Vinod Khosla: Technology Will Replace 80 Percent of Docs

Vinod Khosla: Technology Will Replace 80 Percent of Docs

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I recently viewed health care through the lenses of a technology entrepreneur by attending the Health Innovation Summit hosted by Rock Health in San Francisco. As a practicing primary care doctor, I was inspired to hear from Andy Grove, former CEO of Intel, listen to Thomas Goetz, executive editor of Wired magazine, and Dr. Tom Lee, founder of One Medical Group as well as ePocrates.

Not surprising, the most fascinating person, was the keynote speaker, Vinod Khosla, co-founder of Sun Microsystems as well as a partner in a couple venture capital firms.

“Health care is like witchcraft and just based on tradition.”

Entrepreneurs need to develop technology that would stop doctors from practicing like “voodoo doctors” and be more like scientists.

Health care must be more data driven and about wellness, not sick care.

Eighty percent of doctors could be replaced by machines.

Khosla assured the audience that being part of the health care system was a burden and disadvantage.  To disrupt health care, entrepreneurs do not need to be part of the system or status quo. He cited the example of CEO Jack Dorsey of Square (a wireless payment system allowing anyone to accept credit cards rather than setup a more costly corporate account with Visa / MasterCard) who reflected in a Wired magazine article that the ability to disrupt the electronic payment system which had stymied others for years was because of the 250 employees at Square, only 5 ever worked in that industry.

Khosla believed that patients would be better off getting diagnosed by a machine than by doctors. Creating such a system was a simple problem to solve. Google’s development of a driverless smart car was “two orders of magnitude more complex” than providing the right diagnosis. A good machine learning system not only would be cheaper, more accurate and objective, but also effectively replace 80 percent of doctors simply by being better than the average doctor. To do so, the level of machine expertise would need to be in the 80th percentile of doctors’ expertise.

Is it possible technology entrepreneurs can disrupt health care? He challenged any doctor in the room to counter his points.

Silence.

Was it because everyone agreed? Were the doctors in the room simply stunned? Was there a doctor in the house? And where did he get that 80 percent statistic?

Was Kholsa serious that technology could make health care better by utilizing large data sets and computational power to clinch better and more precise diagnoses?  Was he simply being provocative to hear other points of view to learn even more? Like many others in the conference, he believes that giving consumers more opportunities, access, and choice to information about themselves and their bodies would empower them to do the right thing. He held up an EKG attachment to the iPhone which was just one of many consumer directed products in the pipeline his company has invested in.

Kholsa is a very smart and successful entrepreneur. Does innovation mean the two guys in a garage who come up with a radical idea or is it possible that innovation is having people with different experiences and point of view looking at the same problem as best selling author Malcolm Gladwell noted in his New Yorker piece Creation Myth –  Xerox PARC, Apple, and the Truth About Innovation? Surely to make health care better, technology entrepreneurs must engage with doctors. All the speakers before and after Kholsa spoke about the incredible value and insight different stakeholders to bring to the table.  The most vocal? The doctor entrepreneurs and those who worked with doctors to bring their ideas to market.

Kholsa’s criticism of the health care system is completely valid. Can we do better in being more reliable, consistent, and creating a system process and design that is comparable to highly reliable organizations and industries? Of course. Can we be more systematic and doing the right things every patient every time on areas where the science is known to level of the molecule? Yes. Care must be incredibly simple to access, extremely convenient and intensely personal.

It isn’t that we don’t have smart people. Compared to a century ago more illness are understood, specific medications and treatment protocols can be designed. But we haven’t solved it all. When we thought we knew it all, we were shown how little we truly knew. Thirty years ago, doctors predicted the demise of infectious diseases as a specialty, another footnote in medical texts as more powerful antibiotics and vaccines were available. Enter AIDS, the swine flu, and many super-bugs which have humbled our profession. Ask accomplished physician and writer Dr. Abraham Verghese about his experiences. Dr. Verghese is rightly worried, as many others are, that even doctors are being too focused on the iPatient and not on the real patient as he writes in his New York Times op-ed Treat the Patient, Not the CT Scan. Is this what we want our health care system to look like?

Health and medical care is an incredible intersection of technology, science, emotions, and human imperfections in both providing care and comfort. As conference speaker Dr. Aenor Sawyer, an orthopedic surgeon from UCSF noted, we need to figure out how to have our different cultures of doctors, gamers, designers, and technologists interact. Fixing health care is more than simply “we know the problem and we know the solution”. She reflected that the level of dedication, perseverance, and a willingness to make impact among the different groups demonstrates more similarities than differences.

I know health care can’t simply be solved by smart people in Silicon Valley alone.  To solve health care we need everyone to collaborate. As Harvard Business School professor Amy Edmondson noted in her book Teaming

“For over a century, we’ve focused too much on relentless execution and depended too much on fear to get things done. That era is over…human and organizational obstacles to teaming and learning can be overcome…Few of today’s most pressing social problems can be solved within the four walls of any organization, no matter how enlightened or extraordinary… Generating ideas to solve problems is the currency of the future; teaming is the way to develop, implement, and improve those ideas.”

Perhaps Kholsa’s call to action was simply an entrepreneurial mindset, but simply ignoring those who have chosen a field to improve and safe lives and who meet humanity everyday on the front-lines is problematic and dangerous. There are some things that may never be codified or driven into algorthims. Call it a doctor’s experience, intuition, and therapeutic touch and listening. If start-ups can clear the obstacles and restore the timeless doctor-patient relationship and human connection, then perhaps the future of health care is bright after all.

Davis Liu, MD, is a practicing board-certified family physician and author of the book, “Stay Healthy, Live Longer, Spend Wisely – Making Intelligent Choices in America’s Healthcare System.” Follow him at his blog, Saving Money and Surviving the Healthcare Crisis or on Twitter, davisliumd.

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90 Comments on "Vinod Khosla: Technology Will Replace 80 Percent of Docs"


Guest
Aug 31, 2012

Let me tell you what machinization is going to do to medicine: exactly what it did to “other industries”.
It will industrialize it into several predefined sizes to fit all (more or less).
It will not reduce the number of knowledge workers, but it will allow the work to be moved to areas where labor is cheap, plentiful and hidden from the ultimate user.
It will redefined “quality” to mean “quick ,cheap and lots of it” (think plastic forks).
It will centralize the physical venues for obtaining and distributing it to the masses (think plastic forks at Walmart).
It will create several tiers of service, from Per Se to Cheese Factory to McDonalds, or Neiman Marcus, Macy’s and Walmart, or Lexus, Honda and Chevy Neon (used), or …. everything else.
It will redefine health “care” to be health “services” and all those visionary leaders of ours will make enough money to never have to set foot into one of their “innovative” creations.

Guest
Mike
Aug 31, 2012

To Margalit Gur-Arie:

Most of what you have told us “is going” happen to medicine has already occurred. And already a lab test can diagnose more than half of patient problems. As we improve our testing this number is going to increase, and treatments are going to also be better matched to specific patients.

There is always going to be some “care” in health – for the same reason there are few atheists in foxholes. If we trust progress and maintain faith for human compassion then we can drive most of the mercenaries out of healthcare.

Mr Khosla voiced profound statements; he is successful and talented. But his statements are not new. He had a stage and was able to synthesize the ideas of others to gain appropriate attention to an area of need. Kudos to Mr. Khosla and Dr. Liu!

Guest
Christine Wren
Sep 3, 2012

Mechanization and automation _will_ reduce the number of knowledge workers in the field. It is already happening in other large swaths of the economy.

One of the most significant, if under-reported, aspects of our long jobless recovery is that automation is doing a great deal to improve productivity, while minimizing the need for more human-filled jobs.

Tom Edsall wrote in July about this “hollowing out” (http://campaignstops.blogs.nytimes.com/2012/07/08/the-future-of-joblessness/) wherein jobs at all levels of the economy are losing to automation.

Erik Brynjolfsson and Andrew McAfee of MIT recently wrote Race Against The Machine (http://amzn.com/0984725113/) which makes explicit the claim that the knowledge economy has now developed to a point where knowledge workers are losing to the machines which embed their knowledge.

Doctors are right to be worried that they will lose as automation overtakes healthcare. But they are no more privileged in this fear than are other credentialed professionals (lawyers, etc.) who are also losing the race.

Guest
Linda DiFeliciantonio Rocca
Sep 4, 2012

Thank you, Christine, for stating the obvious but the under-reported: automation has replaced, a stat cited, up to 28% of all jobs in the US. When are the politicians and the media going to bring this front and center? I

The medical community can expedite and perfect the prognosis/diagnoses methodology through the use of advanced intelligence diagnostics but the future also involves changing healthcare delivery in general. Why replace organs when we can re-grow them? We already have the technology in place but we lag behind Europe due to our outmoded FDA regulations, slow adoption of big pharma and their constituency and physicians’ archaic paradigms: we do things because it’s always been done this way?. We all know that Innovation starts with the desire for improvement but change needs to be ‘adopted’ first and foremost. It’s time for cross-functional and multi-dimentional solutions to tip the scales…computers and robots included.

Guest
io
Jul 2, 2013

doctors earn too much for a profession which relies so much on memory! mathematics is much harder and yet paid a lot less!

Guest
Dr. Know-it-all
Oct 11, 2013

so you’re saying that people who play with their calculators should earn more money than people who save lives? how idiotic and absurd. BTW, medicine is much harder than math, and that is a FACT. For proof, just look at people like you who does math for living because you didn’t have the scores to get into medical school. HA!

Guest
Jacqueline Mosqueda
Jul 16, 2014

I agree with you 100% but have a few things to add all based on my experience of 30 years as a Registered Nurse and 6 years as a Clinical Informaticist:
The available technology is phenomenal! But if BMW hires 12 year olds with no experience to build the cars, they aren’t going to function to spec. This is what is happening today in Healthcare Technology. In theory and on project plan, yes, the computer program is safer, smarter, quicker, and more thorough than any human. But the practice of hiring a 20-something keyboard hog (on the cheap) with little life experience and therefore no concept of the magnitude of importance the build holds, coupled with being on a “Team” which in today’s world just means when the thing doesn’t work none of the team members need worry about being held accountable, and add in that the health systems who are buying the technology are relying on the vendor to have a system of checks and balances in place to ensure everything functions correctly—which they do not! Well, maybe they do, in the virtual world, tied up with a fancy ribbon, something to pull out for the regulatory body in on an infrequent percursory visit, but that doesn’t, in all reality, even make it as far as the laptop of the next step builder.
Physicians today who practice clinically, are in it for the calling, not the money. Any person who goes through that many years of study with little or no financial reward, and is intelligent enough to have chosen any profession ,and who could right this minute be lying on a resort beach as a lifestyle while managing someone’s Hedge Fund instead of impacting real people in their real lives on a daily bases–in other words, dealing with blood and guts–these are the people who deserve the awe and the respect.and who’s voice needs to be heard about how technology plays out when the rubber hits the road. But they are not being heard, even when they voice legitimate concern over the computer programs they are contracted into utilizing. Even when they point out the dangers in the technology, and even when they are forced out of practice because they cannot afford the technology and refuse to succumb to partnering with the wealthy technology giants to stay in it–as a matter of ethics.
Personally, if you call yourself a physician but you didn’t practice for 30 years before selling out to Daddy Warbucks, I don’t care what you think–and I won’t be buying what you’re selling.

Member
Aug 31, 2012

idiocy. and they wonder why we look at ’em sideways when they come into our offices selling cloud-based awesomeness.

Guest
Sep 2, 2012

And what’s wrong with awesomeness?

Guest
J.T.
Aug 31, 2012

This absolutely the truth of where we are headed in healthcare from Mr. Khosla . I have thought the exact same thing countless times before myself. The only question is how long it will take to get there.

There is no guild that is safe to capital intensive technology solutions to artificially high guild induced labor shortages. The legal profession is currently in the early stages of being crushed by the e-discovery and legal content industry (legalzoom.com, pangea3, etc.) . A lawyer can supposedly be as productive as 300 lawyers of yesteryear now. Accounting software is further behind in terms of displacing accountants but that is speeding up (turbotax, experian, etc.). Higher education is going to be forced to change radically in the near future and technology will be part of that transition. Next up healthcare…

Contrary to what most self-aggrandizing physicians think, most of their work can and will be done primarily by machines. Better, consistent, reliable, cheaper machines… They will begin morphing into the role of highly skilled technicians, but with much less status. Like many others, their future will be as typical salaried employee wearing a big name tag at eye level “Welcome to healthmart, how can I heal you today?” Only a matter of time…

Guest
Mark Freeman
Aug 31, 2012

You can’t really believe that computers will replace healthcare providers in the next 30 years? “Self-aggrandizing physicians” as you speak, will still be providing the best care…it just that only the wealthy will benefit from their services. For everyone else, you suggest that White Castle will do. Sad.

Guest
House
Sep 2, 2012

Dr. Freeman,

Read Kurzweil’s work on exponential growth of technology. The changes that we are going to see in the next ten years is going to be unimaginable at this time…30 years is way way long time make any projections…

Guest
Russ Gerber
Aug 31, 2012

This piece is from someone who is open to fresh ideas. Not all of them may be great…or even good. But I’d trade the occasional dud for the opportunity to discover a problem-solving idea that was invisible to some people but obvious to others.

Guest
Cynthia
Aug 31, 2012

I imagine it’s much more difficult to design a machine that can care for newborn infants and severely handicapped adults than it is to design a machine that can make decisions and solve problems at top levels of business or accurately diagnose illnesses and devise the best available treatment plans. So if anything, the corporate world has got it all backwards in assuming that it’s easy to replace lower-skilled workers with machines, leaving most of the highly skilled work in the hands of humans.

Look at this way: being a top-notch corporate executive is very much akin to being a grandmaster chess player. Or, being a great medical diagnostician is simply someone who’s really good at algorithmic thinking. Needless to say, these are the kinds of skills that a computer is very good at doing. OTOH, it requires a highly advanced robot with a great deal of touchy-feely skills to care for our neediest and most helpless members of society. In fact, most of our IT companies have designed machines with decision making/problem solving skills that rival that of our most highly-prized corporate execs or our most gifted medical diagnosticians. By contrast, it’s still very challenging for the most advanced robotics labs in the world to design a robot that can do the touchy-feely work that’s required of our most prized and highly valued bedside nurses.

That’s why I propose that we replace most healthcare executives making seven-to-eight figures and many medical doctors with six-to-seven-figures with robots that’ll work for free (24-7), freeing up the necessary funds to provide all bedside nurses (as well as all hands-on physicians) with a much needed cost-of-living raise! It’s time that we get back to rewarding skills that humans will always be far better at doing, despite all of the advancements we make towards making robots more and more like ourselves.

Guest
bmore_bulldog
Aug 31, 2012

The cloud is a paradigm of interconnected openness. Over 60% of web-users under 35 report critical infrastructure weakness in critical tasks at least 3 times a week. Disruptive innovation will spur entrepreneurial synergy that will diversify operations systems, creating opportunities for creative asset parameterization.

I wonder how long I could speak like that at one of these conferences before they noticed I was making fun of them?

Guest
Dixie Dawg
Aug 31, 2012

Another paragraph that includes, pivot, discernable matrix and theonoms and they would throw money at you , especially if you gave them a first round shot at your “A” series. Hay, who wouldn’t want a sunrise theonom that is Think Tank proven to deep shift the lax ellipticals in your burn rate.

Theonom /s an applied for registered trademark /s of the one and only Dixie Dawg from the tale pines of South GA. Even us Rednecks can to the VC thang.

Guest
tcoyote
Aug 31, 2012

Big thinkers like Khosla have had an embarrassing track record investing in healthcare over the past twenty years. The Silicon Valley geninuses have squandered hundreds of millions of dollars of venture money in “molecule of the month” biotech companies, brought us “recreational genomics” from 23andme, etc., and $3000 a test single gene tests with debatable connections to future health risk. It’s been fun to watch. Glad not to be one of their limiteds.

The healthcare landscape sure looks different from 40 thousand feet than it does from the ground. I think Khosla’s thesis is abject bullshit. It’s not just diagnosis physicians do, but manage evolving and complex situations in real time. Knowing the patient and knowing how patients think and act is really important in being a good physician. We’re a hundred years away from knowing enough about human disease to do what he suggests. Sounds great as a TED talk though.

Guest
Mark Freeman
Aug 31, 2012

Excellent analysis tcoyote. Couldn’t have said it better.

Guest
Dixie Dawg
Aug 31, 2012

I live thirty miles from Khosla’s defunct investment known as Range Fuels. Just Google Range Fuels and read all about what “burn rate” means in terms of your tax dollars. This time it was Ethanol from burning pine straw. We are still waiting.

Another of his investments, Lanzatech bought the defunct 100 million plus company at auction on the Court House steps in Soperton, GA for 5 million. Reality is a real kicker.

tocyote I could have saved a lot of typing if I simply cut to your bottom line. ” abject bullshit.” You said it all.

Guest
Peter1
Sep 1, 2012

“We’re a hundred years away from knowing enough about human disease to do what he suggests.”

Exactly! Computer geeks think that entering enough logarithms will solve all our problems. No need for docs, just use IBM’s “Watson”, no thanks.

Guest
Bob O.
Sep 2, 2012

Excellent commentary – couldn’t have been said better.

For further proof – look at what I just spotted on twitter – 30 year venture capital returns comparing healthcare investments made by VCs who understand healthcare vs. healthcare investments by IT-only VCs

https://twitter.com/bijans/status/242278715428585472/photo/1/large

The data is pretty compelling.

Guest
healthquant
Aug 31, 2012

Nope – not gonna happen anytime soon.

Algorithms and statistical models are terrific. They do great things, solve great problems and are just cool.

But this is orders and orders of magnitude more complex than what’s currently possible. Compare this to speech recognition. It’s pretty good, but not perfect, and has taken years to refine. Building an Artificial Intelligence solution to doctoring is a whole different game.

Not to mention even with 6 billion people, there would be a talent shortage to make this happen.

Guest
Snook
Aug 31, 2012

I heard him speak – very disappointing. Not sure he should be in the healthcare arena as he doesnt understand the issues. Offered no real valuable insight into fixing the healthcare crisis. Probably very good at picking companies to make $$$ – but certianly not a healthcare visionary. Tom Goetz did a good job but Khosla was not up to it – note to Rock Health organisers – poor presentation – quality speaker next time please.

Guest
Observed
Aug 31, 2012

There is a syndrome I have noticed in the forty years I have spent working in health care. The syndrome is usually exhibited by people who are smart and accomplished in some other domain (like engineering or finance or economics). They look at the health care system and say “Thank God I’m HERE!. All this time these dumb/greedy physicians have been missing the obvious simple things that could be done to bring health care nirvana. My [insert solution here] will revolutionize health care for nothing in less than a year.”

Boy howdy, here comes an other victim of the syndrome. It will pass, assuming that he has the patience to actually roll up his sleeves and try working in health care.

And creating an iPhone app to monitor exercise and diet doesn’t count.

Guest
Christine Wren
Sep 3, 2012

There is a corresponding syndrome that afflicts people in professions that demand a great deal of intellectual effort to be credentialed. We come to feel our effort somehow insulates us from great economic vicissitudes. Sadly, it doesn’t.

The deep waves of technologically-driven economic change are now beginning to seriously rock the ship of healthcare. Earlier waves had capsized the ships of the manufacturing professions, though we paid little heed.

Now most of us are beginning to feel dread, and some–having moved past that–are beginning to express anger towards the technologists who have no respect for our profession and its history as they work to sink our ship.

Guest

Well stated. When i was a young and naive physician many years ago I was often awed by well spoken professionals from other domains who had the answer to healthcare. Like you I was consistently disappointed by their results, and continued to roll up my sleeves and delivering care the way I knew. I did learn things from them along the way, and they did change many aspects of the way care was delivered. However their refusal to admit they were wrong was disheartening.
I firmly believe that technology will help improve healthcare, but I have matured enough to know there is no single magic bullet that will solve all the issues we face. We need to develop the wisdom to recognise what helps, the strength to remove the barriers to its adoption, and the humility to accept that many things will fail and we have to be able to move on.

Guest
@bootstrapped
Aug 31, 2012

Vinod Khosla – He’s an idiot, he’s a genius. He must be an innovator!

No matter the justification, health care can’t avoid modernization and that will come in the form of innovative technology. It’s already happening and like all other technological advancements, it will continue to accelerate of its own energy.

But machines and algorithms can’t treat every patient, every condition, every disease so that means we’ll always need doctors.

The promise of the “health care system” working with the innovators isn’t the elimination of doctors. It’s that through new technology we’ll eventually need fewer doctors who will be much better armed to care for fewer sick people.

Guest
Outsider
Aug 31, 2012

Many of the so-called visionary leaders from IT behave just like dogs. They go somewhere and pee. That becomes their territory. You know what you get when you are on the ground.

Guest
Daniel Jost MD
Aug 31, 2012

“Health care must be more data driven and about wellness, not sick care.”

Some people get sick. i.e. Rheumatoid arthritis, lupus, genetic diseases, big egos.

These venture capitalist gamblers have no idea what we do.

As for machines. Will they look at the patient in the eye and hold hands? Will they have the compassion to gently inform him/her of a life changing illness? Will they be there to guide them.

Kholsa would you like to spend time with a desktop in a white blouse when your time comes to leave us?

Think man. Stop counting pennies.

Guest
Dr. Mike
Aug 31, 2012

Pharma and DME manufacturers survive in large part due to the army of physicians out in front of them ready to absorb the onslaught of the tort system. Can you imagine the fallout for a company who forgot to say, “As always, consult your physician before using our product.” Machines may indeed continue to creep into their places within the health care system, but true inovation, which includes much more than machines, is going to be very slow in coming for as long we labor under both the current coding/billing monstrosity and the current tort system.

Guest
D'CM
Aug 31, 2012

There is nothing new about Khosla’s ideas, there was software in the 90’s that claimed it could diagnose and suggest treatment. Technology will not be the answer to efficient healthcare until the political will arises to allow it to. Can you really imagine what healthcare would look like if hardly a test, treatment, or admission was done unless it was medically necessary with proven benefit?