Losing my Endo

Gosh Darn-it, my Endo has decided to leave his practice at our area’s largest medical clinic. I am not one that gets sentimental about doctors but I do sorta like this guy. I suspect he is leaving for greener pastures or maybe to return to his home town. I wish him well.

The medical clinic has already said that there will be no replacement Endo for nine months to a year but they are trying to enlist the services of a nurse practitioner to work under close supervision of the remaining Endo at the clinic.

This leaves me with choices to make. Should I hang with the NP until another Endo is recruited or go looking outside of this clinic for a new Endo (the choices are few). Then there is a third option of just working with my internist for a while until things work themselves out. Option 3 sounds appealing but my pump warranty is about to expire and my internist is not willing to prescribe a new one.

Choices, choices, choices. I hate these kind of choices.

My doc retired a couple years ago. She is missed very much, but I was able to find a highly able ARNP who is amazing. She knows my record, she respects my choices, and she is able to prescribe whatever I need and does. Also, if there is a trouble where she is not able to treat or whatever, she has an incredible resource list to refer for such.

The NP seems like the logical choice IMO… at least as a good place to start. With that option you’re getting the expertise of two professionals, the NP and the endo she works with, continuity of care at the same clinic, and presumably they’ll be willing to continue on with the same plan of care that you’ve been on…

Plus you may find more flexibility in appointment scheduling etc with the NP than with another MD… in my experience anyway.

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I agree with @Sam19. The nurse practitioner choice seems likely to provide continuity of care and a realistic bridge to a more permanent situation.

[quote=“Terry4, post:4, topic:57210, full:true”]ARNP?
Yes, Advanced Registered Nurse Practitioner. Or in my personal experience you could replace Advanced with Amazing.

Has this ARNP credential been around for very long? I’ve been aware of the Nurse Practitioner (NP) credential for many years but was unaware of this “advanced” terminology.

They call them by different acronyms based on both field and state by state (as they, like doctors are state-licensed.). Here in Alaska they’re APRN (advanced practice registered nurse) by state license but within that you’ll see them listed as FNP (family nurse practitioner) PNP (pediatric nurse practitioner) CNM (certified nurse midwife), PMHNP (psychiatric mental health nurse practitioner) and maybe a few others but those are the main ones-- those are nationwide categorization s based on their schooling but the different states call them different things such as aprn and also their authority and scope of practice varies state by state

The latest push is for them to complete a DNP ‘doctorate’ degree (doctorate of nursing practice) they’ve been threatinging to make that a requirement for years but it hasn’t really taken hold yet. My wife is working toward her DNP now… so you may also see them called DNP instead of aprn, fnp, etc… then there’s a whole menagerie of specialties they can pursue as well. So if your “doctor” is a DNP-- they’re actually a nurse practitioner… though it’s kinda tacky for a DNP to call themselves “doctor” it does happen regularly

IMO I’d take a nurse practitioner with decades of experience in their field over a md that just fell off he turnip truck any day…


I think you are in a bit of a quandry here. If your pump warranty is expiring and you really need feel concerned that you need someone to prescribe the pump you may have little choice. My understanding is the vast majority of GPs actually don’t prescribe pumps. They are not in general competent to oversee pump regimes and are not prepared for all the hassle of medical necessity letters and working the system. You could probably get you NP to continue your supplies prescriptions and probably convince your internist to continue your supplies prescriptions.

So the decision is really about your tolerance for risk. If you pump bites the big one and you really, really want to stay on pump therapy while things work through over the next year, then you likely need to seek another endo. And even they may require you to see them for a while before agreeing to renewing your pump prescription.

I would probably buy time and go with the ARNP. I think that it is very likely that she will be able to work with you on purchasing a new pump although possibly the remaining endo’s name will need to be on the prescription. At my endo clinic, you work with one of the nurses if you need help selecting a pump and then the endo just rubber-stamps the decision.

I assume that you should be able to ask whether the ARNP will be able to facilitate your next pump purchase.

Good luck! I’ve lost a couple of doctors recently due to retiring or moving, but I live in a large metro area and it’s relatively easy to find a new doctor.

The nurse practitioner does seem like a good choice, at least he or she will be part of the office I now see. If this NP is anything near as good as the NP at my internist office I will be in good hands. I like NPs they tend to have more time for their patients. Like Brain mentioned my internist does not deal with pumps and I’m not sure I want to see my only other choice, I saw this Endo once in the past and did not feel he was a good match for me.

The aggravating part of this whole thing is that my pump warranty expires in late December and my current Endo leaves on Dec 31. I doubt he will be willing to write a pump prescription at that late stage. His timing is lousy, he is leaving 3 days before what would have been my next appointment on January 3rd.

At this point nothing seems set in stone, even the nurse practitioner is not yet a reality. I hope it happens but there is no guarantee.

I suspect that someone will renew his prescriptions whenever your pump supplier sends in the request… it’s just a renewal of an existing rx it’s not like they’re writing you a whole new treatment plan… you could just call the office and discuss these concerns with them before your doc leaves to ensure the conversation is had in advance


You may want to see if current doctor would at least write up the letter of medical necessity before he leaves. That is often more important than the RX itself.
The replacement endo/NP may then have to re-write to submit, but at least they could take into account information from your current endo.


I agree the NP is not a bad way to go. For many years I never saw an endo. I had a wonderful NP for many years who handled everything for me even paperwork for new pump. And for many years saw a PA and it was the same. There is always an endo around for questions or concerns but they never had to call for “advice”. Most times just the dreaded paperwork stuff. But if the NP has a good track record, you might actually want to stay there instead of trying to find a new endo. Good luck!

Why do you think that your doctor won’t prescribe the pump before he leaves? I would certainly ask.

@Laddie You are right, it wouldn’t hurt to ask. I just thought he wouldn’t want to prescribe a pump that he wouldn’t be around to support but why not after all this isn’t my first rodeo