The value of the clinical endocrinologist in the new millennium

In all aspects of today's society, specialization has been associated with increased productivity and enhanced outcomes. In the fields of science, technology, manufacturing, and production, specialization has resulted in improved efficiency accompanied by lower costs. It is ironic that in the field of medicine, as technological and medical advances are occurring so rapidly, the trend away from specialists and back toward generalist care is viewed as progressive and cost effective. As health care delivery changes in the United States, it will be critically important for patients, health plans, and purchasers of health care to recognize the value of endocrinologists. Endocrinologists are specialist physicians who are trained to prevent complications. Care by endocrinologists has resulted in significantly lower costs with improved outcomes, including lower morbidity and mortality rates, reduced hospital length of stay, fewer medical procedures, reduced hospital read mission, and more cost efficient and time saving medical evaluations (Tables I and 2). Similar findings have also been demonstrated when specialists care for patients with congestive heart failure, myocardial infarction, and asthma [1-8]. The cognitive talents and skills of special ists, which can prevent costly procedures, such as bypass surgery and amputations, must become as valued by our health care system as the technical skills of our medical colleagues, who are trained to perform surgical procedures on patients who were not fortunate enough to see an endocrinologist earlier in the course of their disease.