Happy Saturday, and welcome back to our weekly advice column, Ask D'Mine! hosted by veteran type 1, diabetes author and educatoAsk-DMine_buttonr Wil Dubois.

This week, Wil answers a different kind of question relating to diabetes, but one that he has experience in: working in a D-focused field and what kind of careers a fellow PWD (person with diabetes) could pursue with their pancreatically-challenged life as a resume-booster.

{Got your own questions? Email us at AskDMine@diabetesmine.com}


Jennifer, type 1 from Kansas, writes: I love your column! I read it every Saturday and use it as an excellent resource to direct fellow PWDs to when I get questions as a member of the Online Diabetes Support Team. Usually your questions revolve around managing diabetes, but I have a little different one for you. I'm in the process of doing a job search and am trying to figure out what I want to do next. I really love working with fellow diabetics through the ODST, but I'm not really sure how to make that a career. I don't want to go back to school to become a doctor or nurse, but I am willing to look at school for other things. I currently work as a hall director in housing on a college campus and have a master's degree in Educational Leadership. Can you think of any careers that work with PWDs but aren't the traditional doctor or nurse?

Wil@Ask D'Mine answers: Thank you, I was needing a little love after unintentionally insulting 90% of the D-Moms on the planet a few weeks ago! I can think of a bunch of opportunities to help our fellow PWDs. In fact, diabetes careers beyond the traditional doctor or nurse role are poised to grow as fast as the diabetes epidemic itself.

To understand why this is, let me set the stage before we get into the job descriptions. At last count, there were about 4,000 endos in the United States, and our best guess is that there are probably 27 million PWDs—a number that expands by about 6,300 persons a day (give or take a hundred). Anybody seeing a math problem here? We are already woefully short on primary care docs, and health insurance is posed to reinsure all the very sick people the insurance companies jettisoned over the last few decades. Even today, trying to find a primary care doc to take you on as a patient is impossible in some parts of the country. And on top of all these shortages, many docs are getting so pissed off with the paltry reimbursement rates, and the generalized stress and bullshit one has to go through to get paid by insurance companies, that they are throwing in the towel and switching to a cash-only model.

A nightmare preview: A PWD checks her mailbox next year, and she sees IT. Yes! Finally, it's here! After years of scrabbling to survive, she has insurance. With her hands trembling with excitement, she opens the letter that comes with the card: Congratulations! Your new federally-subsidized mandatory insurance card is enclosed. Good luck finding a doctor who will accept it!  

And our medical resource shortages don't stop with doctors. The AADE has done some hand-wringing about the aging of the CDE population and the lack of "fresh blood." Nursing schools nationwide turn away thousands and thousands of qualified applicants every year, because even though we have a nursing shortage, the schools don't have the staff and resources needed to keep up with demand. Oh, and then once the baby nurses get into the field, the current system supports their initial on-the-job training so poorly that fully 20% of new nurses quit the field within the first year.

All of these things fall into the category of the consequences—unintended and otherwise—of waiting too long to fix a badly broken healthcare system.

The silver lining tD-Educationo the dark cloud is that this shortage of certified, licensed warm bodies has created a back door to the hallowed halls of medicine. More and more, you can work in the medical trenches without being a doctor or a nurse.

For the last... well... how many years has it been, now? Hold on, let me check my LinkedIn profile. OK, for the last four years and five months I've been part of a forward-looking program to expand the role of non-licensed people on medical teams. Project ECHO, which is part of the University of New Mexico's School of Medicine, has been teaching community health workers some pretty advanced diabetes stuff for years. It's a grueling training. I know, because I helped create it. And just last week I attended the graduation of our fifth cohort, which had participants from three states (New Mexico, Montana, and Pennsylvania).

As I stood next to the podium with the rest of the faculty and staff, listening to the speeches of the various dignitaries, then passing out the diplomas, and shaking hands, it struck me: these people—these people I helped train—are the future. Diabetes is no longer the exclusive domain of the certified and sanctified. This global mess requires all hands on deck. Now, of course, many of the crusty old docs won't work with our trained paraprofessionals. Not yet, anyway. But when the ship starts to sink yet deeper, I think many of them will be forced to. Meanwhile, the younger docs seem more open-minded (or perhaps more realistic). They understand that diabetes takes a village, and that means you have to play nice with the villagers.

Because of this lack of resources and flood of need, I think community health workers are about to take center stage in diabetes care in the United States. Opportunity is knocking. There's just one problem: you can probably make more money working at Burger King.

Yep. Community health worker pay sucks. As you have a master's degree, you also probably have student loans, so this might prove a disastrous career move for you, unless you are also overweight. The reason I say that is that not being able to afford groceries is one of the best scientifically-proven ways to lose weight.

But all is not lost. Because there's a whole 'nother diabetes-intervention world to work in.

May I suggest that you contact Human Resources at the Evil Empire?

Yes, I predict the next wave of innovation in healthcare is going to come from an unexpected source—our traditional foe—the insurance industry. Here's why: the old model was simple. You got rich by denying coverage. Then, if people got sick because you didn't give them what they needed to stay healthy, you simply got rid of them by kicking them to the curb.

Health insurance reform changes all of that. Like some sort of zombie apocalypse parable, the insurance dead have come back to life and are battering down the doors in the lobby while the executives cower in the conference room on the 31st floor. The sins of the past are posed to wipe out the profits of the future, and people who love money will do anything to preserve it.

I see evidence that the plans know that the jig is up. Well, the old jig anyway. All of a sudden, with no options left to them, the insurance companies are waking up to what all of us have known all along: it's cheaper to keep us healthy than to pay for complications. Well, actually, I think that they've known that from the start. But they also worked out the cold, hard math: Under the old models, their actuaries could calculate that it was more profitable to cut us loose than to keep us healthy. Now they can't do that anymore, so doing the "right thing" is the next most profitable option.

Right now, today, insurance plans are hiring a ton of people in various education, support, and disease management roles. And unlike community health workers, who generally work for clinics, people who work for insurance companies get paid well.

Would working for the Evil Empire mean you've gone over to the Dark Side? On the surface of it, it might seem so, but I really don't believe that. I've spent years hating insurance companies, but I've always liked the vast majority of the people work for them. At a Stanford-sponsored chronic illness management training earlier this year, I met a pack of nurses and social workers from two of my state's big insurance plans. They were lovely ladies. I guess it didn't hurt that the first thing one of them said to me was, "We all just love your books!" But I would have liked them anyway; they had good hearts and good intentions.

So I think opportunity is knocking, at both the front door and the back door. This is a good time, career-wise, to get into fighting the good fight.New Career Ahead

But I have a warning for you, and I can already see (more) stacks of hate mail piling up. The fact of the matter is that this work is not what you're expecting. You've been engaged with fellow type 1s. Most of the work helping people with diabetes is helping the majority of people who have diabetes—and that's the type 2s. And here's where I am going to get into trouble...

Don't get me wrong, I love my type 2 patients, but the disease is different and the mindset is different. Working with type 2s, in general, isn't so much about educating as it is about motivating. So it won't be the wonderful collaborative let me help you understand your diabetes better interaction you might be picturing to yourself. Instead, you may find yourself feeling like screaming: "Why the f--- are your drinking a Big Gulp for breakfast?! In my office, no less?!" You'll scratch your head wondering why someone won't take the free pills you spent countless hours getting them. You'll wonder how sooooooo many people can forget to bring their meters to their appointments.

The fact is that our type 2 epidemic is like a dandelion: you can see the bright yellow flower on the top, but the plant itself is largely underground. If you just snip off the flowers with scissors, you haven't done much. By the time you turn your back, more flowers will sprout from the deep roots of the weed. Likewise, helping many type 2s requires digging deeper, down to the roots, before you can address the meaty stuff you are used to dealing with fellow T1s. It can be a bit more like social work than education.

Now hopefully I haven't insulted every type 2 reading this, but I think you'll admit that if you're a type 2 who is reading D-blogs and  talking about diabetes intensely, you're not a typical patient.

It's important to note that there are a lot of reasons why some type 2s don't engage well in their own care, and 99% of those reasons have nothing to do with the individual. They are issues of poverty, education, medical disparities, health literacy, social denial, and more. Diabetes disproportionately affects those that have the rest of life's deck stacked against them in the first place. Helping people to overcome these hurdles is difficult, challenging, and sometimes frustrating work.

But it is rewarding beyond all measure.

So welcome to my village! Apply at either the front door or the back door. But by all means apply today.


This is not a medical advice column. We are PWDs freely and openly sharing the wisdom of our collected experiences — our been-there-done-that knowledge from the trenches. But we are not MDs, RNs, NPs, PAs, CDEs, or partridges in pear trees. Bottom line: we are only a small part of your total prescription. You still need the professional advice, treatment, and care of a licensed medical professional.

Disclaimer: Content created by the Diabetes Mine team. For more details click here.


This content is created for Diabetes Mine, a consumer health blog focused on the diabetes community. The content is not medically reviewed and doesn't adhere to Healthline's editorial guidelines. For more information about Healthline's partnership with Diabetes Mine, please click here.