I had lunch with a group of physicians recently and along for the ride was a college student thinking of applying to medical school. When talking about the future I suggested that the work of a physician 30 years from now will be hardly recognizable to today’s physician. Everybody disagreed and the student was confused. There was a lot of denial and myopic rationalization.
But I can’t blame them, really. Most of us see what’s immediately changing in our day-to-day work and the bigger picture gets lost. For most of us the role of the physician is hard to see for anything other than it always has been. Most live and work as the self-determined independent care coordinator reactively working to treat disease just as its been done for over a century. But change is happening around us.
I see three forces driving change in the physician role:
Technology. In the 19th century we treated symptoms. In the 20th century we treated diseases. In the future we will predict and prevent disease. Much of what we do diagnostically will be replaced by technology.
Third-party control. The days of independent decision making are numbered. Evidence-based measures rooted in resource control will rule the future. Much of what we do will slowly approximate automation.
Patient empowerment. Since the dawn of medicine physicians have been defined by their unrestricted access and control of information. But unbridled access to information is changing the role of the patient. This shift is changing the way we see patients and the way they see themselves.
I’m in no way predicting the end of the physician. There will always be disease and the need for a human docent somewhere amidst all this technology, information and administrative control. I just think that the way we understand the physician will be remarkably different 30 years from now.
As doctors none of this is in our control. But we may ultimately be defined by the role we play as these changes evolve.
I want to cultivate this into something a little more involved. If you have any ideas that might be helpful leave comment below. If you’re a transparency conscious physician feel free to drop me a line via electronic mail or tightly sealed envelope.
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You are correct…. and this is what I teach residents and medical students everyday. A good friend who is a fellow in Boston, MA and I frequently collaborate about taking this further…. at this point to get *in front of it*… but ultimately so docs especially are not swept away by the changes taking place. There will always be a role for the physician… they will need to learn to assume the role of team member, leader, etc… as opposed to the paternalistic role they now play in health care delivery. Give me a call sometime.
Brian,
I agree with you whole heartedly. I have been in practice for 10 years. I already see the evolution and the daily nudges in that direction.
Medicine will be drastically different 30 years from now. I think it will be almost unrecognizable 10 years from now.
Anyone else uncomfortable with playing the victim? Because I am. And it’s surprising to hear you take this stance, Bryan. The slippery-slope fallacy here is killin’ me.
Technology. Since when is it the enemy? To the contrary; it is a doctor’s weapon to wield as the focus shifts to disease prevention and prediction.
Third-party control. Right now the only third party with control is the corrupt private sector. Evidence-based medicine is taking center stage in the fight against corruption of medicine (that’s you, Pharma). The only way the days of “independent” decision making are numbered because SHARED decision making will take its place, if we do it right.
Patient empowerment. Fits right in with shared-decision making, and your version of “third party control” is in direct conflict with what you say about patient empowerment. How can we have the emergence of patient empowerment at the same time as independent decision making deteriorates (thought I don’t see that happening, as I said).
I see one force driving change in the physician role: physicians.
There’s no getting “in front of it”. Be it. 3.0–I thought this was what we’ve been talking about all along.
Becca. I think you may have misunderstood. And for good reason since the piece could be perceived as a pity party. I was just trying to make the point that what doctors do is changing dramatically. What you wind up doing on a day-to-day basis at the end of your career would likely be unrecognizable to today’s doctor.
You can look at this any number of ways. I see most all of it as positive; the role of technology and the evolution of the doctor-patient relationship is particularly exciting. I have to confess that I find 3rd party control discouraging but it’s likely a necessary evil to control the exploding cost of the tech element. While I’d like to blame it all on the insurance industry I think that we’ve barely begun to understand this issue here in the U.S.
And you are right, physicians are a bigger force than I may have suggested. That’s why its very important that the next generation of physicians participate in the definition of who we are and what we do. That’s you and your comment here is a critical piece of the dialog that needs to happen between generations.
Finally, I love your comment and respect your passion. Your willingness to speak up will define you as one of those leaders of our next medical generation.
Becca Camp- you rock my socks clean off!!
Doctors have been doctoring since technology was “heat up a pot a water so we can sterilize this thing.”
Psychobiologists have been squabbling amongst themselves if the human race is evolving or devolving for fifty years now… FIFTY YEARS.
Devolving? or Changing?
Cheers. Adore you!
Melissa
Thanks, DS. And I adore Becca (and her spirit) as well. I think devolving may need to change. May carry some kind of judgment connotation.
Great points – The patient empowerment part is the most compelling. Because medical knowledge is no longer confined to the alchemist’s scroll or the latest edition of the PDR, a patient’s understanding of his/her condition can sometimes rival or exceed that of a trained physician. While patients have always retained their right to make an “independent” decision, they had not the expertise to effectively and confidently make it – but this is fast changing. Shared decision making is a bit of a misnomer, since ultimately somebody has to take responsibility for the decision. “Shared Knowledge” is probably a better description of that concept, and when employed effectively, can help people confidently manage their health and care with the support of their physicians.
Great points, Mike. What’s exciting about the patient arm of the trifecta is the fact that this is something that we can really influence and mold. The technology and 3rd party stuff is a little harder to simply influence. In fact, doctors and patients have alot more in common and need to band together in properly handling both technology and other outside influences.
DrV, what you talk about here is what we refer to as the 4 Ps, predict, prevent, personalize, participate. What I’m most interested to hear from you is what physicians can be doing today to be a part of all of this. I agree with you that physicians and patients need to work together, but understand that physicians feel squeezed for time. How can the rest of us working in these offices and hospitals support you?
You’re so kind! I am really excited to be a part of the dialogue; I can only hope to spread that enthusiasm to my fellow future docs.
I do definitely think that “devolving” is not the word you’re going for, unless you want to convey nostalgia and stubbornness. I don’t believe that’s quite your style, DrV. “Evolving”, though perhaps an overused term, is what I would call it.
I would like to officially put the concept of “Doctor Empowerment” into the cloud. Maybe it needs a name change—I don’t want anyone to think I’m talking about power dynamics in the dr/pt relationships. At any rate, I’m talking about the mobilization of clinicians to have a voice, to be a player in deciding HOW we integrate all these things that are changing the role of doctors. Can we make WebMD disappear? No. Can we pretend that DTC genomic testing doesn’t exist? Of course not. But can we do research to determine exactly how we can use such things in the clinical setting, resulting in better patient care? Certainly! I can tell you first-hand…I was doing it at Mayo all summer.
To what part of all that would you ascribe the term “devolution”?
Day to day activities will change, yes. But delivering the best possible patient care to everyone is the job of a doctor, and that’s what matters in my book. We should get more people into medical school who feel similarly.
Sidenote: I’m interested why you think private insurance is the headliner for third-party control. I’d say it’s pharma, to whom we can trace back nearly every problem in our system.
I think you are right on target and that the three drivers you identify are the key elements. However, I believe that the only thing that we can predict correctly is that things will change and we will likely be off base in terms of predicting what the nature of the change will be. Delivery the best possible care to patients is not the exclusive preserve of physicians and many of the jobs that physicians do today will be delegated to less expensive people or automated and done by machines in the future. It is the pathway to make health care available and affordable to the many. Resistance to this is justified primarily on the basis of self interest of the medical profession.
For physicians to remain both useful to patients and employed while their previous jobs are delegated converted to rules based tasks is the challenge. Will the technical elements require the knowledge base we require for medical school, or should we look for those who are simply good with their hands? Will the organ based specialty designation survive or will they become useless vestiges like male nipples? Will the training received by a present day resident provide any of the skills that he/she will need in 10 years?
What jobs will patients hire us to do or will we not actually work for patients?
For an insightful analysis see “The Innovator’s Prescription” by Clayton Christensen.
The future of medicine will be very different, however, I don’t believe that framing third-party control is correct. The adherence to evidence based research is because medicine has evolved in many areas from art to science and there is more precision in diagnosis and treatment. It’s not just about resource management. There will always be areas where medicine isn’t as clear cut and reliance on clinical intuition will be paramount and in those areas physician autonomy should be respected.
You also should have focused on the impact of globalization which may play a significant impact and the possibility of outsourcing specialty care. http://davisliumd.blogspot.com/2009/12/why-medical-students-should-chose.html
Not entirely clear if patient empowerment will be significant in 30 years because is this what Americans really want? http://davisliumd.blogspot.com/2010/09/empowered-patient-is-this-what.html
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Davis Liu, MD
Author of Stay Healthy, Live Longer, Spend Wisely: Making Intelligent Choices in America’s Healthcare System
(available in hardcover, Kindle, and iPad / iBooks)
Website: http://www.davisliumd.com
Blog: http://www.davisliumd.blogspot.com
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