The practice of medicine in the U.S. is on the brink of crisis. Our physician work force is facing a shortfall in numbers (particularly the requisite primary care physicians needed), as well as an upsurge in demoralization. Physicians are clearly a highly valuable healthcare lynchpin, yet we lack infrastructure, tools, and an environment that leverages physicians as a health system resource.
Healthcare Productivity Problems
Some troubling facts and alarming conditions contextualize this crisis. Physicians are being overwhelmed by information — both from patient-generated data that forms the medical record and from new research, analysis, and medical literature. This explosion in content is unprecedented: Estimates suggest that clinical knowledge now doubles every 18 months and is likely to accelerate. We lack systems that help physicians make use of all of this information.
On the clinical side, according to a study published late last year in the Annals of Internal Medicine, nearly 50% of a doctor’s work time is spent wrestling with data, documentation, billing codes, and regulatory requirements. Only 30% of a physician’s day in the office is spent with patients. More facile electronic clinical tools and data management systems must be designed with input from the physicians and nurses who comprise end users. Additionally, big data analytics technologies will soon provide insights on a population basis that were not possible until now. We need systems that bridge such technological innovation to practical use in order to improve medical therapies, drive greater value, and enable better health outcomes. These goals will likely not be accomplished if physicians are simultaneously drowning in information and groaning under significant administrative burden. The data revolution should add value, not administrative overhead.
Sadly, healthcare technology lags behind almost all other industries. While the U.S. prides itself on innovation, healthcare is one of the least digitized sectors. For far too long, healthcare practitioners have been forced to work with siloed information systems, which make each patient’s medical information unusable or unavailable outside the point of collection. Such problems are a thing of the past in other fields. Charles Auger makes an excellent analogy in suggesting that patient health information should be available, with appropriate security, in the same manner that Netflix content succeeds in reaching its users.
Administrative nuisances fuel professional dissatisfaction. Longer days with less time to see patients contribute to rampant physician burnout, manifest by emotional exhaustion, depersonalization (treating patients and colleagues in a cynical way), and reduced feelings of work-related personal accomplishment. The 2017 Medscape Physician Lifestyle Report found that over 50% of practicing physicians felt burned out, with a specialty-based range spanning from 46% (Dermatology) to 59% (Emergency Medicine). The top five reasons amongst those surveyed were:
1. Too many bureaucratic tasks
2. Spending too many hours at work
3. Feeling like just a cog in a wheel
4. Increased computerization of practice (EHRs)
5. Income not high enough.
The cumbersome tools, tasks, and processes we employ now sap our physician workforce. The U.S. also lacks a sufficient supply of new physicians joining the profession, exacerbated by the growing disparity between the number of medical school graduates and the lagging number of first year postgraduate training (internship) positions. Left unchecked, the U.S. faces a projected 26,000 to 90,000 fewer physicians than it needs by 2025. To worsen this shortage further, increasing numbers of medical school graduates plan to seek careers where they will not practice medicine. In a recent Bloomberg report, Anne Mostue notes, “More people are coming out of medical school and choosing not to practice medicine. Instead, they’re going into business — starting biotech and medical device companies, working at private equity firms, or doing consulting. In a 2016 survey of more than 17,000 med school grads by the Physicians Foundation and health-care recruitment firm Merritt Hawkins, 13.5 percent said they planned to seek a nonclinical job within three years. That’s up from 9.9 percent in 2012. A separate Merritt Hawkins survey asks final-year residents: ‘If you were to begin your education again, would you study medicine or would you select another field?’ In 2015, 25 percent answered ‘another field,’ up from 8 percent in 2006.”
A Better Productivity Model
What if we started to view physicians as a primary resource in healthcare and apply the concept of “radical resource productivity” enhancement to healthcare delivery?
The idea of radical resource productivity first gained notice in 1999 as a tenet in the development of sustainable environmental models. It is defined as “obtaining the same or increased amount of utility or work from a product or process while using fewer resources, including energy, man-made materials, and natural resources such as air, water, or minerals.” The authors of Natural Capitalism cited radical resource productivity as essential to solve alarming environmental degradation and rapid resource depletion in some industries. As noted above, the U.S. is experiencing a similar degradation and depletion in the resources (physicians) required for the practice of medicine, so why not employ a similar strategy?
A popular Harvard Business Review article highlighted the economic opportunity inherent in curbing waste and destruction: “Through fundamental changes in both production design and technology, farsighted companies are developing ways to make natural resources — energy, minerals, water, forests — stretch five, ten, even 100 times further.” Likewise, technology designed for radical physician productivity enhancement would improve the quality and value of medical practice — augmenting physician use of clinical data and application of new medical knowledge, decreasing time wasted on administrative tasks, and increasing physician-patient contact. These improvements would serve to diminish the forces contributing to high burnout and to encourage medical school graduates to practice medicine, while also generating economic value for health organizations.
Technology for More Useful Tools
Leveraging technologies like artificial intelligence (AI) and machine learning will enable radical resource productivity enhancement in medicine. Focused with an eye to treating the physician as a valued resource to ensure alleviating rather than exacerbating cognitive load, new technology makes possible more useful tools for the practice of medicine:
• Assistive apps and solutions to “capture the massive volume of data that describes a patient’s past and present state, and then project potential future states,” as well as analyze clinical data in real time, assist in reasoning about the best way to achieve patient and physician goals, and provide constant real-time support.
• AI technologies that will compile, integrate, and apply curated knowledge of the medical literature as it pertains to patient care.
• Automated relief from data management scut work so that physicians can practice at the top of their licensing. As was noted in Jack Stockert’s cogent analysis: “The clerical burdens pushed by fickle health care systems onto physicians and other care providers is both unsustainable and a waste of our best and brightest minds. It’s the equivalent of asking an airline pilot to manage the ticket counter, count the passengers, handle the standby and upgrade lists, and give the safety demonstrations — then fly the plane. AI can help with such support functions.”
U.S. healthcare requires a sustainable development principle to both preserve and better utilize its most precious resource: physicians. We should seize on the model for radical resource productivity by treating physicians as high-value, scarce assets and by leveraging transformative technology to better serve them and their patients.