The Future Is Fine. I'm Concerned About The Present

How will the practice of medicine change in this new environment?

I'm sitting outside of Club Isabella waiting for a friend. There are six medical students at a near by table enjoying food, friendship, and a moment away from their daily stress. What do they talk about? They joke and laugh about doctors and classes, routines and procedures, and their daily grind. They are an interesting group. Two are women. Four appear to be of Asian descent. One, a tall thin white guy with his baseball cap on backwards, appears to have been delivered to us from Central Casting. They wave and shout to their friends walking by. They are incredibly normal.

I find this terribly reassuring. At 56, I am looking at the people who will be caring for me 20 years from now. They are bright, engaged, and sound like they are actually enjoying their work. This is important. If all of this work, time, and effort is just to get a title, a job, and a paycheck, they will never be fulfilled. And they probably won't be very good at the practice of medicine. One can only hope that their discussions of cadavers (over dinner!) is a precursor of great careers.

This concerns me, the general happiness of physicians, because so much is changing in the practice of medicine. Many previously independent doctors are now, in 2011, employees of the major hospitals. Some have adjusted to this change. Some doctors embraced this. Many, however, have not. Being an employee, even a highly compensated one, is not the same as being your own boss. There is a certain freedom in being an independent business owner. And other doctors, like radiologists, have seen specialty treated like a commodity.

I'm not ready to have my health dependent upon the lowest bidder.

Our young doc-to-be's at the next table have not experienced any of this. There is no transition for them. Medicine will be a corporate enterprise for them, complete with signing bonuses and holiday pay.

How will this impact the way they practice medicine? For one, they will have been initiated, from day one, into a system that allocates a specific number of minutes per patient. They will be instructed in profitability. They will always know the origins of their income. And once you are in this system, how hard is it to change employers? If, or when, the government becomes the major or single payer of health care, would these doctors even notice?

Hard to say.

We face a looming shortage of primary care physicians and gerontologists. I didn't ask any of the future docs what they wanted to practice. I only wonder if their future employers will bother to ask.

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Steve Rosen September 14, 2011 at 01:47 PM
"Watson" being put to use by Wellpoint is a perfect example of where medicine is going. An effort to employ best practices and statistical based care is where we are heading. That's not to say doctors were not already looking at such evidence when deciding a course of treatment. But, as you point out, more and more of a doctor's discretion will be limited by their working for a corporation. All that talk of "death panels" was silly, but isn't Watson going to decide if Wellpoint will pay for a 91 year old man to have a hip replacement two weeks after being diagnosed with stage four cancer? As you know, technology is changing the way health care is provided. It also has the ability to increase costs or decrease costs, depending on how we use it.
Dave Cunix September 15, 2011 at 12:50 PM
Anthem / Wellpoint, Anthem Blue Cross in Ohio, is very excited about this partnership with IBM to utilize Watson technology. Inevitably, a local doctor's treatment plan will differ from Watson's analysis of best practices. This will trigger an independent third party review. Will this inhibit new ideas and new treatments? The 91 year old needing an expensive procedure is an issue we, as a society, have yet to address.


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