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Prioritizing Patients a Must for a Busy Practice, Physician


In order to help patients with diabetes who need my services most, I've implemented some pre-screening efforts to help prioritize our patient panel.

A recent article states that patients can wait up to nine months for a new patient appointment with an endocrinologist. This is partly due to the lack of endocrinologists in the United States. In 2010, it was approximated that there were 5,800 board-certified endocrinologists. Many of these are in academics, research, industry, or government positions, and therefore, do not see patients. But even if every endocrinologist in the U.S. saw patients, there still would not be enough to see the estimated 24 million people with diabetes, the 20 million with thyroid disease, and the millions of others with osteoporosis, pituitary disorders, hypogonadism, and other hormonal disorders.

Then you throw in the people who think (or "know") they have an endocrine disorder, because they are tired, or can't lose weight, or have acne, or get bad PMS.

Fortunately, in our office, the wait is not nine months. It is, however, too long to wait if someone has blood sugars in the 400s, or if someone has an endocrine disorder and is pregnant, or if someone has an endocrine cancer. Our schedule is backed up with patients without true endocrine disorders and those who could be managed by their primary-care physician. As such, we recently made the decision to triage patients by requiring a request for consultation from their physician and a copy of any pertinent tests before an appointment is made.

Armed with the appropriate information, we can decide who needs to be seen first, who can wait, and for whom can we provide a curbside with their PCP. For people who are not urgent, we can also recommend that certain tests be done before their appointment, then we will have the information we need to make clinical decisions. There are numerous times patients come and we do not have the results of tests that have been done. We spend a lot of time trying to track them down and sometimes cannot do so while the patient is here either because their doctor's office or the imaging center is closed or because the patient doesn't remember what tests were done and where. Without information, we can't make an accurate assessment, and without an assessment, we can't make clinical decisions.

I ran the idea past a couple of referring physicians. They thought it made sense and they are hoping that it results in getting patients in faster. Not everyone is happy, though; especially the patients who are self-referring. But it is our sincere hope that by weeding out the patients who don't really need us, we can get those who do an appointment in a timelier manner.

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