Tuesday, April 03, 2012

The Future of Physicians

My friend, CIO Extraordinaire and fellow blogger Dale Sanders, thought I might want to respond to the following... he was right!   This past week, Ezekiel J. Emanuel, MD posted an editorial in JAMA entitled, "Shortening Medical Training by 30%", in which he argues that we should spend less time and money on training doctors: "there is substantial waste in the education and training of US physicians. Years of training have been added without evidence that they enhance clinical skills or the quality of care. This waste adds to the financial burden of young physicians and increases health care costs. The average length of medical training could be reduced by about 30% without compromising physician competence or quality of care."

The well known KevinMD blog posted a response from Karen Sibert, MD, a professor at Cedars Sinai, Reducing training will diminish the status of physicians, in which she argues the dangers of this option and that the real motive is to be able to pay physicians less long-term by lessening what they do.  She says, "The Emanuel prescription for cutting [training] by 30 percent would downgrade the profession of medicine.  Instead, the prescription should be to support medical education at every level, and uphold the practice of medicine so that the brightest young students will always aspire to be physicians."  

I would even argue a more extreme reversal to Dr. Emanuel's theory and suggest that we actually spend more time and money to make sure physicians are trained VERY WELL... to take care of patients directly, but also to lead a team in the world that will be tomorrow's healthcare system.  But the catch is that we ALSO have to train a lower level of physician extenders to staff that team. In other words, the key is not to simply cut training costs nor to even increase the number of physicians by 10-20%, but to make the physicians we have 100-200% more productive by giving them well designed HIT systems which allow them, empowered by their teams, to take care of a greater number of patients in a much more consistent manner.  

The future of healthcare should see physicians doing less of the structured/mundane/checklist type work (which includes both indirect and direct patient care), and more of the higher ordered care - mainly direct contact with a smaller number of complex patients who really need that level of attention.  Studies have found that this high level of attention on the most complex patients improves care and saves money, while other research has shown that nurses and other paramedical personnel actually do better at handling preventive care and treating stable patients with chronic illness.  So let's free up our doctors to do the hard stuff where they can add the most value (and make sure we train them well to do so)!  

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