Can Endocrine NP Training Help Ease Provider Shortage?
Established in 2016, the program was 'a result of national demand for diabetes and endocrinology providers,' Program Founder and Director Kathryn Evans Kreider, DNP, APRN, FAANP, said at American Association of Clinical Endocrinology (AACE) Annual Meeting 2025.
Downward trends in endocrinology fellowship recruitment concurrent with increases in endocrine diseases, including diabetes, obesity, and osteoporosis, have led to acute shortages of endocrinology providers in many parts of the country. Recent data suggest that 70% of US counties have no endocrinologists.
Kreider, who is a professor of nursing at Duke, told Medscape Medical News , 'My program has always been a combination of advanced diabetes management and general endocrine. I felt very strongly about that because we need NPs out in the world who are able to see these more complex patients. We do not replace endocrinologists. We just know that there's a huge shortage of endocrinologists, and we have to figure out better ways to meet that access gap.'
Asked to comment, Session Moderator Yael Tobi Harris, MD, PhD, associate professor of medicine at the Zucker School of Medicine and chief of the Division of Endocrinology, Diabetes and Metabolism at Hofstra/Northwell, Great Neck, New York, told Medscape Medical News that she supports this type of program. 'I am a physician and I'm a huge fan. We really have a drastic shortage of endocrine providers, and we just cannot meet the demand that is out there for endocrine care. Nurse practitioners are well-trained clinicians and well-suited to deliver endocrine care. It really helps increase access.'
Also asked for input, Matthew J. Levine, MD, endocrinology fellowship director and clinical professor of medicine at Scripps Clinic, La Jolla, California, said, 'There was an uptick in endocrinology fellowship applicants in the last recruitment cycle, and between that and ongoing efforts to increase the endocrinologist pipeline, we hope that this is the beginning of a positive trend to address the shortage. Endocrine NPs can and do certainly help to fill the shortage as well, especially in medically underserved areas.'
However, Levine, who is also president of the Association of Program Directors in Endocrinology, Diabetes and Metabolism, added, 'I would have reservations about them providing care as solo practitioners. With only 1 year or so of training and given that endocrinology is a complex specialty with longitudinal management of intersecting comorbidities, it is best for them to work as part of an endocrine care team with an endocrinologist who went through multiple years of multifaceted training being the leader of said care team.'
According to Harris, 'What matters is whether the patients are receiving the care, and if reserving that for physicians only means that patients don't get care, I don't see what the value is in that. The concern that [advanced practice providers] didn't go to medical school seems somewhat misguided to me, particularly when we have programs like Dr Kreider's that are providing the training.'
Training NPs in Endocrinology: Wave of the Future?
There are currently about 385,000 NPs in the United States compared with roughly 1.1 million physicians. About 70% of NPs are in primary care, while 30% practice specialty care, most commonly in gerontology or psychiatry/mental health. 'The vast majority of nurse practitioners are trained in primary care, so those who go into specialty practice are learning on the job,' Kreider noted in her presentation.
The Duke endocrine NP program is just one of two in the country that are housed within nursing schools. The other, at Mount Marty University in South Dakota, caters specifically to a rural population and includes pediatric endocrine training, which the Duke program currently does not.
Two other programs, at Yale University School of Nursing and the University of California San Francisco, provide diabetes-specific training for NPs, embedded into their master's programs.
When Duke's endocrine NP program began, the nursing school was already offering NPs training in orthopedics, cardiology, oncology, and HIV/AIDS. Initial funding for the endocrine program came from a 3-year grant from the Health Resources and Services Administration. About three quarters of the program's students are currently practicing/licensed NPs, while the rest are current Duke nursing students with NP majors.
The training is divided into three parts: Advanced diabetes management (including hands-on diabetes technology training, recognition of diabetes types, insulin management, and inpatient management), general endocrinology (including thyroid, adrenal, pituitary, lipids, obesity, reproduction, gender medicine, and bone), and 168 hours of clinical rotations with a preceptor who is either an MD, physician assistant (PA), NP, or DO.
The entire program can be completed in two or three semesters over 8-12 months. It is mostly distance-based, but during the summer, there is a 3-day onsite intensive with hands-on training.
The program partners with Duke's Division of Endocrinology for guest lectures and preceptorships. 'Our physician endocrinologists have been wonderful. They are very supportive, and that has been very instrumental with both initiating and now flourishing later, as we continue,' Kreider said.
There were a total of 167 graduates between 2016 and 2025, averaging about 18 per year. Most now practice in medically underserved areas. Kreider anticipates increasing that enrollment. 'We have interest from a private funding source. This might be on the horizon in the next year or so where we can really start to expand what we offer and the number of people that we can bring in.'
Discussions are also underway to expand the number of similar programs for both NPs and PAs. 'We're going to need some really good partnerships with other academic medical centers to make that work,' she noted.
Establishing board certification will also be important. 'If we're training people in standardized ways, how do we validate that knowledge? I think that will be a very valuable part of what we do and what we need to do,' Kreider commented.
Ultimately, she predicted, 'Endocrine advanced practice providers will be the primary providers in the care of under-resourced and underprivileged patients, positioned as indispensable providers and team members across healthcare settings.'
Kreider and Harris had no disclosures. Levine reported being a speaker for Ascendis Pharma and an advisory board member on one occasion for Madrigal Pharmaceuticals.
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