The mismatch in supply and demand: reproductive endocrinology and infertility workforce challenges and controversies

Abstract

Infertility affects a significant proportion of the population. When including people interested in fertility preservation or family building services as part of the LGBTQ+ community, the number needing fertility care far exceeds the current supply of providers and clinics. The field of reproductive endocrinology and infertlity needs to comprehensively address this mismatch in supply and demand with both short and long term solutions. In the short term, networking with primary Ob/Gyns to provide initial fertility care and integrating advanced practice providers into our practice can help to reduce some of the current needs. Ultimately, making meaninful changes to the current REI fellowship training program is critical to improving the number of trained reproductive endocrinologists available. Expanding fellowship positions may necessitate building a closer relationship with private practices and potentially private equity funded practices. Ensuring that these relationships would train independent REIs is of the utmost importance and could potentially be addressed through a comprehensive national curriculm as well as some protections on post-training obligations. Furthermore, although some have proposed the utilization of primary gynecologists for ART counseling or procedures, also known as "upskilling," such quick solutions may not provide the depth and breadth of care that many infertile patients require. The field of REI is at a criticial juncture. With many competing interests to address this mismatch, as REIs, now is the time to develop solutions that will maintain the integrity and quality of our field.