New Diabetology Specialty Emerges as Healthcare Crisis Deepens

A revolutionary approach to diabetes care is gaining ground in the United States, as primary care physicians create a new medical specialty to address the overwhelming burden of diabetes management in healthcare systems worldwide.

In November 2022, the Leona M. and Harry B. Helmsley Charitable Trust awarded $2.99 million to a group of primary care physicians determined to establish an educational pathway for diabetes-focused medical practice. This investment has now yielded the American College of Diabetology (ACD), recently recognized by the American Medical Association with the official taxonomy of "diabetologist."

Market-Driven Innovation in Healthcare

The initiative represents a classic example of market forces responding to unmet demand. Primary care physicians found themselves overwhelmed by the complexity of modern diabetes management, particularly with the advent of insulin pumps, continuous glucose monitors, and individualized treatment protocols.

"It is a lot to ask a PCP to handle all of that," explained Dr. Jay Shubrook, professor at Touro University California's College of Osteopathic Medicine. "There is a lot that goes into the management of diabetes. We can meet those needs and challenges patients face, if we have more time."

This private-sector solution emerged organically from practitioners recognizing inefficiencies in the current system. Rather than waiting for government intervention, these physicians took entrepreneurial action to create specialized training programs and certification pathways.

Economic Efficiency Through Specialization

The new certification system addresses significant market failures in healthcare delivery. Previously, primary care physicians with diabetes expertise could not bill for consulting with colleagues on complex cases, creating perverse economic incentives that discouraged knowledge sharing and collaboration.

Board certification now allows these specialists to receive appropriate compensation for referrals and consultations, creating sustainable economic models for specialized diabetes care. This represents efficient resource allocation, directing expertise where it's most needed while ensuring practitioners are properly compensated for their specialized knowledge.

Dr. Kinga Pluta, practicing at Cooley Dickinson Hospital in Massachusetts, highlighted the practical benefits: "I no longer need to seek out a qualified colleague to sign for me when I want to prescribe an insulin pump. Insurers want someone with board certification to sign the request."

Private Investment Driving Innovation

The Helmsley Trust's investment is spurring the creation of fellowship programs across the country, with at least 10 programs already operational. This private funding model demonstrates how charitable investment can catalyze systemic healthcare improvements without requiring taxpayer resources or government bureaucracy.

Jenny McCoy, the college's executive director, reports receiving three to five inquiries monthly from institutions interested in starting their own fellowship programs. This organic growth reflects genuine market demand for specialized diabetes care.

Addressing Healthcare Workforce Shortages

The timing of this initiative is particularly relevant given projected healthcare workforce shortages. The U.S. government anticipates a shortage of 87,150 full-time equivalent primary care physicians by 2037, especially in rural areas.

Current diabetes care statistics reveal significant gaps in treatment quality, with 89% of diabetic patients failing to meet basic guidelines for blood sugar control, blood pressure management, cholesterol levels, and smoking cessation. These failures represent both human costs and economic inefficiencies in the healthcare system.

Dr. Leonard Bertheau, fellowship director at Brown University's affiliated program, embodies the entrepreneurial spirit driving this movement. After completing informal training with Dr. Shubrook, he struggled to find practices that understood how to support diabetology as a specialty. Rather than accepting this limitation, he created his own fellowship program.

Sustainable Growth Model

The fellowship programs are designed with sustainability in mind. At Brown, fellows receive comprehensive training from dieticians, diabetes educators, pharmacists, podiatrists, nephrologists, ophthalmologists, and pediatricians. This multidisciplinary approach creates well-rounded specialists capable of independent practice.

With 14.7% of U.S. adults now having diabetes, the economic argument for specialized care becomes increasingly compelling. The current system's inefficiencies create costs for patients, insurers, and healthcare systems alike.

As Dr. Bertheau noted optimistically, "Now when I step away, there will be a fleet of physicians who can do what I do." This multiplication of expertise through private initiative and investment represents exactly the kind of market-driven solution that can address healthcare challenges without expanding government involvement or increasing taxpayer burden.

The success of the American College of Diabetology demonstrates how professional innovation, private investment, and market incentives can combine to address complex healthcare challenges while maintaining economic efficiency and professional autonomy.