13The Diabetes Care Gap Most Women Never Hear About7 min read

Why Endocrinologists Aren’t Set Up to Fill This Role

Many women with diabetes rely on their endocrinologist as their main point of medical contact. That arrangement makes sense for managing the condition itself — endocrinologists specialize in hormonal and metabolic disorders, and diabetes is a significant one. But as Dr. Marilyn Tan, an endocrinologist at Stanford Health Care, explained, most endocrinology practices are not structured to provide contraception counseling or age-appropriate cancer screening. The visit agenda is built around blood sugar, medications, and related metabolic issues. That focus is appropriate and necessary — but it leaves preventive care in a gap zone where it isn’t clearly anyone’s responsibility.

How the Fragmented Healthcare System Plays a Role

The U.S. healthcare system is not organized around comprehensive, coordinated care for individual patients. It tends to operate in silos — specialists handle their area, primary care handles its area, and the hand-offs between them are inconsistent. For women with diabetes, this fragmentation creates a specific vulnerability. When the specialist is focused on the chronic condition and there’s no primary care physician actively managing the rest of the preventive checklist, things fall through the cracks. Dr. Wisk described it directly: the system isn’t especially good at care coordination, and someone needs to be actively ensuring that preventive services are happening — which doesn’t always occur in practice.