This is a guest post by Wen Dombrowski, MD
During medical school and residency I realized that individual physicians can choose to Lead or Be Led. Each of us can try to design and manage the systems of care we would like to see (whether care models or technology that enables them), or physicians can be victims of what others decide we should do (such as administrators, sales reps, or well-intended developers without user experience insight).
I recall over a decade ago there were critics who lamented the rise of HMOs and Pay For Performance would end the Practice Of Medicine as we know it. Various medical organizations encouraged physicians to run away from these changes so they could continue business as usual. But while many physicians had their head in the sand and academic faculty were often shielded from practice management realities, the business world continued to evolve with new budgets, rules, and technology.
There are parallels to then and now : physicians are facing unprecedented changes -- some embrace or at least reluctantly accept change as inevitable, but many physicians have told me "I don't understand what any of that ACA/ACO/PCMH/MU/ABCDEFG is about, so I'm just going to ignore it and just be a doctor." Then they are surprised when their hospital, state, and federal policies don’t reflect what they would want.
When I tell people I chose to focus on healthcare administration and technology, many often ask "why did you stop being doctor?" My response is that I am still a doctor, and every day I use my knowledge of diseases and workflow to help not just 20 patients per day, but to improve the health of thousands of patients each day.
This brings up the question of what defines a Physician?
Both healthcare professionals and nonprofessionals often only think of the 10 x 10 foot office or hospital rounds. But like many other physicians, I chose medicine because it is a Helping Profession, and I want to help as many patients as possible to maintain and improve their health. We each have a responsibility to use our talents and tools to help patients...for some this may mean being a neurosurgeon, researcher, public health official, or CMIO, et al.
There are several converging factors in healthcare influencing upcoming trends such as telehealth and decision support:
* High cost of medical care
* Shortage of health professionals
* Rising consumer demand for convenience and instant answers
* Increasing development of predictive data analytics algorithms and internet connected technologies.
Telehealth will be a game changer for physician roles. Home monitoring, video visits, and other ways to connect patients and health information to clinical experts will disrupt the current face-to-face-only model of care.
Clinical Decision Support is often discussed in the context of physician decision making, but I think it’s inevitable that some CDS tools will move to the lay health worker and consumer level. However, I don’t think CDS computer algorithms can fully replace humans, especially with complex cases that don't fit the common presentation of common diseases. Also, artificial intelligence projects like IBM Watson are limited by Publication Bias because research about rare diseases or drug trials that show adverse effect are not published. These challenges create opportunities for physicians to position themselves as the Expert about complex rare cases and/or get involved in developing AI algorithms that make sense.
The technological and economic context of healthcare continues to change rapidly. Physicians can either proactively lead the change, or settle for whatever others impose on them.
About the author:
Wen Dombrowski, MD
Physician executive intersecting Technology, Business, and Policy