Letter to the Editor: Who’s to Blame for the Shortage of CDEs?

“I would think that both organizations would be doing all they can to grow the field. They should recognize that non-RNs and RDs are quite capable of doing the job and doing it well. There is more than enough to do for everyone.”

| Feb 19, 2009

Dear Editor,

You are right when you wrote that CDE's were becoming an endangered species, but were you aware that the National Certification Board for Diabetes Educators (NCBDE) is part of the problem?

I earned a Master's in Public Health (MPH) from UCLA in the late eighties.  Because of the growing public health problem of type 2 diabetes, I decided to become an "expert" in that area. I passed the exam and became a CDE, and I have worked successfully in the field for close to 15 years.  I recently passed my exam for the third time with flying colors.

Here is my concern - the NCBDE has decided to no longer accept an MPH or other master's level health education degree as meeting their criteria to become a CDE. Anyone who received a degree after 2005 is no longer eligible to sit for the exam.  I have written their board several times addressing the matter, and I have notified the American Association of Diabetes Educators (AADE) of my concerns.  Unfortunately, nothing has changed.  In fact, I dropped my membership with the AADE since they did not appear to support my efforts.  A colleague of mine who is an excellent educator-also with the MPH background-is unable to take the exam even though she graduated prior to 2005. Why? Because the NCBDE also set a 5-year time limit from graduation to the time one applies. She was essentially penalized for taking a break to raise her family.

I would think that both organizations would be doing all they can to grow the field. They should recognize that non-RNs and RDs are quite capable of doing the job and doing it well. There is more than enough to do for everyone. I urge anyone with similar concerns to write to the boards at both the NCBDE and the AADE.

Catherine Goldberg, MPH, CDE

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Posted by Anonymous on 23 February 2009

And medical schools years ago, maybe still, deliberately limited the number of students they took as to keep doctors' rates high. So today we have to import our doctors. These associations think at the level of their lowest members, which brings their actions pretty close to mob level. Helen Mueller. One of these days I will really register!

Posted by jameshill1563 on 23 February 2009

I agree, the NCBDE has become too much of a clique. I don't have a CDE or Masters degree, but I do have a BSN in nursing which includes Public Health cerification. I've had insulin dependant diabetes for over 30 years. What I don't have is 2000 hours of officially supervised patient care experience with diabetes patients by a CDE. Therefore, I don't qualify to take the CDE exam. I have helped one of my co-workers pass the CDE exam. She qualified to take it based on experience at an Indian Health care center with many diabetics. She thought it was absurd that I could not take the CDE exam and tells me I already know far more about diabetes than she will ever know. The NCBDE is a professional clique, perhaps they fear those of us who know more about the disease than they do, but don't have as many letters following our RN, or RD.

Posted by angivan on 24 February 2009

This is discouraging news. I am 42 years old with a business degree, 25 years with Type 1, and am interested in a 2nd career as a diabetes educator. But the sheer number of years that I would have to quit work and go to school is completely unrealistic (a minimum of 6 years full-time is what the AADE told me). This article makes it seem unachievable at my age. I would love to still pursue it if anyone has any advice as to how to get started in a more expedient manner. Thanks for the article.

Posted by Barbara Bradley on 24 February 2009

Another road block once you have obtained the CDE is that unless you are a Registered Dietitian, Nurse practitioner, or MD you cannot bill insurance payors if you are self employed. AADE has not pursued legislative action on this, yet the Registered Dietitians did lobby successfully to be included as providers who can bill. Without an advanced practiced degree, I am not able to directly bill insurance companies, Medicare, or Medicaid. I would have to bill the individual for diabetes management counseling. This does work for some independent providers, but I am not in a position to do that. Many people who need the education do not get it if they have to pay out of pocket.

Posted by Anonymous on 24 February 2009

Indeed, the NCBDE is an inclusive and exclusive organization. I understand some standardization is needed as are other criteria. Pharmacists graduating today have a doctorate level education of six years, many have added additional certifications and residency programs to specialize. Irregardless of the education, a CDE should be certified with passing the exam and a BS/MS/Doctorate program completion plus documented training that is reasonable.

Posted by LaNora Cook on 24 February 2009

NCBDE is too stringent in their requirements. We have a RN that volunteers 2 days a week at a diabetes clinic at a hospital near us. She is Spanish speaking and has taught their classes the past three & half years - volunteer hours do not count. We have Promotores - their full-time jobs are diabetes education - they are not RN or RD so may not sit for the exam. They don't adjust meds but make recommendations to the MDs. Let's get qualified people to be able to become CDE.

Posted by Anonymous on 25 February 2009

Like "angivan" I have considered a second career as a CDE, but have been dissuaded by the years of education that would be required. I am a lawyer, 52, and type one for 32 years. It doesn't make sense to be that a diabetes educator needs to have an RN or RD degree.

Posted by Anonymous on 26 February 2009

Tell me this is not a government operation.

Posted by Anonymous on 27 February 2009

I agree with Barbara Bradley in that as nurses it's hard to find a place to deliver diabetes education. There are patients who go do physicians who are not part of a clinic and refer pts to educators but there are fewer programs to refer pts to as hospitals, etc do not want to put money into their programs. I was an ADA Recognized program coordinator and left because the hospital did not want to give me a support staff person, and a year and a few months later closed the program. There needs to be more leaway for payment/reimbursement so there can be more providers and inovative ways to provide diabetes education by CDEs to those who need it.

Posted by Anonymous on 28 February 2009

I agree that we are shooting ourselves in the foot. All we here at meetings is there is a shortage but we bend over backwards to make it difficult to get new educators in the field. The leaders of AADE, NBCDE need to get out of the ivory tower and into the trenchs taking care of patients and helping pts have access to educators.

Posted by Anonymous on 3 March 2009

I have had type 1 diabetes for 47 yrs. and have the following education: Chemistry technologist, Advanced Diabetes Education,
currently writing a Canadian Diabetes Educator. However, I will not be allowed to work because my diploma was not a nurse or a dietician or a pharmacist. As far as I am concerned, I think they should just list the requirements in Canada as a medical professional instead of insisting people be a nurse or a dietician. I have more pertinent education as a Chemistry Technologist than any nurse or dietician when dealing with diabetes.

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