Demand is high for dermatologists and endocrinologists. The trouble is producing more doctors in those fields.

The dermatology residency program at West Virginia University's School of Medicine is the state's only such training program. It accepts one student each year.

According to published reports, Dr. Norman Ferrari, chairman of WVU's medical education department, said that a national accrediting body limits the number of dermatology graduates that member schools are allowed to produce.

To increase its number of graduates, WVU would have to show the Accreditation Council for Graduate Medical Education that there is a need for more dermatologists in the state and that the university has enough qualified faculty to accommodate a larger program.

"They determine how many you're authorized to have," Ferrari said. "We're not at liberty to summarily increase that because there's a need."

Endocrinologists treat patients who suffer from diabetes, thyroid diseases, metabolic and hormone disorders, and certain cancers.

Although residency programs for endocrinologists are readily available, Dr. Joseph Shapiro, Marshall University's medical school dean, said very few endocrinologists are trained each year and fewer students are interested because the pay is less than other medical fields.

Family doctors and general practice physicians can manage most endocrine patients, leaving endocrinologists to treat advanced disorders. And because it's time consuming, endocrinologists cannot treat as many patients per day as other physicians and therefore cannot make as much money. Endocrinologists also do not perform as many procedures as other specialists, Shapiro said.

"You make less money as an endocrinologist than you would as a general practice physician," Shapiro said. "Why would you want to train more to make less?"

Until physicians start earning more money or graduate from medical school with less debt, Ferrari is concerned that interest in endocrinology will continue to decrease.

"Will students end up picking specialties based on the availability of that specialty to help them pay off their debt quicker?" Ferrari said. "It's hard to know how much that weighs into [their decision]."

Dr. Glenn Crotty, chief operating officer of Charleston Area Medical Center, said CAMC has two endocrinologists and is looking to recruit four more, while there are only about 3,000 in the entire country.

With fewer specialty doctors in practice, patients have to jostle for limited available appointments, he said.

And since they likely aren't trained in West Virginia, the chances are greater that specialty doctors will set up practice near the place they last trained, Shapiro said.