Empowering Patients Through Independent Diabetes Care with Dr. Sumana Gangi (Owner of Southern Endocrinology)

In this episode of The Hard Things About Healthcare, we sat down with Dr. Sumana Gangi, a board-certified endocrinologist and founder of an independent clinic in Dallas, Texas. With decades of experience treating diabetes, Dr. Gangi offers a refreshingly honest look at what it takes to build a thriving specialty practice in today’s fragmented healthcare system—from clinical decision-making and technology use to rising overhead and staff turnover.

A Personal Start with a Professional Impact

For Dr. Gangi, diabetes care is more than a specialty—it’s a mission rooted in personal experience. With a strong family history of diabetes, she developed an early interest in nutrition and lifestyle medicine while attending medical school. Recognizing the lack of accessible, evidence-based education for people with diabetes, she began exploring how behavioral guidance could be delivered more compassionately and effectively.

The Realities of Independent Practice

After completing her endocrinology fellowship at the University at Buffalo, Dr. Gangi moved to Texas and launched her private practice. Like many physicians new to the business side of medicine, she discovered the steep learning curve of billing, coding, and operations.

"I thought like you know starting a practice means you open an office and you see a patient and somewhere magically the money gets deposited into the bank account."

Since 2001, reimbursement rates for outpatient visits have remained largely stagnant, even as the cost of running a practice—rent, staff, software—continues to rise. According to the Medical Group Management Association (MGMA), physician-owned practices have seen a 39% increase in operating costs over the last decade, while Medicare payment rates have increased just 9%.

"Every year the reimbursements are going down while our cost of running the business has gone up... to compensate, we end up seeing more patients."

Dr. Gangi’s solution? Shared overhead through physician partnerships, offshore staffing for back-office work, and process standardization using EMR templates and checklists. Today, her clinic operates with a streamlined flow that downloads CGM and insulin pump data before the visit, updates pharmacy and medication history, and triages quality metrics like A1C, foot exams, and vaccinations.

The Cost of Prior Authorization

One of the biggest challenges Dr. Gangi faces is the administrative friction caused by prior authorizations. What used to be a minor hurdle is now a full-time job.

This isn’t an isolated issue. A 2023 American Medical Association (AMA) survey found that 94% of physicians reported delays in care due to prior authorizations, and 33% said those delays led to serious adverse events for patients. Worse, decisions are often made by non-specialists—podiatrists, chiropractors, or physical medicine reviewers—without the clinical expertise to evaluate endocrinology treatment plans.

"If I decide that my patient benefits from this medication, there shouldn't be any questions to be asked... more than half the time, my peers are not endocrinologists... how can they make a decision about my quality of care?"

Staffing Challenges in a Post-COVID World

Like many small practices, Dr. Gangi’s clinic experienced an exodus of staff during the COVID-19 pandemic. Long-tenured employees left for higher-paying, temporary hospital jobs subsidized by emergency legislation. Though those roles often ended within months, the disruption to independent clinics was significant.

Even now, staffing remains a top concern. In a 2024 MGMA report, nearly 60% of medical groups ranked staff recruitment and retention as their No. 1 challenge. Dr. Gangi has tried to counter this by cultivating a workplace culture of respect and connection—offering benefits, encouraging team bonding, and emphasizing mutual trust. It’s helped reduce turnover, but finding skilled medical assistants remains difficult.

Balancing Business Operations with Patient Relationships

Despite growing pressures, Dr. Gangi continues to center patient care. She delegates business operations to an office manager but draws a clear line between clinical time and admin time. During visits, she avoids typing at the computer—opting instead for eye contact and uninterrupted conversation. Her notes are completed later, often in the evenings, supported now by a scribe.

"I always tell myself that I'm a physician first and the business owner next."

The impact is measurable: More than 75% of her patients maintain A1C levels below 7%, a benchmark recommended by the American Diabetes Association (ADA). She attributes this to individualized care, trust, and taking the time to listen. Research supports this approach—studies have shown that higher physician empathy scores are associated with better diabetes outcomes, including lower A1C and reduced complications.

The Future of Independent Endocrinology

With 80% of U.S. counties lacking a full-time endocrinologist, the need for community-based diabetes care is urgent. Dr. Gangi believes independent clinics—empowered by telehealth, remote monitoring, and access to modern therapeutics—are well-positioned to fill the gap.

"Once you join a bigger health system, you are merely an employee... you come under the category of a provider, not a physician."

With modern technology, she believes small clinics can thrive—especially in underserved areas.

"80% of the counties in United States doesn't have an endocrinologist... I don't see a reason to join a bigger health system."

This era is a “golden age” for diabetes care—with access to new medications like GLP-1 receptor agonists, better monitoring tools, and more actionable data. But she also emphasizes caution: Technology should support, not replace, the doctor-patient relationship.

Final Thoughts

Independent clinics like Dr. Gangi’s are doing some of the most vital work in healthcare—especially in chronic disease management. But they’re doing it with fewer resources, shrinking margins, and rising expectations. Her story is a testament to what’s possible when you combine clinical excellence with creativity, compassion, and a relentless focus on what matters most: the patient.

To hear the full conversation, listen to this episode of The Hard Things About Healthcare.