The United States is running out of endocrinologists.
That statement is not hyperbole. Researchers projected that the U.S. would face a shortage of roughly 2,700 endocrinologists by 2025, while the Association of American Medical Colleges projects a shortage of up to 13,400 non-primary care specialists by 2034. Approximately 40 percent of currently practicing endocrinologists are nearing retirement age, and only 270 to 300 new endocrinologists are trained annually in the United States, a figure that is nowhere near sufficient to meet growing demand. The average wait to see an endocrinologist in the U.S. is currently 3 to 6 months, and in some areas wait times extend well beyond that, with many endocrinology practices closed to new patients entirely.
Meanwhile, 85 percent of people living with diabetes in the United States will never see a diabetes specialist, even though specialist involvement can significantly improve outcomes.
The conditions driving demand are not getting better. Diabetes, thyroid disorders, obesity, metabolic syndrome, and osteoporosis are all rising in prevalence across every demographic. The pipeline of new specialists is not expanding fast enough to close the gap. And the reimbursement structure of U.S. medicine actively discourages physicians from entering endocrinology, a specialty built around prevention and long-term management rather than reimbursable procedures.
This is not a short-term staffing problem but rather a structural feature of U.S. healthcare that no domestic workforce intervention is likely to resolve within the next decade.
This raises a question that very few people in U.S. healthcare administration are asking yet: what clinical resources exist outside U.S. borders that could meaningfully help those residing inside U.S. borders?
The Generalist Foundation of Colombian Medical Training
To understand why South American clinicians, and Colombian physicians in particular, represent a genuinely useful resource for the U.S. market, it helps to understand how their training differs from the U.S. model.
In Colombia, all physicians complete a full generalist medical education before any specialization is possible. This is a foundational requirement rather than an elective rotation. Every physician who goes on to specialize in endocrinology, internal medicine, gynecology, or any other field has first spent years functioning as a complete general practitioner across all body systems. The clinical reasoning that results from this formation is integrative by default. An endocrinologist trained through this path does not encounter the thyroid in isolation. They encountered it alongside cardiology, neurology, nutrition, gastroenterology, psychiatry, dermatology, and more before they ever began their specialty training.
This matters in practical terms. When a Colombian endocrinologist considers a patient with hypothyroidism, fatigue, skin dryness, and mood changes, the training they are drawing on includes the whole metabolic and systemic picture, not just the thyroid panel. The U.S. system, by contrast, trains specialists in lanes. A U.S. endocrinologist enters fellowship after completing an internal medicine residency, but the clinical culture of the specialty increasingly mirrors the fragmented system around it. The patient with low TSH and low T4 gets their labs normalized on paper and is sent home. The mood changes get referred to a psychiatrist. The fatigue goes unaddressed. Nobody holds the full picture.
This is what happens in a system that pays for procedures and discrete interventions rather than provides incentives for the kind of integrative thinking that takes time and does not generate a billable code.
The Bilingual Gap Is Bigger Than It Appears
One in four Spanish-speaking Hispanic adults in the United States has difficulty finding language-concordant healthcare providers. The AAMC has flagged this at the congressional level as an urgent workforce problem, noting that the U.S. needs more Spanish-speaking physicians across virtually every specialty.
The nutrition and dietetics field illustrates the problem particularly clearly. Latino registered dietitians are significantly underrepresented in the U.S. workforce relative to the Hispanic patient population. Starting in 2024, new master's degree requirements for the registered dietitian qualifying exam are likely to widen this gap further, as unpaid internships and high tuition costs already make the field disproportionately difficult to enter for first-generation and lower-income professionals.
What this means in practice is that U.S. dietitians who speak Spanish, and there are many, are actively looking for clinical partners, content collaborators, and educational resources that can help them serve their patient population more effectively. The nutritional and metabolic knowledge that Colombian dietitians and endocrinologists carry, combined with their clinical culture of patient education and accompaniment, is precisely what this underserved population needs. The connection has simply not been made in a systematic way yet.
Why Wait Times Create a B2B Opportunity, Not Just a Patient Support Opportunity
The standard framing of the international clinician conversation is patient-centered. U.S. patients, frustrated by long wait times and dismissive care, seek providers outside the U.S. system. That framing is accurate and the patient demand is real. However, it misses a larger and more durable opportunity on the B2B side.
U.S. health systems, telehealth companies, direct primary care practices, and nutrition platforms are all facing the same underlying problem: the clinical talent they need to serve a growing, diverse patient population does not exist in sufficient quantity domestically. They cannot hire enough Spanish-speaking endocrinologists. They cannot find enough dietitians with genuine metabolic depth to staff their chronic disease programs. They cannot close the wait time gap with the domestic training pipeline they have.
International partnerships, educational collaborations, and knowledge-transfer programs with South American clinicians represent one of the few scalable paths toward closing these gaps. A U.S. telehealth platform that partners with Colombian endocrinologists for educational content, patient orientation services, and clinical knowledge sharing is not importing foreign labor. It is accessing a clinical knowledge base that the domestic system was not designed to produce.
The same logic applies to continuing medical education. U.S. clinicians who work with complex thyroid patients, Hispanic patients with metabolic syndrome, or patients seeking more integrated hormonal care are hungry for clinical perspectives that go beyond the standard algorithmic approach. A family member of mine who now has U.S. citizenship fired her U.S. endocrinologists due to their poor bedside behavior and lack of further investigation in her case for a thyroid disorder and now works virtually across the border with a Colombian endocrinologist who actually considers the patient narrative as a valuable resource.
Colombian clinicians, and Latin American clinicians more generally as a trend, have been trained to think across body systems. These healthcare professionals bring a genuinely patient-centered clinical culture and an understanding of how to use the patient narrative as data, something to teach that U.S. CME programs are not currently offering.
The Private-Pay Structure Creates Mutual Incentive
One nuance worth understanding is the economic structure that makes this cross-border knowledge transfer particularly viable right now.
Colombia has a substantial private-pay medical sector alongside its public insurance system. Private-pay endocrinologists, gynecologists, and internists in Colombia typically have more scheduling flexibility than their counterparts embedded in large hospital systems or EPS networks. In Colombia, EPS is the abbreviation for Entidad Promotora de Salud (translated: Health Promoting Entity), which is a health insurance management organization in the country's public healthcare system. At the same time, the cash pricing of the Colombian private system, while high by local standards, is a fraction of what comparable U.S. care costs.
This creates a mutual incentive that is not present in most other international medical labor markets. Colombian private-pay clinicians have both the professional independence to engage in cross-border educational and consulting work and the financial motivation to generate income in USD, which carries significantly more purchasing power in the Colombian market. U.S. patients and U.S. organizations, in turn, gain access to clinical depth and Spanish-language capacity that would cost dramatically more to acquire domestically, if it were acquirable at all.
What Is Already Happening, Organically
It is worth noting that this transfer is already underway in unstructured ways. Colombian-trained physicians are practicing in U.S. endocrinology departments, as the faculty rosters of institutions like Prisma Health in South Carolina illustrate. Colombian psychologists are already attracting English-speaking U.S. patients through search results, without having designed for that market, simply because their content describes patient experiences that U.S. patients cannot find addressed by domestic providers.
What is missing is not the clinical talent or the patient demand. What is missing is the infrastructure and the strategic awareness on the U.S. side that would allow health systems, platforms, and professional organizations to recognize South America as a deliberate resource rather than an incidental one.
The Practical Implications for U.S. Health Organizations
For U.S. healthcare organizations thinking about workforce gaps, content strategy, or service expansion into the Spanish-speaking market, several concrete implications follow from the above.
Bilingual clinical content partnerships with Colombian clinicians represent an underutilized approach to building credibility with both Spanish-speaking patients and English-speaking patients who want a more integrative approach to hormonal and metabolic care. The depth of metabolic knowledge in the Colombian clinical training tradition is a differentiator that U.S. content alone rarely achieves.
Continuing medical education (CME) and professional education collaborations with South American clinical educators would expose U.S. clinicians to integrative thinking on thyroid, metabolic, and hormonal health in ways that existing U.S. CME programming does not typically address. The patient-centered consultation style embedded in much of Latin American clinical culture is itself a teachable skill that U.S. practices interested in improving patient satisfaction scores and reducing dropout rates would benefit from studying directly.
Clinical referral networks that connect U.S. patients seeking educational and orientation support with Colombian private-pay clinicians operating in the wellness space are already forming. Organizations that recognize this early have the opportunity to shape how that network develops rather than discovering it after it has been built by someone else.
The Untapped Resource and the First-Mover Moment
Clinical referral networks and educational partnerships connecting U.S. patients and organizations with Colombian private-pay clinicians operating in the wellness and professional education space are already forming organically. U.S. residents who were born in Colombia who cannot get an endocrinology appointment for three to six months or who are dissatisfied with the U.S. healthcare system are finding Colombian physicians in databases and using services across borders. Other English-speaking, monolingual U.S. patients are finding Colombian psychologists through Google searches in their desparation for better psychotherapeutic support, often without either party having designed for that outcome. Organizations that recognize this early have the opportunity to shape how that network develops rather than discovering it after it has been built by someone else.
The conversation about international clinical talent in the U.S. context has largely centered on immigration, licensing, and the pathways for foreign medical graduates to enter the U.S. system. That is a legitimate and important conversation. But it is a slow-moving one, constrained by regulatory frameworks, licensing reciprocity, and credentialing processes that operate on timescales of years.
The wellness and professional education markets operate on a different timeline and under a different regulatory structure. Educational services, health coaching, patient orientation, and cross-border consultation in a non-clinical capacity do not require U.S. licensure. They require clinical knowledge, language capacity, and the ability to communicate that knowledge in ways that English-speaking patients and U.S. professional audiences can access and trust. This is where the opportunity is most immediately actionable.
The AI Dimension: Clinical Reasoning as a Training Resource
There is a dimension to this conversation that almost no one in the health technology sector is discussing publicly yet. The current wave of AI development in healthcare has a documented problem: AI tools, including those in dietetics and metabolic health, frequently lack a clinical reasoning layer. Research has argued that prevailing technology-centric approaches to AI in medicine remain fundamentally incompatible with clinical practice, specifically with diagnostic reasoning and decision making, because they prioritize benchmark performance over the kind of nuanced contextual judgment that real clinical encounters require.
In nutrition and dietetics specifically, AI-assisted tools have shown promise in dietary assessment and chronic disease management, but clinicians have consistently raised concerns about data accuracy and the absence of the individualized reasoning that effective dietary counseling requires. A recent systematic review of AI applications in nutrition noted that while AI can process dietary data efficiently, the contextual understanding of a patient's cultural background, food access, family dynamics, and lived experience with their condition remains largely outside what current tools can model.
This is precisely where South American clinical expertise has something to offer the technology sector that domestic training data cannot replicate. I have had health technology companies reach out to MedicalOfficeMarketing.org to ask that I advocate for their brand while admitting that their dietetics software lacked the ability to individualize dietary plans extensively, was unable to go into detail on micronutrients, and did not have what one European company described to me as a "clinical reasoning layer." Notably, one company admitted not having a presence in South American markets and had not considered South America as a resource or a consumer, despite having operations in Spain, which makes the issue of a language barrier an insufficient explanation for the gap. The real gap is awareness.
During a call with a Colombian dietitian, she described her patient intake process in detail. She used a lengthy, structured interview designed to understand not only what the patient eats but what resources they already have, what barriers they face, what knowledge gaps exist, and how to individualize a plan accordingly. She noted that Colombian patients sometimes complain about the volume of questions. That thoroughness, that systematic effort to build a complete and individualized clinical picture before making a recommendation, is exactly what AI systems need as training data and what U.S. patients (and Spanish patients) consistently report not receiving from algorithmically-driven nutrition platforms.
The implication for U.S. health technology companies is direct. The clinical reasoning embedded in South American medical and nutritional training represents a knowledge resource that has not been recognized, structured, or compensated as such. As AI tools in healthcare become more sophisticated, the quality of the clinical reasoning used to train them will increasingly determine their usefulness. Companies that begin building relationships with South American clinical educators now will have access to a depth of integrative, patient-centered thinking that domestic training pipelines are not producing in sufficient quantities.
South America as a Deliberate Resource
South America, and Colombia in particular, has the clinical knowledge, the patient-centered consultation culture, the integrative approach to hormonal and metabolic health, and a growing generation of English-capable clinicians, all converging at a moment when U.S. demand for exactly these qualities is at its highest point in decades.
What has been missing is not the clinical talent or the patient demand. What has been missing is the strategic awareness on the U.S. side that would allow health systems, platforms, professional organizations, and technology companies to recognize South America as a deliberate resource rather than an incidental one.
The organizations that build that recognition now, and develop the relationships, the content, and the partnership infrastructure to act on it, will be the ones that define what cross-border clinical collaboration looks like for the next decade.
Marion Abigail Davis, M.A. is the founder of the health education platform, MedicalOfficeMarketing.org , in Atlanta, Georgia, and is a 2024 Comcast RISE grant receipient for her work in this area. She works with international clinicians and U.S. health organizations to address healthcare gaps, the patient narrative as data, clinical knowledge transfer, market strategy, and the English-speaking wellness market.