Friday Futures: The End of the Physician

Published June 26, 2009 @ 11:25AM PT

Physicians take a long time to train, and they are expensive to pay. Physicians are extremely expensive repositories of diagnostic and treatment information. They are hard to keep up to date with the newest medical information. And they make bad decisions surprisingly often.

You know what else is a repository of diagnostic and treatment information? A computer or PDA. We don't need to train people to be giant walking databases. We can use actual databases for that. We can use electronic databases and health care providers trained in using them to do the vast majority of the care that physicians used to provide.

We are already seeing a shift to care being provided by physician's assistants, nurse practitioners, and midwives. That shift is going to continue. There are a host of factors in its favor. Moving away from physician care reduces brain drain, because non-physicians are less mobile on the global market. It's cheaper to train and pay non-physicians, and you can educate a nurse, midwife, or community health worker a lot faster than a physician.

Diagnostic algorithms like IMCI can simplify diagnosis and treatment to the point where non-physicians can easily make appropriate decisions. Combine that with powerful handheld computers and mobile health initiatives, and the need for physicians will shrink dramatically. Physicians could end up like specialists in an HMO; you'd only be referred to one if your case couldn't resolved by a nurse or nurse practitioner.

This will improve health care. Every single time we get computers involved, or increase standardization, the quality of care improves. Minimizing the role of deeply fallible, expensive individuals, will be for the better.

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Comments (4)

Thanks for the post - I spent some time this afternoon going through the blog and can't believe I haven't seen your blog earlier.

Anyway, what do you think of the trend of trained physicians increasingly leaving clinical careers to more administrative positions in the global health field? How do you think this trend will impact non-clinically trained global health workers (MPH/PhD/DrPH) holders and their future job prospects? Could you also do a Friday futures piece on future job prospects for MPH/PhD/DrPH holders?

Posted by Nneoma Nwachuku on 06/26/2009 @ 01:43PM PT
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" The practice of medicine is an art, not a trade: a calling not a business; a calling in which your heart will be exercised equally with your head. Often the best part of your work will have nothing to do with powders or potions, but with the exercise of an influence of the strong upon the weak, the righteous upon the wicked, the wise upon the foolish".
(William Osler)

Prof. Camillo O. Di Cicco, MD Although available to the public via the Internet, this material is targeted to an audience of trained clinical physicians/dermatologists.

http://digilander.libero.it/camdic/HOME%20PAGE.html

Posted by Camillo Di Cicco on 06/26/2009 @ 02:45PM PT
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I heard a high level Kaiser medical director say 2 weeks ago that in the US in 10 years 80% of what a PCP (primary care physician) does can be done by a CHW with the aid of an intelligent device that has diagnostic capabilities. In 2000 an article was published in JAMA pitting nurse practitioners against MDs, after 6 months there was not much difference:

http://findarticles.com/p/articles/mi_qn4182/is_20000105/ai_n10134918/

(btw - thanks for the shout out in your earlier post!)

Posted by Aman @GlobalHeal... on 06/26/2009 @ 04:56PM PT
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As a primary care physician and HIV specialist, I have a hard time with this post. Yes, mid-level practitioners are an essential part of a strong health care system. What I don't understand is this concept that we have to put down entire groups of people (physicians). Medicine is difficult~ it does not fit into cookie cutter computer algorhythms. If it did, I would not spend countless sleepless nights trying to figure out the answers to my patients' medical conditions. Rather than berate and minimize the benefits of physicians, it seems logical to try to find the strength of each type of provider and build a system from there.

The mid-level practitioners that I work with are excellent, and they also know their limitations. They "curbside consult" the physicians on a continuous basis. This makes it quite difficult to compare quality care, since it is not always clear if medical decision-making is being made by the practitioner on her/his own or with the assistance of a physician consult.

Most importantly, the physicians in developing countries deserve more respect rather than less. When I went to Rwanda as an HIV clinical consultant, I was surprised at the limited amount of information that community-based physicians had regarding the reasons behind their HIV protocols. To Rwanda's credit, they are one of very few countries in the world that have physicians who are intimately involved in developing protocols at a national level. On the other hand, physicians and nurses at the community level were given algorhythms and told to follow them without clear explanation. These providers WANT to understand the 'why' ~ and it is essential that they do understand the why so that they know what to do when an individual doesn't fit the mold that has been presented in the algorhym.

Thank you for posting this. Although I am not in total agreement, it is a natural and important discussion to have as we move forward with health care reform in our country and health care infrastructure building in developing countries.

All the Best~ Wendy

Posted by Wendy Leonard on 06/27/2009 @ 08:58AM PT
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Author

Alanna Shaikh has spent the last ten years immersed in global health; she has worked for NGOs, companies, universities, and the US government on projects that ranged from preventing antibacterial resistance to improving maternal and child health.