mdl-31666233

ABSTRACT

Technological progress in the past half century has greatly increased our ability to collect, store, and transmit vast quantities of information, giving rise to the term "big data." This term refers to very large data sets that can be analyzed to identify patterns, trends, and associations. In medicine-including diabetes care and research-big data come from three main sources: electronic medical records (EMRs), surveys and registries, and randomized controlled trials (RCTs). These systems have evolved in different ways, each with strengths and limitations. EMRs continuously accumulate information about patients and make it readily accessible but are limited by missing data or data that are not quality assured. Because EMRs vary in structure and management, comparisons of data between health systems may be difficult. Registries and surveys provide data that are consistently collected and representative of broad populations but are limited in scope and may be updated only intermittently. RCT databases excel in the specificity, completeness, and accuracy of their data, but rarely include a fully representative sample of the general population. Also, they are costly to build and seldom maintained after a trial's end. To consider these issues, and the challenges and opportunities they present, the editors of Diabetes Care convened a group of experts in management of diabetes-related data on 21 June 2018, in conjunction with the American Diabetes Association's 78th Scientific Sessions in Orlando, FL. This article summarizes the discussion and conclusions of that forum, offering a vision of benefits that might be realized from prospectively designed and unified data-management systems to support the collective needs of clinical, surveillance, and research activities related to diabetes.


Subject(s)
Big Data , Biomedical Research/methods , Diabetes Mellitus/therapy , Electronic Health Records/organization & administration , Health Information Management , Delivery of Health Care/organization & administration , Delivery of Health Care/standards , Diabetes Mellitus/etiology , Electronic Health Records/standards , Endocrinologists/organization & administration , Endocrinologists/standards , Endocrinologists/trends , Expert Testimony , Health Information Management/methods , Health Information Management/organization & administration , Health Information Management/standards , Humans
10.
Fertil Steril ; 112(2): 197-202, 2019 08.
Article in English | MEDLINE | ID: mdl-31352958

ABSTRACT

A crisis is occurring in that reproductive endocrinologists are not doing the surgeries that are a part of their discipline. We list those procedures as a blueprint for training reproductive endocrinologists.


Subject(s)
Endocrinology/trends , Fertilization in Vitro/trends , Infertility/surgery , Reproductive Techniques, Assisted/trends , Education, Medical, Continuing/trends , Endocrinologists/education , Endocrinologists/trends , Endocrinology/education , Endocrinology/methods , Female , Fertilization in Vitro/methods , Gynecologic Surgical Procedures/methods , Gynecologic Surgical Procedures/trends , Humans
11.
Ann Pharmacother ; 52(11): 1091-1097, 2018 11.
Article in English | MEDLINE | ID: mdl-29775079

ABSTRACT

BACKGROUND: Gaining glycemic control in patients with type 2 diabetes (T2D) usually requires more complicated medication regimens. Increased medication regimen complexity (MRC) negatively impacts adherence and clinical outcomes. OBJECTIVE: Compare MRC change in patients with uncontrolled T2D referred to a collaborative pharmacist-endocrinologist Diabetes Intense Medical Management (DIMM) clinic "tune up" model versus similar patients receiving usual primary care provider (PCP) care over 6 months. METHODS: Retrospective, observational, comparative cohort study compared MRC of complex DIMM clinic patients to a similar group (adults with T2D, glycosylated hemoglobin [A1C] ≥8%), continuing to receive usual care from their PCPs. The MRC Index (MRCI) was used to quantify MRC. RESULTS: Both DIMM (n=99) and PCP (n=56) groups were similar, with high baseline mean MRC scores as measured by number of medications and MRCI (12.0 [SD=5.7] vs 13.7 [SD = 5.6], and 32.7 [SD=17.0] vs 38 [SD=16.5]), respectively. Mean MRC change over 6 months was not significantly different between groups, although mean A1C reduction was significantly greater in the DIMM versus PCP group (-2.4% [SD=2.1] vs -0.8% [SD=1.7], P<0.001, respectively). CONCLUSIONS AND RELEVANCE: Outcomes represent the first report demonstrating how treating patients with an innovative DIMM model can help complex T2D patients achieve glycemic control without increasing the MRC to more than a comparator group. With the growing prevalence of T2D and associated elevated treatment costs, identifying effective means for achieving glycemic control without increasing complexity is needed. Application of this model may be considered by other health systems to aid in achieving outcome measures.


Subject(s)
Blood Glucose/drug effects , Diabetes Mellitus, Type 2/drug therapy , Endocrinologists/standards , Hypoglycemic Agents/therapeutic use , Medication Therapy Management/standards , Pharmacists/standards , Adult , Aged , Ambulatory Care Facilities/standards , Ambulatory Care Facilities/trends , Blood Glucose/metabolism , Cohort Studies , Diabetes Mellitus, Type 2/blood , Diabetes Mellitus, Type 2/diagnosis , Endocrinologists/trends , Female , Glycated Hemoglobin/analysis , Glycated Hemoglobin/metabolism , Glycemic Index/drug effects , Glycemic Index/physiology , Humans , Hypoglycemic Agents/pharmacology , Male , Medication Therapy Management/trends , Middle Aged , Pharmacists/trends , Professional Role , Retrospective Studies
12.
Ann Endocrinol (Paris) ; 78 Suppl 1: S1-S10, 2017 Oct.
Article in French | MEDLINE | ID: mdl-29157484

ABSTRACT

Parathormone (PTH), produced by parathyroid glands, is the main regulator of calcium homeostasis. Hypoparathyroidism (hypoPT), due to decrease of PTH production, is a rare disease. Symptoms are multiple, altering function of several organs and leading to a decrease of quality of life. Acquired etiologies, including thyroïdectomy, the main cause of hypoPT, can be distinguished from congenital etiologies, including genetic defects. HypoPT, which is classically treated by supplementation by calcium and active vitamin D, can now be treated by recombinant injection in certain indications as a poor control under classical therapy. Here are summarized current knowledge on etiologies, epidemiology, clinical manifestations and management of hypoPT.


Subject(s)
Hypoparathyroidism , Calcium/metabolism , Diagnosis, Differential , Diagnostic Techniques, Endocrine , Endocrinologists/trends , Genetic Diseases, Inborn/diagnosis , Genetic Diseases, Inborn/epidemiology , Genetic Diseases, Inborn/therapy , Humans , Hypoparathyroidism/diagnosis , Hypoparathyroidism/epidemiology , Hypoparathyroidism/etiology , Hypoparathyroidism/therapy , Practice Patterns, Physicians'/trends , Receptors, Calcium-Sensing/genetics , Receptors, Calcium-Sensing/metabolism
13.
Fertil Steril ; 105(5): 1281-1286, 2016 05.
Article in English | MEDLINE | ID: mdl-26774576

ABSTRACT

OBJECTIVE: To identify the current and future state of the practice of reproductive medicine. DESIGN: Cross-sectional survey. SETTING: Not applicable. PATIENT(S): None. INTERVENTION(S): Not applicable. MAIN OUTCOME MEASURE(S): The survey included 57 questions designed to assess practice patterns/metrics and professional satisfaction and morale. RESULT(S): A total of 336/1,100 (31%) responded, and they were 38% women, 61% men, and 76% Caucasian, with a mean age of 54. Respondents averaged 2.3 jobs and averaged 53 hours of work per week: 44% work in academia and 50% in private groups. Average practice size was 5.5, with an average of 470 fresh IVF cycles performed per year. Percent effort included 63% infertility, 10% endocrinology, 10% surgery, and 9% research. Respondents performed an average of 13 major surgeries, 69 minor surgeries, and 128 oocyte retrievals per year. A total of 60% were salaried, and 40% were equity partners. Compensation was highly skewed. Greater than 84% had a positive morale and had a positive view of the future, and 92% would again choose REI as a career. The most satisfying areas of employment were patient interactions, intellectual stimulation, interactions with colleagues, and work schedule. The least satisfying areas were work schedule and financial compensation. Training was felt to be too focused on female factor infertility and basic research with insufficient training on embryology, genetics, male factor infertility, and clinical research. In the next 5 years, 57% suggested that the need for specialists would stay the same, while 20% predicted a decrease. A total of 58% felt we are training the correct number of fellows (37% felt we are training a surplus). Compared with academia, those in private practice reported higher compensation, less major surgery, more IVF, less endocrinology, and less research. Men worked more hours, conducted more surgery and IVF cycles, and had higher compensation than women. Morale was similar across age, gender, practice type, and geography. CONCLUSION(S): Our subspecialty has an extremely high morale. We are a middle-aged subspecialty with disparate compensation and a focused practice. Some respondents sense a need for a change in our training, and most anticipate only mild growth in our field.


Subject(s)
Endocrinologists/psychology , Endocrinology , Infertility/therapy , Personal Satisfaction , Practice Patterns, Physicians' , Societies, Medical , Adult , Aged , Aged, 80 and over , Cross-Sectional Studies , Endocrinologists/trends , Endocrinology/trends , Female , Health Workforce/trends , Humans , Infertility/epidemiology , Male , Middle Aged , Practice Patterns, Physicians'/trends , Societies, Medical/trends
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