The Economist came out with an article last week, “Squeezing out the doctor: The role of physicians at the centre of health care is under pressure,” which argues that a physician’s traditionally exalted status in our society is weakening. The authors cite the health of the world is changing in a way that may find many physicians unprepared. First, with technology becoming a larger part of health, the role that doctors play may be diminished or shaped in a way that gives less flexibility in their decision-making (through automation, variation elimination through evidence-based medicine, etc.). In addition, as it is reported that about half of American adults have a chronic condition, many doctors who are educated to address episodic care (broken legs, flu, surgery, etc.) lack the training to deal with chronic health problems like diabetes and asthma.
I found this topic very relevant and thought I would continue the conversation myself. It is true that physicians are finding themselves more and more in a digital world, and their role in care delivery is evidently changing as a result. Over the last years, we have seen an explosion of technology in healthcare and a dramatic increase in the use of electronic health records for hospitals and physician practices across the country. Furthermore, as pointed out in the Economist article, massive amounts of private dollars are being spent in home health and mobile technologies to empower consumers to monitor their health. Therefore, I could reason that a doctor’s ability to make independent decisions or professional judgment calls will be severely limited. Data mined from patient records will soon direct doctors to a certain course of action in any particular situation; critics will argue that anything else advocated by a physician than what is prescribed on screen is reckless and counter to evidence-based medicine and research.
On the flip side, I could easily argue that the role a doctor plays today has never been more important in serving his or her patients. In many ways, recent legislation is placing doctors (notably primary care physicians) in the driver seat. The new regulations around accountable care organizations (ACOs) as a part of the Affordable Care Act require physician participation and place a much greater emphasis on primary care (affording it higher reimbursements and a central role in coordinating patient care). In April, the Center for Medicare & Medicaid Services selected 27 groups to become ACOs, of which 21 were physician-run. In the past, primary care doctors in many cases were expected to hand off their patients to specialists after an initial diagnosis. They would never be given the opportunity or tools in which to coordinate care or the chance to lead a healthcare organization. (And this might not be a bad thing: recent research has shown that physician-run hospitals had a 25% higher quality score than those run by non-clinical CEOs.)
No matter what side you fall on, doctors will (and must) cede power to consumers. There is an expectation, whether among payors or employers or the government, that consumers should play a larger role in monitoring their health and selecting health services. We are seeing this come true. Financially, high deductible plans are more in vogue than ever before and require customers to be more conscious of the health services they purchase. We also see that customers are more knowledgeable about their health, as a vast majority of patients flock to the web for health reasons and more frequently challenge their providers in the advice they receive.
With this shift of behavior for consumers, doctors will have to reevaluate how they interact and serve their patients. Some will embrace this change and others won’t. According to a new PricewaterhouseCoopers study, 42% of doctors worry about losing control of their patients due to health apps and mobile technologies that allow patients to be more independent.
Will technology push out our doctors? No. Are their roles changing in how they practice medicine? Absolutely. In fact, with the increasing demand of health services due to an aging population, doctors may be increasingly called upon to cede power to others, particularly mid-level providers (nurses, etc.). The Advisory Board reports that mid-level providers are able to perform about 80% of a primary care physician’s work while collecting about 70% as much in revenue. Doctors, who are under constant pressure to see more patients, may have no choice but to ask others for more help.
Doctors must change with the times, whether that may mean adopting new responsibilities required by advances in technology or ceding other less technical duties to mid-levels. One thing is certain about doctors though; their job may be different today than it has been in the past but no one can argue that they won’t always serve a critical need on the frontlines of healthcare.