PNA Spotlight: Dr. James Grua
This month the PNA Spotlight shines on Dr. James Grua, an endocrinologist in Salt Lake City and Saint George, Utah, a Clinical Instructor of Medicine at the University of Utah, and an adjunct Assistant Professor at the University of Nevada Las Vegas. Dr. Grua earned a PhD in Steroid Biochemistry and then got his MD at the University of Utah, did his residency at the University of Wisconsin, Madison, and returned to the University of Utah for a fellowship in adult and pediatric endocrinology. He specializes in acromegaly, growth hormone deficiency, hypopituitarism, pituitary adenomas, and thyroid issues. Dr. Grua is also a member of the PNA. He agreed to answer some questions from Highlights editors. Here are his responses.
What is your primary focus?
I do just pituitary and thyroid cases, with an interest in growth hormones, as we spent years doing clinical trials.
What do you see as the future of your field?
I see endocrinology as being more influenced by genomics - DNA testing and more monoclonal antibody treatments.
What should patients know about endocrinology?
I worry that many pituitary deficiencies are not treated - such as looking at a TSH only in assessing thyroid function - which seems less than ideal if a patient has a pituitary problem.
I most worry that the explosion of government regulations in the past 10 years and those planned for the next 8 years are so destructive to the medical practice and so costly, that no doctor can afford to do endocrinology. Despite a huge shortage of endocrine doctors, reimbursements are among the lowest in all of medicine.
You doctor has to spend all of his or her time with his or her back to the patient typing on the computer – because of all the unending government-required rules on documentation.
Doctors are quitting, quality of care is going down, and costs are skyrocketing all because of rules made by nameless bureaucrats.
I am immensely bothered by the explosion of 'hormone' clinics popping up all over the U.S., staffed by naturopaths, chiropractors, family docs, and/or nurse practitioners who have no training and just decide to market themselves as hormone specialists.
What should patients know about you?
I love what I do, I enjoy almost all patients as friends. Patients should also know that not all fatigue and weight gain is due to their hormones.
Why did you get involved with the PNA?
My focus is on pituitary issues and PNA is a great voice to educate patients and providers.