Nancy Fabozzi's Blog


Predicting the Future of Healthcare and the Evolving Role of Doctors

11 Apr 2016 | by Nancy Fabozzi
Share this:

Expect Not a Doctorless Future but a Future with Less Doctors

While the traditional doctor-patient relationship and mode of interaction has many positive benefits, it is a highly expensive and inefficient model (at least in the US) that denies access to medical care to a large swath of the population. Why? Because a) there are not enough doctors to serve all patients, and b) many people cannot afford to go to doctors - increasingly, even if they have health insurance.

There is great concern about a growing shortage of doctors in the US (America’s facing a shortage of primary-care doctors). There is also great concern about unsustainable medical cost inflation and the lack of affordability of basic healthcare services.  Is there a better way to provide high quality and low-cost medical care beyond the traditional doctor-centric approach?

Doctors are extensively and expensively trained and are some of the highest earning professionals in the US. As a society, we have given individual doctors a great deal of control over healthcare decision-making and allocation of expenditures and yet have some of the poorest health outcomes relative to expenditures among all the countries of the world.  Thus, one could argue that the US model that places the highly paid doctor at the top of the medical care hierarchy is broken and what’s needed instead is a flatter medical care team that incorporates non-physician care-givers to handle more routine tasks. This is absolutely the trend in US healthcare today, with nurses and physician assistants taking on greater importance as pressure grows to find a more efficient and effective means of providing greater access to medical care at an affordable cost.

Payment reform is also driving the trend to expand responsibilities among the medical care team. Fee-for-service reimbursement is still the predominate healthcare payment system in the US although that's changing rapidly with the move to value-based reimbursement (VBR) which puts more onus on doctors to be accountable for patient outcomes.  The advent of VBR along with the doctor shortage is opening up the need to incorporate a more diverse set of actors to manage all aspects of patient care. The role of information technology (IT) is a key facilitator of this paradigm shift, and holds great potential to expand access to care and empower both physicians and non-physician caregivers as well as patients themselves.

Today, the traditional doctor-patient relationship is being disintermediated. Lower cost, non-physician care givers will be able to safely and effectively take on more medical responsibility with the aid of advanced IT systems deployed across all care settings, including the home.  In addition, a variety of IT, med tech, and scientific innovations combined with cultural and socio-economic changes are coming together to create a future where we will rely less on human doctors (and other human caregivers) for routine primary care and medical treatment. That inevitably means that we will depend more and more on IT, and yes, eventually, this technology will absolutely replace some of the work that human caregivers, including doctors, are doing now. The notion of "doctor" and even “nurse” will be expanded and advanced to include digital or "electronic" doctors and virtual care. It may be hard for some to imagine now but I believe that people will come to accept this mode of medical care as quite natural, convenient, and appropriate—and it will happen sooner than we think due to the cost pressures facing the US healthcare system. 

The short-term implications of the looming US doctor shortage will likely mean that access to care will become even more difficult for some segments of the population. The good news is that we are entering a renaissance of innovation in digital health and scientific innovation that will revolutionize medical care.   Many great minds are at work to figure out how we can move beyond our dependence on an expensive, doctor-centric model of healthcare to a more expansive system that can better solve some vexing issues around cost, quality and access.  The Qualcomm Tricorder X Prize is one example of how technology is enabling this transformation. The pieces have not all come together yet but they absolutely will.

Does this mean we face a dystopian future dominated by cold, analytic medical cyborg "electronic" doctors? I absolutely do not see it that way. Many aspects of life that influence our health and well-being are in dimensions that are beyond the traditional focus of our healthcare system. We must devote greater focus and greater financial resources to these areas which include things like our social interactions, community settings, housing status, nutrition, transportation, employment, stress levels, and so on—the so-called "social determinants of health". Perhaps if we shift more dollars away from high-cost, doctor-centric traditional medical care we can open up more resources to devote to other types of care giving, with human and non-human intervention, that can positively impact our health.

So what about doctors? They won’t disappear anytime soon. Yes, we will still need and depend upon doctors of medicine and surgeons to care for us when we are sick – under certain situations.  However, as a society, we will start to make the transition away from the notion that all medical care must necessarily be dictated by a physician.  Honestly, do we need to pay a doctor $200 for a blood pressure check in this day and age? National health systems must start planning for a future that is less dependent on doctors – and that’s not necessarily such a bad thing. 

Comments: