Given the shortage of endocrinologists and the ever-growing number of patients who need them, expanding the healthcare team to include nurse practitioners and physician assistants is certainly necessary in some areas. Under the guidance and direction of an endocrinologist, these team members can provide needed services and help to alleviate some of the access issues. My former practice included two wonderful NPs/CDEs. Patients would alternately see them and their endocrinologist. If the NP had questions, they knew there was a physician to back them up.

Having said that, many states are now allowing independent practice for nurse practitioners. Indeed, there is legislation up for review here in my own state of New Jersey that would grant such. The main argument for it has been to improve access to primary care, especially in areas where there are few physicians. Unfortunately, many of these nurse practitioners are not practicing primary care nor are they opening their practices in areas of need. I certainly don’t mean to suggest that none of them are, but many are opening “specialty” clinics. Medi-spas. Weight-loss clinics. “Hormone clinics.” They tout themselves as “thyroid experts” or “metabolism gurus”. They label themselves as "Dr." and patients don't realize they are not seeing a physician let alone an endocrinologist

AACE believes in elevating the practice of clinical endocrinology by empowering an endocrinologist-led team. I firmly believe that the length and depth of training that endocrinologists undergo followed by the subsequent years of additional education through quality-CME and the hands-on experience of clinical practice are necessary for safe, effective, evidence-based treatment of our patients. Since access to excellent evidence based endocrine care is always the goal, the addition of APPs under the supervision of and collaboration with an endocrinologist would be the safest and most effective way to achieve this goal.

A hybrid care model of endocrinologist collaborating with APPs might improve access to care. AACE can provide the educational materials that would be appropriate for all levels of background and training. However, the endocrinologist's background training, experience, and certification requirements should be the gold standard for determining the standard for endocrinology practice.