First published February, 2012
Physicians consistently ask me where I see medical practice in the future, what is the evolution of medicine as it relates to the doctor patient relationship and to the physician’s role and position in the clinical arena.
Up until a few years ago, I described a future where physicians could either sit on the sidelines and allow the control of medicine to pass them by or they could step up to the plate and take on the “big boys” in health systems and insurance companies and wrestle for control.
After all, a few years ago there was still a light at the end of the tunnel. Physicians were on a nearly 30-year slide from being the top dogs in the healthcare hierarchy, but I thought they had a chance to regain their prominence.
That was then; this is now.
Now, with ACO’s looming on the horizon, 30-40 million new patients being added to the roles of “the insured,” and the crossing of an important milestone – more than 50 percent of all physicians in the U.S. are now “employees” of someone, it appears to me the die has been cast for at least the next couple of decades – yes, decades.
Clayton Christensen, in his excellent book, “The Innovator’s Prescription” speaks to medical “focused factories” where organizations perform a narrow band of healthcare at a highly efficient and highly effective rate, as well as the need for physicians (whom he advocates to become commoditized through the replication of their knowledge in medical equipment and devices) only being used when their intuitive intellect is absolutely necessary for complex diagnostic decision making.
What picture does this paint?
In a mid 21st Century medical practice, I predict the average primary care physician will have a patient load of 10,000 patients translating into approximately 40,000 patient visits per year. Currently, the average patient visits physicians 3.2 times per year. With increased focus on education and prevention, that visit level should increase somewhat – I’m predicting to 4.0 visits per year.
To handle this increased case load the physician will have 10 exam rooms staffed by 10-15 mid-level providers and techs. The physician will spend her day in a control room with monitors displaying the activities in each exam room along with wireless personal digital communicators for each staff member. She’ll be able to hear and see each examination and intervene verbally as she determines necessary or answer questions as required.
Assuming current statistics hold true – it is commonly stated that mid-levels can perform 95 percent of the required diagnostics and care for the average patient, the physician will physically intervene only five percent of the time, equaling 2,000 personal physician visits annually – similar to a current patient load. However, those are in addition to “observed exams.”
The remainder of the time the physician will be the woman behind the curtain, pulling the strings and making sure the clinical process runs smoothly. One thing will not have changed in this future practice; the physician will still have the liability for everything that happens in her office.
Surgical practices will follow a similarly remote experience. While technically possible today, in the future, surgeries will need to be conducted remotely in order to spread the expertise of the shrinking number of physicians to a global stage. Computer advances will allow some stages of surgery to be preprogrammed when coordinated and guided by advanced imaging capabilities, much like an unmanned drone flying over remote villages of the Middle East. Technicians or physicians only need to activate and control the most critical elements of the mission or surgery.
With these capabilities, surgeons can often perform multiple minor procedures simultaneously and multiple surgeons can collaborate on a complex procedure whether located in one room or from disparate remote locations. This collaboration will further enhance the “focused factory” concept whereby physician expertise can be measured and allocated as discreet components within a complex clinical process.
Through technology and shrewd packaging, physicians will be almost completely removed from the doctor patient relationship, replaced by a computer monitor and an avatar developed by healthcare marketers to reflect the most pleasing and reassuring image and voice, in the patient’s native language, for each patient.
On the plus side, no more patient rounds, no more long hours. Patient care will be delivered 24/7/365 from any control panel in the world and physicians will only need to work their designated shifts, relived by the next “intuitive commodity” at the end of the day.
Reflecting back to today, the conversation I constantly hear among healthcare administrators, policy experts, politicians and vendors is one of making physicians more efficient. Whenever I engage one of these conversations, my constant admonition is simply this, “When in an exam room with my physician, I want my physician to be effective – I don’t care a wit about efficiency.” Which physician do you want to be?