Limited exposure to the specialty, low pay and uneven distribution of doctors are widening a workforce gap affecting children with diabetes and other hormone disorders.
Pediatric endocrinology in the United States is facing a workforce squeeze that experts say is already affecting access to care for children with diabetes and other hormone disorders. Speaking at the Breakthrough T1D Clinical and Research Congress in Philadelphia, Tandy Aye, a paediatric endocrinologist at Stanford Medicine Children’s Health, said the shortage is being driven by a mixture of limited early exposure to the specialty, weak financial incentives and an uneven distribution of clinicians.
Aye said one of the central problems is that many trainees never encounter paediatric endocrinology in a meaningful way during medical school or residency. A survey of graduating residents conducted by the American Academy of Pediatrics found that interest in a disease area or organ system was the leading reason doctors chose a subspecialty. When students and residents do spend time in the field, Aye told Healio, they often respond positively to the close mentorship and the long-term relationships built with patients.
The staffing problem is not just about interest. Healio reported that data from the National Resident Matching Program showed that between 2015 and 2025, 8% to 20% of paediatric endocrinology fellowships went unfilled each year. Compensation is also a major deterrent: Doximity’s 2023 physician compensation report put average annual pay for paediatric endocrinologists at $218,266, below the $276,548 average for adult endocrinologists. In a 2021 survey published in Endocrine Practice, 84% of 550 Pediatric Endocrine Society members said salary was the least appealing part of the job.
The clinical impact is substantial. Aye said there are about 300,000 children with type 1 diabetes in the US, served by only 1,800 to 2,000 paediatric endocrinologists, which works out to roughly 150 children per specialist. Separate research published by the American Academy of Pediatrics found that just 3.8% of paediatric endocrinologists work in rural areas, while more than 20% spend less than half of their time on direct patient care, suggesting that headcounts can overstate the true clinical capacity. Other recent reviews and studies have pointed to the same pressures: low pay relative to training length, heavy workloads, debt and burnout.
Aye argued that the response needs to start earlier and be more deliberate. She said clinicians can help by mentoring medical students, letting them shadow in clinics, involve themselves in research or see diabetes camps and other parts of the specialty in action. She also pointed to the need for better payment models that recognise the time spent adjusting technology, changing doses and managing newer treatments. Recent research has likewise suggested value-based remuneration, streamlined training and improved referral systems as possible ways to ease the bottleneck.
Disclaimer: This content is for informational purposes only and is not intended to be a substitute for professional medical judgment, advice, diagnosis, or treatment.
