The Answer To the Doctor Shortage Isn’t More Doctors

flying cadeuciiThe answer to the doctor shortage isn’t more doctors

Yesterday, the New York Time’s Editorial Board published a piece on the shortage of physicians in the United States and what’s needed for healthcare workforce redesign.

It’s a good, concise piece about the common thinking around the gap between the needs of our growing patient population and the number of doctors available to deliver the care they need. As as an example, the article refers to a recent statement by the Association of American Medical Colleges whose models predict a shortage of 90,000 doctors in the U.S. by 2020. In Canada, the story is sometimes different where physician unemployment is growing due to inadequate infrastructure and poor workforce planning.

While I do agree that ensuring access to care is important, to think that the solution is simply more doctors comes from framing the question incorrectly.

The question shouldn’t be “how many doctors do we need for a growing population?”. Rather, the question should be “how do we care for a growing population in a cost-effective way?”

When you reframe the problem in this manner, it’s  easy to see that simply churning out more doctors isn’t the answer. In fact, with the direction healthcare is heading, those numbers are likely overestimates.

The major problem with workforce planning models is that they assume healthcare delivery of the future looks very much like healthcare delivery of the present. That the future will continue to be, in many ways, very doctor-centric.

It won’t.

First, we tend to underestimate the impact technology will have on healthcare delivery in the future. Over the past few years, we are already seeing that some processes of care can be shifted from in-person doctor-patient encounters to virtual care (telemedicine, doctor-patient messaging, etc.). We are seeing increased consumerization of healthcare (e.g. activity trackers, self-management apps, etc.) and as we enter the age of technology-powered convenience, patients are expecting healthcare to come to them.

We have barely scratched the surface when it comes to digital health, and I suspect the virtualization of healthcare will increase exponentially over the next 10 years. This will allow many more patients to be cared for by fewer physicians.

Second, there has been an ongoing shift of roles from physicians to other healthcare providers. For instance, much of care in the community can been shifted from primary care physicians to nurse practitioners and other providers with excellent outcomes. Unfortunately, fear of losing “job territory” is an impediment to progress, both in terms of adopting new technology and shifting processes of care to more cost-effective models. The medical culture on these issues must change.

As the culture in healthcare makes the shift from provider-centered care to true patient-centered care, the need for more physicians will fall with it.

Once we stop equating “more care” with “more doctors”, we are one step closer to building a more sustainable healthcare system.

 Liu is the CEO of SeamlessMD, working to transform surgical care with mobile technology. He was named a Forbes 30 Under 30 in Healthcare in 2014.

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  1. A face-to-face physician visit is the most expensive and inconvenient way to deal with a non-life threatening symptom … for all involved – patient, patient’s family, physician and provider organization. The future of healthcare – if you choose to use your insurance – will be team based with layers of non-physician coaches and outreach caregivers interacting with you via different electronic channels. Phone, text, email, webcam, booth in a retail setting.

    That is not a bad thing and is certainly a way to expand access without needing more doctors. The questions remain, is this really what patients want and will it provide quality care when it is implemented here in the USA? That implementation will be piecemeal, random, different in every market as the volume to value shift happens one payor at a time.

    If there is a backlash of patient dissatisfaction with being seen mostly by non-physicians and in a non-face to face environment … direct pay/concierge is the backstop if you can afford it.

    My two cents,

    Dike Drummond MD

  2. The HMS Titanic sailed on her maiden voyage and set a steamship speed record approximating 45 kt (about 50 mph). Unfortunately, her speed record was set in the vertical direction – that is the peak speed as she pierced the briny under, and slammed into the bottom of the ocean.
    We go in cycles of impressing the hell out of ourselves with our technological prowess, and then smacking into Reality at an impressive speed. From the Tower of Babel until the Technomiracle of 21st Century Medicine, human culture often collides with Reality. Rarely does Reality suffer from the impact.

  3. Oh, rubbish. “Lose weight now, ask me how.”
    The first wave in every revolution is the Vanguard of the Nitwits. Fire them up, give them a sledgehammer, let them do some “creative wrecking!”
    Lenin and Hitler were cunning students of revolution – they both let the eggheads and goo-goo boys wear themselves out, and wreck the infrastructure so that nothing worked and everybody was terrified.
    Then, the Second Wave.
    When the second wave comes, none of this nonsense about “Twitter EKG’s” and “Digital Ear Monitors” will be heard any more. The people of the Second Wave are not sympathetic, and they use the sickle not the hammer.

  4. “A Lot Of People In This Industry Are Just Evil.” Swell. That’s just the kind of reformers that are running around in Iraq and Syria getting rid of all the evil people. Everyone with a Kalashnikov is an idealist.

    “I believe in those innovative entrepreneurs who have the “potential” of upsetting the whole “sick care” system.” It’s just a new version of the Red Guards of the 60’s, but with snappier suits.

    A jolly good purge of the counter-revolutionaries always shines a fresh beam of sunshine into every problem, yah.

  5. 1. It’s 900 million that the Koch brothers have budgeted for the 2016 election. They can spend it how they see fit.
    2. Money and politics have been dating for a long, long time. Citizen’s United just updated their relationship.
    3. Yeah, it’s still a lot of money.

  6. I’m not wrong about the political spending of healthcare companies, so we may be close to being doomed, given the Supreme Court’s Citizens United decision and the fact that the Koch brothers plans to spend nearly $900 BILLION in the 2016 election.

    But I try not to hide my head in the sand as a pessimist. Instead, I’m bullish on the future of healthcare, because I believe in those innovative entrepreneurs who have the “potential” of upsetting the whole “sick care” system. I invite you to follow my posts on http://www.mHealthTalk.com.

  7. Steve O….

    Here’s just another in a long list of articles from British newspapers telling the story of their own medical system.


    I’m not sure I want to try their system either.

    Nothing’s free in life no matter whether I’m told that by a Brit or American socialist or not. While there’s obviously a problem with drug companies pushing drugs and doctor’s pushing them, it isn’t exclusive to drug pushers or any other pusher.

    Litigation is a huge problem which is directly connected to the above issue. A doc will prescribe any and all because if sister suzzy dies, brother tony sues his pants off. Maybe the doc even gets shot as has happened a couple times that I’m aware of.

    Truly uneccessary operations are highly costly! Here’s a run down on a few.

    Abortion – 1B per year

    Ritalin and other Methylphenidate drugs….feeding kids ritalin like it’s candy.
    Imagine all the associated costs to that. Who’s fault is that?

    Viagra / Cialis – Should that be covered by medical insurance?

    Birth Control – Should that be covered by medical insurance?

    Anti-Depressants? – Jimminy Cricket! We’re the most heavily drugged country in the world! Why?

    Heroin – Suboxone, OxyContin, both in the top 40.

    While there are some reasons for some of these drugs, the fact is that everything is utilized for any number of reasons. This is a small listing of what is a multi-pronged problem, and unless all of it is weeded out, it really doesn’t fix anything. It’s not just the drug companies at fault.

    This doesn’t fall just on docs or drug companies. It can fall on everyone for one reason or another.

  8. “…one would think it should be easy to cut in half our $3 trillion/year spending while simultaneously improving care, but there are forces in the medical industrial complex that don’t want to lose money, and their total spending on lobbyist is more than twice that of the military industrial complex…”
    C’mon. That’s either utterly wrong, or we are doomed. What makes the MIC a standard anyhow?

  9. Here is what IS coming. It is not the same as what ought to be coming. In America we have pretty much written off any responsibility for the future, and let THEM tell us how it’s going.
    “Oto, the cellphone attachment that snaps an image of the inner ear sparing frazzled parents one more trip to the doctor’s office for yet another infection….”
    1) Visits to actual-MD physicians will be rare, and subject to gatekeeping, unless you are a cash-payer.
    2) Mid-level inflation will rise to the point where EMT’s prescribe for some things. PA’s can practice independently, why not EMT’s?
    3) Pharmacist prescribing will become a widespread (and lucrative) standard. The potential conflict of interest will be ignored.
    4) “Clinics” will be ubiquitous components of multi-delivery service locations such as Wal-Mart.
    Except for #4, that’s pretty much a description of how healthcare is done in rural Mexico or Ghana. Why are these our new models for the future? We’ve even given up on rivaling the NHS in Britain.

  10. I remember when technology was going to eradicate the need for paper. That was how long ago? Even ‘IF’ it eliminates paper, will it be more efficient if the computers at the store go down, which happens quite often.

    How many times have you made a call and heard this:
    I’m sorry, our system is reaaaaly slow today or..
    I’m sorry, but our system is down today
    Our computers have been down for 3 days now. We can’t take your order.

    Will technology that is hacked today in ALL sectors including military (non-public) be what you want directing medicine?

    Why does anyone think that someone in Russia, China or in Oskosh Wisconsin with a computer and the correct knowledge cracking into VPN’s, be any less successful at the medical industry?

    Will the same operating systems and software applications that ‘protect’ the banking, retail systems be the same that the healthcare industry uses? Ooops… they already do!



    Yes, use tech, but use it appropriately and wisely.

  11. We think one key is the ability to increase Doctor : Patient Ratios without affecting the quality of care. We have the tools to accomplish this now!

  12. Wayne, as the Chair of a medical school department devoted to biomedical informatics, I am bullish on technology too. But I am also evidence-based. There have been plenty of instances over the years when technology has not lived up to what we hoped, and sometimes even made life worse. (Just read the other replies!) We need to apply technology in ways that benefit patients and clinicians, and approach it in a positive but skeptical manner.

  13. Thanks, Bill, for your response and conversation. While my perspective is from 40+ years in technology and marketing with 30 at IBM, I appreciate yours in medicine and acknowledge my shortcomings there.

    One thing I’ve noticed in my career is that predictions of future technology applications are often too conservative, not too aggressive. (See False Predictions at http://cazitech.com/press_quotes.htm )

    And I’ve seen some amazing progress when engineers are given a challenge and an incentive, including landing a man on the moon. Success or failure, however, can sometimes depend more on a set of non-technical market drivers and inhibitors, including politics and the behavior of market incumbents. We’ve seen many technologies buried by big corporations, for example, by buying patents or companies just to shutter them and prevent competition.

    With Americans spending twice as much on health care as other nations but still living sicker and dying younger, one would think it should be easy to cut in half our $3 trillion/year spending while simultaneously improving care, but there are forces in the medical industrial complex that don’t want to lose money, and their total spending on lobbyist is more than twice that of the military industrial complex.

    As a technologist and writer on its future in health reform at Modern Health Talk, I’m quite bullish on the “potential” of technologies like telehealth, telemedicine, big data analytics, and the blending of info, bio, nano and neuro, but I’m not sure the current political climate is serving public interests.

  14. Wayne,

    The site won’t let me reply to your message directly, so I am starting a new reply here. Your “proof” of scientific efficacy of Watson all comes from news articles, and mostly consist of quoting a Dr. Samuel Nussbaum of Wellpoint. I am not able to find any articles in the peer-reviewed scientific literature by Dr. Nussbaum relating to Watson. Are you aware of any?

    The only peer-revewied study of Watson in medicine I have seen was discussed in my blog post [Ferrucci, D, Levas, A, et al. (2012). Watson: beyond Jeopardy! Artificial Intelligence. 199-200: 93-105.] and showed a 70% efficacy rate. Unfortunately, it did not compare Watson to anything else, human or computer.

    Don’t get me wrong. I see the great potential for Watson technology. But as a physician and scientist, I want to see evidence for its efficacy before I make claims like yours.

    Bill Hersh

  15. Companies that clinicians and healthcare organizations would work should be constantly improving the user experience. A lot of the incumbents don’t or do so too slowly, and that’s not okay. When possible, stop working with technology companies that don’t take user experience and feedback seriously, and start working with those who do. I know it’s not this simple of course, unfortunately.

  16. My claim that Watson has a better diagnosis track record than “any physician” was a bit premature since it’s only used as a tool for docs today and is not yet intended to replace them. I too have written a lot on Watson (http://www.mhealthtalk.com/?s=watson&search=Search), but not to belittle the point, I’m citing some external references that back up my viewpoint.


    “According to Samuel Nessbaum of Wellpoint, Watson’s diagnostic accuracy rate for lung cancer is 90%. In comparison, the average diagnostic accuracy rate for lung cancer for human physicians is only 50%.” (http://www.qmed.com/news/ibms-watson-could-diagnose-cancer-better-doctors )

    “Its ability to absorb and analyse vast quantities of data is, IBM claims, better than that of human doctors, and its deployment through the cloud could also reduce healthcare costs.” (http://www.wired.co.uk/news/archive/2013-02/11/ibm-watson-medical-doctor )

    “According to Samuel Nussbaum of WellPoint doctors are only 50% accurate when diagnosing lung cancer. It is believed that Watson will improve accuracy by 40% thereby saving time, money, and not least of all lives.” (http://www.industrytap.com/supercomputer-watson-increasing-medial-diagnoses-accuracy/1314 )

    “Watson is already capable of storing far more medical information than doctors, and unlike humans, its decisions are all evidence-based and free of cognitive biases and overconfidence. As IBM scientists continue to train Watson to apply its vast stores of knowledge to actual medical decision-making, it’s likely just a matter of time before its diagnostic performance surpasses that of even the sharpest doctors.” (http://economictimes.indiatimes.com/articleshow/34199362.cms )

    “When doctors first tested Watson’s accuracy at making treatment recommendations for breast and lung cancer, the computer system was about 40% accurate. By the ninth test, its accuracy had improved to almost 80%. The experts are continuing to refine the computer system.” (http://www.breastcancer.org/research-news/20130612 )

  17. “I would encourage clinicians and patients to demand that better experience.”

    How do we do that?

  18. No. Siri will connect your with IBM’s Watson, which has a better diagnosis track record than any physician, even though it does not yet replace the MD but is used by her as a tool. That, I think, will change, but one of the keys to effective application of any technology is getting the incentives right, and right now the medical industrial complex has a lot to lose from health reform — at least half of the $3 trillion/year that we currently spend. That’s why they spend twice as much on lobbying as the military industrial complex.

    As an amateur futurist, I examine many alternate scenarios based on extrapolations of trends, what researchers are preparing to bring to market, and social, economic and government drivers and inhibitors. Technology, as I wrote in my paper, is an enabler, and my predictions may prove to be way too conservative, or too radical, in time, but my track record so far with over 40 years of tech experience has been pretty good.

  19. Joshua, I hate to be so negative when a person is so pleasantly optimistic, but we have almost 50 years of Medicare and Medicare fixes by government to take the smile out of anyone’s face. None of the fixes worked and the technology at hand was misused and abused by our bureaucrats. In fact the bureaucracy prevented technology from developing organically and now they are trying to control some of that technology they previously prevented.

    I don’t enjoy saying these things because I wish I had confidence that government was the answer. My many decades tell me otherwise.

    Enjoy and I hope some of your optimism is warranted in the years to come.

  20. All good points here regarding limitations of the EMR experience. I certainly agree that the clinician and patient experience for any new technologies must be significantly better than their predecessors. I would encourage clinicians and patients to demand that better experience.

  21. Allan,

    Certainly those are unfortunate cases where regulation hasn’t gone well. It’s been better in the U.S. than Canada when it comes to digital health, but again cautiously optimistic. Things can change quickly. Here’s to hoping it improves, because without it, technological progress and care delivery will be hampered.

  22. Excellent post, Nurse Autrey!!

    AS someone who also has spent years in the ER, I would agree with you 1000%.

    I also do not think that we will “need fewer doctors” in the future. Unless NPs are being trained to do cardiac caths and PTCA’s, and robots are going to do colonscopies and cataract surgeries, I think there will be a pretty decent need for doctors.

    I have discovered that I actually have a pretty rare skill = I know how to take care of actual sick people and occasionally save their lives. This skill was NOT acquired easily, it took hundreds of thousands of dollars and many years of training and experience. I also know how NOT to spend a million dollars on worthless lab or x-ray or other items that the patient does not need. All the “apps” in the world will not (see other posts above) will not take the place of this.

    As we see NP roles explode, and their entrance into the workforce outpace physicians, many are wrongly predicting the reduced need for MD/DO’s. Well I’m sure the hate mail will respond but the biggest issue that I see with NP’s is that they tend to over-order labs and CT’s and consultations, not because they are not bright, but they lack the same degree of clinical training and do not feel “comfortable” in telling the patient “no, you don’t really need a CT scan of your head today.”

    So costs and utilization will continue to go up and up and up. NP’s in the primary care role, where they are supposedly exquisitely suited, send patients to my ER with BP’s of 170/100, which is exactly what the patient’s blood pressure is every day of their life. What do they expect for me to do for this person? Give a big wad of clonidine and then watch them have a watershed stroke? I just send them back home, which is not often easy since the ambulatory provider has just scared the crap out of them telling them to rush to the ED immediately.

    We have combined a consumerist approach from the patient with zero-fail expectations. This is a bad combination. Everything in American healthcare now has to be:
    a) perfect
    b) exactly what the patient demands, regardless of what they actually need
    c) state of the art
    d) documented with 17 pages of “data” to suit CMS
    e) provided IMMEDIATELY with no waiting, and most importantly,
    f) totally FREE

    If you don’t believe me, just ask that Georgetown law student . . .

  23. Excellent post. Physicians put a lot of time into treating the EMR and when they press enter it is recorded. So far I haven’t heard of any EMR deaths, but patient death and morbidity is another problem.

    What happens when the physician spends more time treating the
    EMR than the patient?

  24. Joshua, I’m not so optimistic where government is concerned. Look at the ACA and since you brought up transportation look up Amtrack.

    Then again look at Hemolung. Not yet approved by the FDA, but approved in Europe and Canada. The first use of that machine in the US just occurred without approval. Less expensive, less invasive for its specific use, proven success, simplicity yet no approval. I would think the FDA would want a tentative approval on such technology, but no for they haven’t had their field tests to prove its safety when it is the only alternative for specific patients who will die without it.

  25. “minimal care with maximum documentation”

    Great post. Thank you.

  26. I continue to hear that technology is going to revolutionize medicine. As an ER nurse, I can tell you, it’s changing the focus away from the patient to the EMR, the medication reconciliation program and ways to extrapolate more data in a ‘more efficient way’.

    It takes the physician longer to document the care provided than it does to provide it. They have gone from scribbling on their T-sheets or other documents, to scribbling on a blank page instead so they (or their scribe) can enter that same data once they’ve left the bedside. Or, they are having good discussions with the patients and their families to get the great history and list of symptoms… only to then sit at the desk and regurgitate it back to a voice-to-text program. Ultimately doubling the work. I realize not all of them are this inept at documenting real-time, but it’s definitely practice I see every shift. (AND, to make it better.. we also have nursing staff who are documenting the exact same thing.)

    Furthermore, technology.. the way we dream of it, will never happen. You won’t see the bio-chip implanted into people or the health care card that contains all their medical history because they are too scared that their health-care data will be stolen (or they won’t be able to afford to sit with a practitioner at the outset in order to have the data entered.) The data would then have to be able to be shared from different facilities using different software, etc. in order that it be the most effective. Unfortunately, the companies who would make it affordable and available won’t… because they see how much oversight, regulation, and government mandates have made it almost impossible to finance such a venture because of all the hoops they’re made to jump through. (yes, I realize that the oversight and regulations are important.. but there needs to be a bit of common sense as well)

    From my ER vantage point, we have to get medicine back to primary care… and I believe we do need more providers in order to do that… more PRIMARY CARE PROVIDERS. Make it more lucrative in some way to make the primary care physician financially equivalent to the specialist. I realize that the expectation is that someone who has specialized in a certain field should get paid for their expertise, but shouldn’t someone who specializes in general health and well-being of an ENTIRE patient be paid just as much as someone who simply cares for their feet… or their hands, or their reproductive systems, etc.? Shouldn’t the ER physician be paid for their expertise in recognizing what is an actual emergency and what can wait to be seen by a primary care provider?
    Oh… no… greater than 50% of hospital admissions are through the ER. Gotta keep those numbers up… keep the hospital full…. so when the really sick patients arrive… we now have to board them in the ER… where we have neither the facilities or staff to care for them and no way to moderate the persistent arrivals through the front doors and rescue bays.

    Makes too much sense to send the patient’s home to follow up with primary care in the morning… oh… wait.. they tried that, but they can’t get in to see their primary care until a month from now…(so now, we’ve admitted a patient who could have gone home with follow up.. because there is no available follow up.). /facepalm.

    Now, instead of primary care.. we have hospitalists… groups of physicians who’s only job is to take care of admitted patients… no worry about follow up.. just “admit them for the primary care… document.. and send them home to follow up with someone else”. The ‘best’ part of this.. is that for frequent admission patients who don’t have primary care… we’re not even admitting them to the same groups of hospitalists… we shuffle them between groups because they don’t have insurance or they don’t comply with recommendations. Unfortunately.. you can’t fix stupid… so we shuffle it around so it doesn’t smell so bad.

    Primary care is the answer… whether it’s a physician, a group of PA’s or nurse practitioners… we have to make health care more available to everyone in a timely manner so they’ll learn to navigate the systems appropriately. People should go to the ER for an emergency.. .no matter what the emergency is… but we also need to define the word emergency and teach them what it means.

    Instead, we continue to provide minimal care with maximum documentation. We now pay for computers, upgrades, 24/7 IT support, but can’t finance someone to mop the floors between patients. I suppose that is the difference between administration and bedside… the priorities are so vastly different it’s depressingly comical.

  27. Hi Allan,

    That’s a wonderful point. Government regulation will have a significant impact on the potential for technology-enabled care delivery, as it is for other major fields currently undergoing technology/regulation challenges (e.g. transportation). With the FDA’s recent efforts on mobile medical app guidelines, including revisions post-Apple’s announcement of HealthKit, I’m momentarily optimistic.

  28. I think you are way overestimating the effects of technology. Health and tech are not strangers. Routinely, costs rise with both when partnering. Remember how Home Health was going to save money, reduce office visits and prevent hospitalizations? Now you must have a face to face encounter because the fraud got so out of control. Still waiting on all those promised outcomes. In your example, Siri is going to tell you to take her to the nearest Emergency Room where you will pay for that in addition to the SiriDoc app or whatever.

  29. One other consideration is like many others in professions. How much of the doctor’s time is wasted doing non-patient essential functions? Yes we all need to complete charts, paperwork and the like, but how much of this nonsense is Meaningless Use? How much more could be gained from doctors spending quality time with explanations and teaching rather that just handing the patient info and turning back to a computer?

  30. If we are going to redesign the healthcare workforce, we will need to first understand what we want to accomplish with “healthcare” and how we will address “sickcare” where the majority of the money is dedicated in the system. Currently, much of the payment system, including Medicare and Medicaid, is structured around the fact that the patient has to be seen by a doctor to receive payment–so to redesign the workforce, you will have to redesign the payment system to support it, then licensing and scope of practice, and then maybe you will see change.

    If “healthcare” means working to keeping people healthy, much of that care can be handled by ancillary medical staff (APN, PA, RN, etc.). Vaccinations, screenings as recommended by USPSTF, treatment for simple hypertension and diabetes, some behavioral health, dietary and social interventions could fall under “healthcare.”

    “Sickcare” includes care that has to be provided on an individual basis since it is complex and requires specialized training (eg. hip replacements, abdominal surgery, complex medication managements, etc.). Hospitals (or healthcare systems) have the greatest financial stake in redesign, and are notorious for resisting change which threatens their cash flow situations.

    Bottom line: To change the system, change the cash flow.

  31. We make so many predictions that are wrong because the future has unexpected turns that change the dynamics. Technology could make the necessity of more physicians greater or lesser.

    The real determiner of how many physicians we need will be who has predominant control over the healthcare sector. Government or patients? If the former, like its own bureaucracy, we will likely need many more practitioners no matter how they are named. If the latter then perhaps we will need less than predicted even without the highly trained ancillary personal.

  32. The exponentially accelerating pace of tech innovation is having a profound effect on health care. (See http://www.mhealthtalk.com/2013/07/moores-law-and-the-future-of-healthcare/.)

    As a result of cheaper, smaller, and easier to use devices, many medical functions will move down-market for MD to PA, NP, RN, LVN, aide or tech, and to consumers themselves. Telehealth video consultations can then occur between the patient and remote experts across town, across state lines, and across international borders. Canada’s doctor surplus could be put to work providing remote support for U.S. Patients, for example. And if care is cheaper and better in the Philippines, then patients could choose that option too.

    It’s not just about tech getting smaller and cheaper but also getting larger and more powerful, and from that I’m talking about IBM’s Watson and last week’s partnership announcement for Apple & IBM, where iOS apps will be tied to cloud services.

    “Siri, Suzie has an ear ache, and her temp is 100.4. Here’s a picture of her ear inside. What should I do?”

    The cloud service already has the family’s medical records and possibly genotype, phenotype, and remote sensor data too. The doc sees a simplified version of all that on a dashboard and can drill down with ease, consulting Watson and other specialists when needed. And with anonymized data, Watson can monitor population health across the globe and recommend personalized treatments based of an analysis of millions of related cases, not just the dozen or so that the local doc sees. All of this frees the doc to do what only she can.

  33. One elegant if partial fix would be to stop allowing companies to pay people to go to the doctor when they aren’t sick, or fine them if they don’t. Ultimately, the co-pay for preventive visits should be reinstated.

    When a product is in shortage, the last thing you want to be doing is subsidzing it. This is particularly true when, like checkups, the particular product has no value.

  34. I would have to agree, but I think the largest impact will be with nurse practitioners and possibly RNs taking over much of the workload. The problem with the technological solution is that it still requires the doctor spend time on each patient. It is convenient, and saves time for the patient, but it doesn’t really save time for the doctor.
    Now I could see a nurse conducting physical exams and other things they are already doing in many offices, and that could be expanded, with the doctor only an electronic device away to provide consultation if something unusual comes up. Most doctors visits don’t require a full fledged doctor at all. Flu shots, sprains, most cuts and bruises, aches and pains, regular checkups, don’t really require a doctor, but it does require someone with a good level of medical training.

  35. Hi William,

    Thanks for your comment. To clarify, I’m not saying we don’t need to train more physicians – surely we do. But I think sometimes the way the problem is framed makes it sound like it’s the only thing we should do.

    I’m not an expert on workforce modelling by any means, and so I’ll leave it to the experts to develop such models. But my hope was to emphasize the importance of framing this as a care delivery problem (as opposed to simply a doctor-shortage problem) – and the important implications that view would have on modelling, particularly given recent trends in care delivery. And of course, that our culture should better support those trends as a complimentary solution to simply training more doctors.

  36. I hate to sound like a curmudgeon, and am in general agreement with you that healthcare needs to change, and is changing, along the lines you describe.

    However, you present no data to back up your claim, and there could be a real downside to not training enough physicians if you are wrong about the need. Let’s engage in some data-driven discussion, based upon better models that assume changes in healthcare, before making blanket statements that we do not need to train more physicians.