I don’t know if it is health care today or what but I’ve seen 5 Endocrinologists and liked one of them!!! I’ve been either talked down to or basically dismissed and delegated to a nurse practitioner… I am not sure what is up with these practices. Maybe they are overwhelmed with patients??
I saw a new Endo yesterday and while he was ok, he was in and out of there in record time. I’ve noticed some of these people seem distracted, disengaged or in a big hurry. A shame because I’ve seen other specialists and have not experienced this. I wonder what is up with Endocrinology??? I waited 3 months to see this guy and he had glowing reviews online. Oh, and while checking out, the receptionist said that my next appointment may be with an NP. I traveled 1.5 hours for this appointment. It’s so frustrating.
Have others had this experience with finding a good Endo???
I am sorry. Not much help. But when I moved to MA, I had an endo that was a good doctor, just didn’t meet my particular needs. When I started having unconscious insulin reactions (back around 1991), I was hospitalized, and that is where I met my current endo. She sees me twice a year. I talk with her staff when I am having problems. But I do not feel rushed or like a number, whether I am doing well or poorly. I wouldn’t have found her on my own. I wish you “luck” in finding the best doctor.
Thanks Ame, I appreciate your story. Glad you found the right doctor for you!!
I just needed to vent. It’s a very frustrating disease indeed, especially when you do all the lifestyle management that you can do and it still creeps up on you. Then, you take a half a day, drive to a new doc who sort of blows you off… I did have an Endo that I liked but he couldn’t keep me because I had started that practice with another doctor and saw him when she was out on leave. He was the bomb!!! I begged them to keep me but he wouldn’t. I understand him not wanting to poach his partners patients. It’s bad manners and I bet most of them wanted to stay with him. LOL…
I completely understand. It’s a struggle finding a good endo you like. In all my years battling this disease, I’ve probably had about 10 endos. I’ve liked 3. My previous endo used to scold me when my A1c’s came back in the 5’s. He wanted me in the 7’s. It was awful as he didn’t even want to discuss this issue. At that point, I decided it was my goal to find an endo who was also a Type 1. I think a person who lives with the day to day life as a diabetic truly gets it. I did finally find a Type 1 endo, and I like him. He’s not too close distance wise to me, but I only see him twice a year. I’m not a fan of his office manager, which is too bad, but I’m easy and just deal with it.
I think another issue, especially is that diabetes is to a large extent is a DIY disease to deal with. Those of us that take the 3 legs of the diabetic stool seriously (Control over Blood Sugar, Cholesterol, and atherosclerosis) end up knowing our body’s limitations better than any endo could ever know so we form a partnership with our endo and learn what we need to from our endo while training the endo in our wishes and desired outcomes.
In short, some patients rely very heavily on their endo, and when things don’t go well, they get frustrated, blame the endo, and look for another one. Others like myself, don’t really need or want an endo except perhaps on call for a question every few years and prescriptions and medicare requirements. Medicare requires Insulin patients on a pump to visit every 90 days and if on multiple daily injections then every 180 days. I always have referred to my endo as my drug dealer as I am not an MD and therefore can not prescribe all my own medications. For me, I would most likely do quite well with the endo you dislike as the quicker I can get in and out of the office with a prescription renewal, the happier that makes me.
I don’t claim that my approach is good or even appropriate for all, but just want to shed light on the relationship with an endo is not endo good or endo bad, just that the endo relationship has to be a win-win proposition for both the endo and the patient. Sometimes that win-win balance just can not be struck and a change needs to be made.
That was one of the first things I was worried about when I moved. The first endo I had was a jerk. He wanted to put me back on meds that had made me sick and when I asked him if I could be a type 1 because it ran in my family, he said no and never tested me. When I asked about the side effects of a new medication he said in the old days people just took the meds and never asked. I did not go back to him after the second visit. He was supposedly a great endo. My next endo tested me right away even without me asking and I was finally diagnosed right. She was a gem, a type 1 herself, so was her NP. So moving away from her was worrisome after my first experience but my third endo seems really good, I was spoiled by that second endo and virtually need no help now except maybe input from her if I want to try something new. But I mostly just need someone to write the prescriptions.
I realize there is a huge shortage of endos, and that they are swamped. It is always in the back of my mind, that there are too many endo jerks out there. I just hope the endo I have stays put, so I don’t have to try to find another one!
My endo is great and I always take the very first appointment of the day with her because she will give each patient as much time as they feel they need which means by her second appointment she is normally running late for the rest of her day. I always feel guilty as I just want her to check the Medicare boxes she needs to and give me my prescription and bolt from her office so she can spend more time with patients that really need her help. I am really just wasting her valuable time, however, Medicare requires those visits to in their exact words “save money”.
Prior to Medicare I saw my endo twice a year and she would have been fine with once a year. Now with Medicare it is that “every 90 days” and for sure it is a waste of my time and her time. And Medicare’s money.
That being said, I always feel better mentally after endo appointments because she is my biggest cheerleader. And I think she really likes our appointments because I am one of her easiest patients. I am not perfect but I always try hard. I think that she is wonderful and I guess that I am her cheerleader also.
But back to the original poster @jean63, there is a great shortage of endos and they are one of the poorest reimbursed specialties. Hopefully your future visits will be better and anyway–lots of people like their NPs better than the doctors.
Finding a Dr. that you like and fits your needs can be frustrating and time consuming. I’ve had 3 endo’s that I liked in over 30 years of having diabetes. One was a type 1 himself, one was a professor at Stanford that taught all the other Dr.s how to be endo’s and my current endo who I see through telemed. Have you considered seeing an endo through telemed instead of driving all over for appointments?
It is not required because of my diagnosis. An endo visit in the last 90 days is required to get pump supplies and insulin for my pump under Part B DME. People who get their insulin under Part D prescription do not have the 90-day requirement.
People who want to get CGM coverage under Medicare are required to see their medical professional every 180 days. I do not think that is a requirement for insulin under Part D.
I was on Medicare for a few years before going on Dexcom and demonstrated to Medicare that I had been keeping my A1C in the 6.0-6.5% range for over a decade on Insulin and therefore did not need to visit my endo more than once a year as I had been visiting every 12 -18 months for the past few decades. Astonishingly, I actually got a response and it said that I would need to visit my endo within every 180 days. They also said the reason that the 180 day limit visits were required was that it would save Medicare money.
Maybe the rules have changed, maybe it was because I was using 8-10 test strips a day with finger sticks, who knows. My assumption was that Medicare needed a one size fits all policy and that a large majority of Medicare diabetics are out of Medicare acceptable A1C range so we must all abide. This, of course, was just a guess.
For sure I don’t know. The 8-10 test strips could have caused that requirement since they are covered under Medicare Part B.
Part D drug plans are administered by private insurance companies and I don’t see Medicare imposing a medical visit frequency requirement. But of course people need active prescriptions and most doctors require annual visits and maybe visits more often.
I think @Laddie is right, I think if it falls under Part B, requirements hit. Last year I finally called Optum RX and Medicare to make sure I didn’t have to have a visit every 90 days because of my Omnipod. My endo is really busy and she was out for over a month. She canceled days before my appointment so it was impossible to see her in time. I didn’t know if I had to scramble to get into a doctor. Medicare said they had no requirements for the Omnipod and Optum Rx said they had no requirements for any of my scripts at all. With Omnipod your insulin is through part D. I still have to see her every 180 days because of the Dexcom I have.
Of course you have to call and ask Medicare to find out about the requirement to make sure, but even then…you might have to call twice!
I sure did not know this info and I have been on Medicare since 2007. I alternate Endo and NP so I see them each twice a year. Once a year would be fine with them except for Medicare. I am on Part B and see no reason to change at this point. Both endo and NP work with me vs ‘telling’ me. I am curious how things may change after I get on Tandem but time will tell.
But @jean63 if you feel comfortable just saying to the endo that you do best when you can work in a partnership and both of you work out the self management system that you will work in real life for you.
Because the practice I go to is the only one in my region, they do allow dr. changes and after my all time fave retired, the one they assigned me to did not work because he kept thinking I was T2 when T1 was all over my chart. I was able to switch to my present endo and he is fine. Well, there is a smaller endo practice actually but mine does allow doc changes. It makes sense.
My first experience was with a P.A., he was amazing! It has been 31 years,and with training I have done well. I now see a CDE,with aF.N.P as back up. I did see and endo 3 years ago. He said I am doing great. All my appointments have been 60 minutes. I know I am very lucky. Nancy50
Do you have an Advantage plan? Basic Medicare has the 90-day requirement but Advantage plans can set some of their own rules. And many/most probably do not require an every 90-day visit.
Are you on a pump now? Or will Tandem be your first pump? If you have Basic Medicare and use Tandem, you will be required to see one of your medical professionals every 90 days in order to get pump supplies and Part B insulin. The requirements for pump coverage by Medicare are halfway down in this document.
“ Continued coverage of the insulin pump would require that the patient has been seen and evaluated by the treating physician at least every three months.”
If you have an Advantage plan, you are subject to the rules of that plan.
Laddie, if I ever see that Endo again, I will talk to him about feeling brushed off. I mean, he didn’t even comment about the readings from my CGM, just told me my A1c wasn’t too bad… But, he did give me an oral medication and if it works, it might change the course of this disease for me by going off insulin for type 2…
I’d bet a lot of money, I’ll get sent to his NP. I am waiting to see how it all works out. I might be singing his praises in a few months.
