Understanding the Decline of Pediatric Endocrinology Workforce and the Path Forward

To evaluate the pediatric endocrinology and diabetes workforce shortage, identify contributing factors, and propose strategies to address this crisis.

We reviewed 2015-2025 workforce trends (fellowship positions, applicant numbers, and fill rates) and examined systemic and structural factors influencing recruitment, retention, and provider well-being.

The incidence of type 1 and type 2 diabetes, endocrine disorders, and lipid conditions continues to rise, yet fellowship applicants have declined by 4.6% over the past decade. Despite an increase in positions (66 to 104 between 2015 and 2025), nearly one third remain unfilled, with a 64% match rate in 2024, underscoring a widening workforce gap. Key factors contributing to this crisis include low financial compensation relative to training length, substantial medical education debt, prolonged training, and a high clinical workload leading to burnout. Pediatric endocrinologists also earn less than their adult counterparts and other pediatric subspecialists. Fewer medical students are choosing pediatrics overall, which further worsens the shortage and results in a maldistribution of specialists, particularly in rural and underserved areas. This threatens patient's access to care.

The pediatric endocrinology workforce is at a critical juncture. Urgent priorities include addressing financial barriers through improved compensation, expanded loan forgiveness, and reimbursement reform that reflects the time-intensive nature of care. Equitable reimbursement, integration of endocrinology education into medical school and residency, recognition of nonclinical responsibilities, and expansion of telemedicine pathways are also essential. Immediate coordinated action is needed to revitalize the workforce and meet the growing health care needs of children with endocrine disorders.